Pustular Eruption Research Articles

Neonatal Miliaria Pustulosa-A Case Series.

Miliaria pustulosa is a noninfectious, transient skin eruption of pustules overlying erythematous plaques secondary to obstruction of eccrine glands. There are very few case reports in the literature detailing miliaria pustulosa in neonates. When presenting in neonates, its similarity to life-threatening infections may cause diagnostic confusion. By differentiating this condition from similar presentations, unnecessary treatments and tests in this population may be avoided. Retrospective review of the medical records of nine neonates presenting with a pustular eruption diagnosed as miliaria pustulosa. Patients were seen at a children's hospital in Chicago, IL, USA; cases were selected by investigator recall. In this case series, miliaria pustulosa presents in nine neonates as clusters of eruptive pustules with resolution or significant improvement noted after an average of 2.6 days (range 1-5 days). The average age was 4.6 days (range 1-10 days old) and the average gestational age was 34.7 weeks (range 26.3-40.1 weeks). All patients had pustular outbreaks in areas occluded by swaddling, clothes, or adhesive. Seven patients had geometric lesions that were underlying sites of intravenous (IV) site adhesive or electrocardiogram (EKG) leads. The consistent morphological features of this pustular eruption at sites of skin occlusion and the transient course in the setting of an otherwise well-appearing infant are strongly suggestive of the diagnosis of miliaria pustulosa. It is important for clinicians to be familiar with this benign presentation and to differentiate it from other neonatal pustular eruptions to minimize invasive tests and treatments in this vulnerable population.

Eosinophilic pustular folliculitis associated with IgA deficiency

AbstractEosinophilic pustular folliculitis (EPF) is a noninfectious follicular based inflammatory dermatosis. We present a case of a 57‐year‐old female of Indian ethnicity who developed a pustular eruption, with certain lesions displaying Koebnerization. Given that the morphologic distribution most represented the immunosuppressant EPF subtype, additional testing led to the discovery of concurrent IgA deficiency. This case highlights a particularly unusual presentation of EPF associated with IgA deficiency and Koebner phenomenon.

Monkeypox in Pakistan-First case report

Monkeypox (mpox) is an uncommon zoonotic contagious viral ailment, resulting from the poxvirus. Symptoms include fever, headache, muscle aches, and a characteristic rash. There is no specific treatment, and only a limited number of antiviral drugs and vaccines are available. Employing stringent contact and respiratory precautions is essential to curb disease transmission. Till April 17, 2023, no mpox cases have been reported from Pakistan. Here we present the case of a 41-year-old male with a travel history to Saudi Arabia and a week-long history of multiple nodular and pustular eruptions on various parts of the body. It is essential to emphasise that due to its infrequency, a high index of clinical suspicion is imperative in facilitating an accurate diagnosis. Keywords: mpox, MPXV, Pakistan, Travel history. Orthopoxvirus. Vaccine.

Real-world use of spesolimab for the treatment of generalized pustular psoriasis: reports from four cases

Generalized pustular psoriasis (GPP) is a rare, chronic, autoinflammatory skin disease characterized by painful widespread pustular eruptions. Patients with GPP experience a substantial physical, social, and emotional burden, with significant impacts on their quality of life. Historically, treatment for GPP in the United States mainly involved off-label use of therapies approved to treat plaque psoriasis. Dysregulation of the interleukin-36 (IL-36) pathway appears to play a key role in the pathophysiology of GPP. Spesolimab is a first-in-class humanized monoclonal antibody that binds specifically to the IL-36 receptor and antagonizes IL-36 signaling. In September 2022, spesolimab was approved by the U.S. Food and Drug Administration for the treatment of GPP flares in adults and was subsequently approved for GPP flare treatment in other countries across the world. Here, we describe 4 cases from our respective clinical practices, in which individuals with GPP were treated successfully with spesolimab. These cases demonstrate the difficulties experienced by patients with GPP regarding the disease burden and its effect on patients’ lives. These cases also illustrate some of the challenges that health care professionals may face when seeking to initiate spesolimab treatment, as well as highlighting the need for wider awareness of both the impact and severity of GPP and of the efficacy of spesolimab in GPP treatment.

Palmoplantar Pustulosis: Therapy Update

Palmoplantar pustulosis is a variant of psoriasis and a chronic skin disorder in which pruritic pustular eruptions appear on the palms and soles. It is thought to arise from a variety of genetic and environmental factors, is limited in prevalence, and has proven quite difficult to treat. The symptoms it inflicts on those affected are quite debilitating and the treatment landscape is constantly evolving, thus emphasizing the need for updates of the literature as time passes. Current treatments include topical agents, oral therapies, and phototherapy, amongst other treatments. In this systemic review, we explore newer literature from 2015 to 2022 on various treatment regimens for palmoplantar pustulosis. J Drugs Dermatol. 2024;23(8):626-631.     doi:10.36849/JDD.doi:10.36849/7612R1.

Rare Filaggrin Variants Are Associated with Pustular Skin Diseases in Asians.

Reactive pustular eruptions (RPEs) can manifest in a variety of conditions, including pustular psoriasis (PP) and adult-onset immunodeficiency syndrome due to anti-interferon-γ autoantibody (AOID). These RPEs can be attributed to different causes, one of which is genetic factors. However, the genetic basis for pustular skin diseases remains poorly understood. In our study, we conducted whole-exome sequencing on a cohort of 17 AOID patients with pustular reactions (AOID-PR) and 24 PP patients. We found that 76% and 58% of the AOID-PR and PP patients, respectively, carried rare genetic variations within the filaggrin (FLG) gene family. A total of 12 out of 21 SNPs on FLG had previously received clinical classifications, with only p.Ser2706Ter classified as pathogenic. In contrast, none of the FLG3 SNPs identified in this study had prior clinical classifications. Overall, these variations had not been previously documented in cases of pustular disorders, and two of them were entirely novel discoveries. Immunohistochemical analysis of skin biopsies revealed that FLG variants like p.Ser860Trp, p.Gly3903Ter, p.Gly2440Glu, and p.Glu2133Asp caused reductions in FLG levels similar to the pathogenic FLG p.Ser2706Ter. These results highlight rare FLG variants as potential novel genetic risk factors contributing to pustule formation in both AOID and PP.

A genome-wide meta-analysis of palmoplantar pustulosis implicates TH2 responses and cigarette smoking in disease pathogenesis

Palmoplantar pustulosis (PPP) is an inflammatory skin disorder that mostly affects smokers and manifests with painful pustular eruptions on the palms and soles. Although the disease can present with concurrent plaque psoriasis, TNF and IL-17/IL-23 inhibitors show limited efficacy. There is therefore a pressing need to uncover PPP disease drivers and therapeutic targets. We sought to identify genetic determinants of PPP and investigate whether cigarette smoking contributes to disease pathogenesis. We performed a genome-wide association meta-analysis of 3 North-European cohorts (n= 1,456 PPP cases and 402,050 controls). We then used the scGWAS program to investigate the cell-type specificity of the association signals. We also undertook genetic correlation analyses to examine the similarities between PPP and other immune-mediated diseases. Finally, we applied Mendelian randomization to analyze the causal relationship between cigarette smoking and PPP. We found that PPP is not associated with the main genetic determinants of plaque psoriasis. Conversely, we identified genome-wide significant associations with the FCGR3A/FCGR3B and CCHCR1 loci. We also observed 13 suggestive (P< 5×10-6) susceptibility regions, including the IL4/IL13 interval. Accordingly, we demonstrated a significant genetic correlation between PPP and TH2-mediated diseases such as atopic dermatitis and ulcerative colitis. We also found that genes mapping to PPP-associated intervals were preferentially expressed in dendritic cells and often implicated in T-cell activation pathways. Finally, we undertook a Mendelian randomization analysis, which supported a causal role of cigarette smoking in PPP. The first genome-wide association study of PPP points to a pathogenic role for deregulated TH2 responses and cigarette smoking.

Recognizing rare rashes: A case of acute generalized exanthematous pustulosis.

Acute generalized exanthematous pustulosis (AGEP) is a rare, pustular rash that occurs most commonly after exposure to a medication (typically antibiotics or diltiazem). This case describes a patient who developed a widespread pustular eruption shortly after beginning empiric antibiotics for community-acquired pneumonia. Diagnosis of AGEP was difficult in this scenario due to the patient's pulmonary infection and atypical skin biopsy results. However, after AGEP was correctly identified, the offending agents were discontinued and the patient had subsequent resolution of her symptoms.

Pustular eruption on the face revealing HIV infection

Pustular eruption on the face revealing HIV infection

Real-World Efficacy of Spesolimab: Reports from Four Patients with Generalized Pustular Psoriasis

Introduction: Generalized pustular psoriasis (GPP) is a rare, chronic, autoinflammatory skin disease characterized by widespread pustular eruptions that may be accompanied by systemic symptoms. GPP is painful, distressing, and adversely affects patient quality of life (QoL). Spesolimab is a first-in-class anti-IL-36 receptor monoclonal antibody approved for the treatment of GPP flares. Methods: We describe 4 cases from our respective clinical practices, where individuals with GPP were treated successfully with spesolimab. Results: Four patient cases of GPP were included; an 18-year-old male, a 58-year-old female; a 36-year-old male, and a 40-year-old female. One patient had a history of GPP, and had experienced 3 prior flares in the preceding year. Two patients had a history of plaque psoriasis. Events preceding the current GPP flare included hydroxychloroquine treatment (n=2), and corticosteroid treatment (n=3). All patients presented with sudden onset of worsening pustular rash (affecting lower extremities [n=1]; extremities and trunk [n=1]; whole body [n=2]). Two patients had systemic symptoms at presentation (1 case: fever, chills, malaise, fatigue; 1 case: severe weakness), and required hospitalization. Two patients received an initial mis-diagnosis of acute generalized exanthematous pustulosis (AGEP). Significant impacts on QoL were reported; all 4 patients were unable to perform normal daily activities; the 18-year-old patient was targeted at school because the skin lesions were perceived to be contagious. The 4 patients received multiple therapies prior to, and concomitantly with, spesolimab treatment, including topical agents, antibiotics, corticosteroids, retinoids, immunosuppressants, and biologics. All 4 patients received two 900 mg intravenous infusions of spesolimab with treatment intervals between 7 and 20 days. Treatment was given at an outpatient infusion center (n=3*), or using a home infusion service (n=1); *1 patient received their first infusion as an inpatient. Significant clinician-assessed improvement in pustules occurred within 1 week of the first spesolimab infusion in 3 patients; the remaining patient reported improvement 1-2 weeks after the second infusion. One of the hospitalized patients experienced 75% improvement in itching, pain, and pustules within 24 hours of the first spesolimab infusion, and was discharged the next day. Spesolimab treatment also improved QoL, with patients experiencing rapid improvements in pain, and their ability to resume their normal daily activities. Conclusions: These cases demonstrate the efficacy of spesolimab in the real-world, highlighting the ability of spesolimab treatment to rapidly improve GPP symptoms and patient QoL. Administration of spesolimab in an inpatient setting allowed for rapid patient improvement and discharge the next day. These cases also highlight the association of certain drugs as triggers for GPP flares, as well as the importance of AGEP in the differential diagnosis of GPP

Human Leukocyte Antigen Markers for Distinguishing Pustular Psoriasis and Adult-Onset Immunodeficiency with Pustular Reaction.

Pustular skin diseases, with pustular psoriasis (PP) being the prototype, are immune-mediated diseases characterized by the presence of multiple pustules, resulting from neutrophil accumulation in the layer of epidermis. Sterile skin pustular eruption, like PP, is also observed in 20-30% of patients with adult-onset immunodeficiency syndrome (AOID) and anti-interferon γ autoantibodies (IFN-γ), leading to challenges in classification and diagnosis. While the mechanism underlying this similar phenotype remains unknown, genetic factors in relation to the immune system are suspected of playing an important role. Here, the association between human leukocyte antigen (HLA) genes, which play essential roles in antigen presentation, contributing to immune response, and the presence of skin pustules in AOID and PP was revealed. HLA genotyping of 41 patients from multiple centers in Thailand who presented with multiple sterile skin pustules (17 AOID patients and 24 PP patients) was conducted using a next-generation-sequencing-based approach. In comparison to healthy controls, HLA-B*13:01 (OR = 3.825, 95%CI: 2.08-7.035), C*03:04 (OR = 3.665, 95%CI: 2.102-6.39), and DQB1*05:02 (OR = 2.134, 95%CI: 1.326-3.434) were significantly associated with the group of aforementioned conditions having sterile cutaneous pustules, suggesting a common genetic-related mechanism. We found that DPB1*05:01 (OR = 3.851, p = 0.008) and DRB1*15:02 (OR = 3.195, p = 0.033) have a significant association with pustular reaction in AOID patients, with PP patients used as a control. A variant in the DRB1 gene, rs17885482 (OR = 9.073, p = 0.005), was observed to be a risk factor for PP when using AOID patients who had pustular reactions as a control group. DPB1*05:01 and DRB1*15:02 alleles, as well as the rs17885482 variant in the DRB1 gene, were proposed as novel biomarkers to differentiate PP and AOID patients who first present with multiple sterile skin pustules without known documented underlying conditions.

P26 A life threatening case of Von Zumbusch psoriasis

Abstract We report a case of a patient admitted to intensive care with a pustulating skin eruption and haemodynamic compromise with near immediate response to infliximab. A 16-year-old male with a six-month history of mild plaque psoriasis presented to acute dermatology services with widespread annular pustular eruption, which developed days after a throat infection. Histopathology was consistent with pustular psoriasis. After an initial partial response, the pustules spread and persisted despite 2-month treatment with topical steroids and ciclosporin (dosed to 4 mg/kg). With raised inflammatory markers and repeated growth of Staphylococcus aureus, high dose intravenous flucloxacillin was administered. Four hours post infusion the patient became erythrodermic and haemodynamically unstable, requiring management in ICU. Repeat skin biopsy showed features of psoriasis without clear drug reaction features. Switching classes of antimicrobials and administration of intravenous immunoglobulins led to infection resolution but no significant clinical status change. A multi-disciplinary decision was made to trial intravenous infliximab. This resulted in near-immediate 90% improvement of skin and haemodynamic status. His excellent clinical response has been maintained on adalimumab thus far. Genetic screening for possible mutations associated with pustular psoriasis, including IL36RN and CARD14, are in process.

Farmacodermia em gato após uso de múltiplas medicações para tratamento de afecções sistêmicas

Drug eruption, also known as cutaneous adverse drug reaction, is a rare disease that is difficult to diagnose, requiring a combination of history evaluation, physical assessment, and histopathological examination. Clinically, it presents with variable signs, from mild urticaria to epidermal necrosis. Treatment consists of discontinuing the causative or similar medication; lesion management; and, sometimes, implementing systemic immunosuppressive treatments. The prognosis is generally good, except when there is systemic involvement or extensive skin necrosis. This study aims to describe the lesions, diagnosis, and evolution of a young cat presenting with drug eruption following the use of multiple medications for the treatment of systemic conditions. The patient underwent skin biopsy after showing progression of alopecic and localized lesions, which resulted in a suggestive diagnosis of superficial pustular drug eruption. Previous drug treatments were interrupted, but due to the lack of improvement in the lesion pattern, we chose to re-administer chlorambucil at a dose of 2 mg/cat every 48 h for therapeutic purposes. Up to the present time, the patient has been undergoing treatment and lesion management, with healthy-looking scar tissue and almost complete resolution of the skin lesions.

Taxane-induced scleroderma-like skin changes – review of the literature and case report

Abstract: Taxanes (paclitaxel, docetaxel) are antineoplastic agents used in advanced ovarian, breast, lung, head and neck cancer. Diverse cutaneous adverse reactions associated with taxane administration have been reported such as bullous eruption, onycholysis, acral erythema, erythema multiforme, pustular eruption, scleroderma-like skin changes of both upper and lower extremities. Here, we report a case of 48-year-old female patient, who presented for consultation with rheumatologist with complaints of hand and finger oedema and stiffness. Oedema and mild skin thickening of the fingers and hands were evident at physical examination. Inflammatory joint pain, synovitis, Raynaud’s phenomenon and trophic changes were not present. Standard laboratory tests i.e., complete blood count and biochemistry tests were within normal values. The patient was euthyroid. Immunological tests were negative (antinuclear antibodies; antibodies against extractable nuclear antigens – dsDNA, Sm, RNP, Scl-70; antiphospholipid antibodies – anticardiolipin, anti-beta-2-glycoprotein; anti-CCP antibody and rheumatoid factor). Capillaroscopic examination did not reveal signs of microangiopathy. Skin biopsy was perfomed in the area of a proximal phalanx and the histological examination revealed dermal oedema and superficial scant perivascular infiltrate containing lymphocytes and histiocytes. The patient had undergone an operation for breast cancer 13 years ago and subsequent second operation because of cancer recurrence 7 years ago. After the second operation chemotherapy was performed that included 1 cycle with paclitaxel and 4 cycles with docetaxel. The analysis of the case led to the conclusion that the scleroderma-like skin changes of the fingers and hands are induced by taxane administration in the past. The patient received corticosteroid treatment for 7 months with gradual resolution of symptoms.

Parvovirus in dermatology: A review

AbstractParvovirus B19 is a small nonenveloped single‐stranded DNA virus belonging to the parvoviridae family. The dermatological manifestations are varied ranging from infective to inflammatory, but the most common among infective etiologies is erythema infectiosum, also known as the fifth disease or ‘slapped cheek’ disease, which is mildly contagious. Clinical corroboration of symptoms and signs with serum antibody levels has been seen in acute and persistent parvoviral infections. Other dermatological manifestations of parvovirus B19 infections include erythema multiforme, vasculitis, reticular erythema, maculopapular eruptions, pustular eruptions, papular‐purpuric gloves and socks syndrome (PPGSS) and Gianotti‐Crosti syndrome. Skin lesions are quite characteristic and begin with oedema and erythema symmetrically localized to the hands and feet. Subsequently, petechial and purpuric changes appear varying from a few millimetres in diameter to larger, confluent patches. The primary target of parvovirus B19 is the hematopoietic‐erythroid cell line, specifically near the pronormoblast stage and the vulnerability to cellular damage increases along the differentiation lineage. There's multimodal clinical phenotypic presentation seen in parvoviral infections. Among the clinical expression of HPV B19 infections, the most common is dermatologic, however other manifestations such as rheumatologic and hematologic are not uncommon. However, some infections can be asymptomatic, especially in immunocompetent hosts, whereas in others with haematological abnormalities, these can lead to aplastic cellular crises.

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review.

From the beginning of public vaccinations until the relaxation of COVID-19 measures, many case reports, case series and case-control studies have been published indicating cutaneous side effects of COVID-19 vaccination. Post-vaccination pustular eruption was reported as well, with a challenging differential diagnosis between pustular psoriasis, AGEP (acute generalized exanthematous pustulosis) and neutrophil pustular eruptions. We report a case of 56-year-old woman presented with acute generalized pustular flare up culminated 5 days after the second dose of BNT162b2(Pfizer) vaccination. She was diagnosed with pustular psoriasis flare and due to the regulating role of IL-1 in pustular psoriasis and in the cytokine storm observed in cases of COVID-19 postvaccination inflammation; we decided to treat the patient with an IL-1 antagonist, subcutaneous anakinra (100 mg daily) along with acitretin. One week later, after anakinra withdrawal, she presented a pustular psoriasis flare and a 7-day anakinra re-administration led to a satisfactory improvement in the skin lesions. We also reviewed the medical literature and found 28 case reports with pustular eruption after the COVID-19 vaccination. We compared the patients reported, regarding sex, age, number of doses, post-vaccination period and vaccine brand, and compared those results with our patient. Finally, as indicated by our case and other cases with similarly treated pustular eruptions. targeted therapy to this cytokine imbalance such as anakinra (IL-1) antagonist can improve the clinical course of the patient.

PA12 A case of pustular psoriasis in epidermolytic ichthyosis: coincidence or common pathway?

Abstract An 8-year-old boy with epidermolytic ichthyosis (EI) due to a heterozygous KRT1 mutation presented with a striking bullous skin eruption. Microbiological swabs were sent, and oral antibiotics were prescribed for suspected bullous impetigo. He deteriorated clinically, developing a fever and more extensive pustular rash reminiscent of generalized pustular psoriasis (GPP). Skin biopsies from two distinct cutaneous sites revealed histology strongly supportive of pustular psoriasis. Oral ciclosporin was commenced in addition to intensive topical emollient therapy. Following widespread desquamation, the pustular eruption fully resolved. Recurrence upon weaning of ciclosporin necessitated the introduction of ustekinumab. The rash remains controlled on this therapy. The EI is caused by heterozygous mutations in KRT1 or KRT10, and presents at birth with erythroderma and widespread skin denudation. The erythema and skin fragility abate in early childhood, giving way to prominent hyperkeratosis. Severe palmoplantar keratoderma is seen in those with KRT1 mutations. The GPP is a rare but life-threatening condition characterized by sterile pustules with or without systemic involvement. Interleukin (IL)-36-mediated inflammatory signalling plays a pathogenic role, as evidenced by loss of function mutations in IL36RN, which encodes an IL-36 receptor antagonist (Marrakchi S, Guigue P, Renshaw BR et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med 2011; 365:620–8), and the efficacy of IL-36 receptor inhibitor spesolimab in a recent phase II trial. Both EI and GPP are rare, and the confluence of these entities in this case is striking. Four other cases in the literature describe a GPP-like eruption in patients with congenital ichthyoses. The coexistence of these conditions might be explained by their immunological profiles. Studies of the skin of patients with congenital ichthyoses have shown immune dysregulation with T helper 17/IL-23 skewing, and upregulation of associated inflammatory cytokines, including IL-36γ. The latter encodes for an IL-36 receptor agonist (Paller AS, Renert-Yuval Y, Suprun M et al. An IL-17-dominant immune profile is shared across the major orphan forms of ichthyosis. J Allergy Clin Immunol 2017; 139:152–65). Thus, increased IL-36 receptor agonist activity in congenital ichthyosis could theoretically lead to GPP in genetically predisposed individuals with already upregulated IL-36 receptor-mediated signalling.

BH05 Successful treatment of acrodermatitis continua of Hallopeau with methotrexate

Abstract A 39-year-old woman was referred with a 3-month history of brittle nails, painful fingertips and psoriasiform plaques affecting her torso and limbs. She had a past medical history of macrocytic anaemia secondary to dietary B12 and folate deficiencies, which required inpatient transfusions. She had no previous dermatological concerns, and there was no history of infection or trauma to the affected sites. On examination of her hands and feet, there was evidence of nailbed pustulation, subungual hyperkeratosis, onychodystrophy, anonychia of multiple nails and dactylitis, consistent with acrodermatitis continua of Hallopeau (ACH) with associated psoriasis. At diagnosis, the patient’s Dermatology Life Quality Index (DLQI) was 16, she had a Psoriasis Area and Severity Index (PASI) score of 18 and a Psoriasis Epidemiology Screening Tool (PEST) score of 4. Nail fungal culture was negative. Plain radiographs of the hands and feet demonstrated a flexion deformity of the left fifth finger distal interphalangeal joint, with otherwise normal bone texture, alignment and joint spaces. The patient was initially treated with potent topical corticosteroids and vitamin D analogues, with little improvement. The patient was commenced on 15 mg subcutaneous methotrexate (MTX), with close monitoring of serum and red cell folate given her background of folate deficiency, which was being actively replaced. Within 3 months of starting MTX monotherapy, the patient’s hands had dramatically improved with skin and fingernail changes largely resolved, and an improvement in manual dexterity (DLQI 11, PASI 3, PEST 5). MTX was increased to 20 mg once weekly and the patient was also started on sulfasalazine 500 mg twice daily by her rheumatologist for psoriatic arthritis. ACH is a chronic pustular eruption initially affecting distal phalanges with gradual proximal progression and the potential development of generalized pustular psoriasis. ACH is considered a variant of palmoplantar pustulosis, commonly affecting adult females with localized trauma and infection as possible triggers. Given the rarity of ACH, the evidence base for therapy is limited to case reports and series, with no standardized treatment guidelines. Topical therapies include corticosteroids, calcineurin inhibitors and vitamin D analogues. Local phototherapy and systemic therapy with acitretin, MTX and ciclosporin have been described, with wide-ranging results. In severe cases such as this, patients typically receive biologic therapy, with variable responses reported with tumour necrosis factor-α inhibitors, anti-interleukin (IL)-6 therapy, and anti-IL-12/IL-23 and anti-IL-17 therapy. We present a rare case of severe ACH and psoriasis, treated with MTX monotherapy, which was not only clinically effective but also cost-effective.

Rare Skin Eruption Caused by Paracetamol: A Case of Acute Generalized Exanthematous Pustulosis

Background: This case report aims to enhance clinicians' ability to identify and effectively manage rare skin eruptions, specifically focusing on Acute Generalized Exanthematous Pustulosis (AGEP) by providing valuable insights into the context of its diagnostic challenges and clinical implications.&#x0D; Presentation of Case: We present a case of AGEP in a 16-year-old Indian boy who developed generalized pustulosis after taking Paracetamol (Acetaminophen). The patient's diagnosis was initially delayed due to the resemblance of AGEP with other skin conditions. Furthermore, the inadvertent reintroduction of Paracetamol exacerbated the condition.&#x0D; Discussion: We discuss various treatment options and emphasize the importance of prompt and accurate diagnosis of AGEP by utilizing the AGEP validation. By employing this scoring system, clinicians can enhance their diagnostic accuracy and avoid unnecessary delays in treatment initiation.&#x0D; Conclusion: The prompt identification of AGEP using the AGEP validation score is crucial for timely management. This case report highlights the potential risks associated with common drugs like Paracetamol and emphasizes the need for vigilance in prescribing medications. Clinicians should be aware of the distinctive features of AGEP and consider it as a differential diagnosis in patients presenting with pustular skin eruptions following drug intake. Improved awareness and application of diagnostic tools can aid in better patient outcomes.

Athena: Speciality Certificate Examination case for general dermatology and dermatology in primary healthcare.

A 62-year-old man was referred to the emergency department with a 6-day history of a progressive pustular eruption; he had commenced ceftriaxone to treat suspected facial cellulitis 2 days prior. He had no significant past medical or dermatological history. This is a case of a rare severe cutaneous adverse reaction to a prescribed drug.