Acute Generalized Exanthematous Pustulosis

Abstract

Acute generalized exanthematous pustulosis (AGEP) is an acute, self-limited, widespread cutaneous eruption characterized by the development of numerous, non-follicular, sterile pustules on a background of erythematous, edematous skin. The eruption usually develops within hours to days of exposure to medications (antibiotics, antifungals, calcium channel blockers, and carbamazepine most commonly), but it has also been documented to be associated with various infections (mostly viral), spider bites, and herbal medications. After the inciting medication is removed or precipitant infection clears, the skin reaction resolves spontaneously within 1–2 weeks. The histologic hallmark of AGEP is spongiform subcorneal and/or intraepidermal pustules with marked papillary edema, polymorphous perivascular infiltrates with neutrophils, and exocytosis of some eosinophils. AGEP is immunologically mediated by a T cell-orchestrated neutrophil response through the expression of neutrophilotactic chemokines such as CXCL8.