Over-the-counter medications are readily available and convenient. However, intake may result in cutaneous adverse reactions such as acute generalized exanthematous pustulosis (AGEP). The need to differentiate the disease to similar pustular diseases such as pustular psoriasis and subcorneal pustular dermatosis is essential, to give way to proper patient management. Its appearance with psoriasis vulgaris is uncommon.

We highlight a 36-year-old Filipino female with a known case of psoriasis vulgaris, undergoing phototherapy with good compliance and response, who took one dose of mefenamic acid due to headache. Three days after, she presented with multiple, pin-point pustules surrounded by multiple, erythematous plaques and desquamative scales over the body, including non-psoriatic areas.

A skin punch biopsy on the left arm revealed that the epidermis shows a subcorneal pustule with spongiosis and focal vacuolar alteration at the base. The dermis showed edema and was infiltrated mainly of lymphohistocytes and eosinophils, consistent with acute generalized exanthematous pustulosis.

Treatment with cyclosporine of 3.0 mkd was given, with topical corticosteroids of clobetasol 0.05% ointment mixed with petroleum jelly. Gradual tapering every two weeks was done, with 90% improvement. Blood pressure monitoring was done while on treatment. No recurrence of pustular lesions seen thereafter.

Apart from NSAIDs, beta-lactams, and beta-blockers are common causes of AGEP. There have been few published case reports about concomitant psoriasis vulgaris and acute generalized exanthematous pustulosis. To ascertain the diagnosis among subcorneal pustular dermatosis, pustular psoriasis, acute generalized exanthematous pustulosis, clinical and histopathologic correlation should be done.

Human ; Female ; Adult: 25-44 Yrs Old ; Acute Generalized Exanthematous Pustulosis

Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia affecting children 2-5 years old. The clinical presentation ranges from self-resolving localized disease to fulminant, fatal disseminated disease. While the most common presentation of LCH are small, translucent crusted papules on the trunk, intertriginous areas, and scalp, it may present as crusted plaques and alopecia. A 3-year-old male presented with a 4-month history of solitary, well-defined, hyperpigmented plaque with yellow-brown crust on the left parieto-occipital area of the scalp measuring 1.5 x 1.5 cm and a solitary, well-defined, hairless patch with areas of erythema on the left parieto-occipital area measuring 5.0 x 6.0 cm. Scalp biopsy revealed diffuse collection of lymphohistiocytes interspersed with distinct kidney bean-shaped cells. CD1a is positive for cells of interest. Skeletal survey revealed lytic lesions involving the skull, thoracic cage, spine, pelvis, and upper and lower extremities. The rest of the physical examination findings revealed lymphadenopathy, crackles, globular abdomen with right and left upper quadrant dullness. The patient had episodes of fever, difficulty of breathing, and abdominal pain. The patient received chemotherapy as multisystem LCH based on prednisone and vinblastine. Following 3 courses of chemotherapy, there is noted hair regrowth and sloughing off of crust.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Alopecia ; Histiocytosis, Langerhans-cell ; Vinblastine