Terbinafine is now widely used for the treatment of dermatophytic infections of the skin and nails. Cutaneous side effects of terbinafine are rare and mild. They includes erythema, pruritus, urticaria, desqumation, and macular exanthem. In addition, fixed drug eruption, erythema multiforme, Stevens-Johnson syndrome, and erythema annulare centrifugum-like psoriatic drug eruption were recently described in the literatures. Herein, we reported a case of acute generalized exanthematous pustulosis induced by terbinafine.
Acute Generalized Exanthematous Pustulosis* ; Drug Eruptions ; Erythema ; Erythema Multiforme ; Exanthema ; Pruritus ; Skin ; Stevens-Johnson Syndrome ; Urticaria

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a rare and severe subtype of drug eruption, characterized by acute, extensive, non-follicular, sterile pustules on an erythematous background, accompanied by fever and leukocytosis. OBJECTIVE: The purpose of this study was to characterize AGEP in Korean patients in terms of clinical, laboratory, and pathologic findings. METHODS: Thirty-six patients (M:F=17:19) with AGEP were identified from an extensive review of medical records over a 15 year period. All patient cases were confirmed by biopsy and fulfilled the diagnostic criteria. RESULTS: The patient ages ranged from 4~80 years (37.6+/-19.4). The incubation period was 1~23 days. The duration of disease was 5~14 days. Neutrophilia (36/36), high CRP (14/36), and eosinophilia (30/36) were common laboratory findings. A history of drug administration existed in 23 of 36 patients; herbal medications, lacquers and radiocontrast media were the unique causative drugs. Spongioform subcorneal or intraepidermal pustules in the epidermis was observed in all patients. Thirty-six patients were subdivided into 2 groups: group A (n=23) was strongly associated with known agents; and group B (n=13) had no identified causative agents. There was no significant difference between the 2 groups. CONCLUSION: Our results demonstrate the characteristic features of AGEP in Korean patients as follows: lower identification of causative agents; herbal medications, lacquers, and radiocontrast media were the main causative agents; and no significant differences existed between the 2 groups.
Acute Generalized Exanthematous Pustulosis ; Biopsy ; Contrast Media ; Drug Eruptions ; Eosinophilia ; Epidermis ; Fever ; Humans ; Lacquer ; Medical Records

Acute generalized exanthematous pustulosis (AGEP) is an uncommon aseptic pustular eruption that usually follows recent administration of oral or parenteral drugs. Characteristic AGEP features include the sudden onset of fever with widespread erythematous eruption, rapidly progressing to a fine, non-follicular, micropustular rash. The illness usually resolves spontaneously with fever and pustulation clearing within 15 days, sometimes followed by desquamation. Histopathology shows non-follicular spongiotic pustules in the epidermis filled with neutrophils, a mixed perivascular infiltrate of neutrophils and occasional eosinophils with papillary dermal edema. We describe a 10-month-old boy with AGEP secondary to exposure to amoxicillin. This is an uncommon condition in children.
Acute Generalized Exanthematous Pustulosis ; Amoxicillin ; Child ; Drug Eruptions ; Edema ; Eosinophils ; Epidermis ; Exanthema ; Fever ; Humans ; Infant ; Neutrophils

BACKGROUND: Drug reactions are common problems in hospital inpatients and outpatients. Reliable diagnosis is essential but often difficult. OBJECTIVE: This study attempts to define the clinical features and causative drugs in the patients with drug eruptions, and to evaluate the diagnostic value of skin tests. METHODS: Sixty one patients with drug eruptions were reviewed clinically. In 18 patients, patch and prick tests were performed using suspected drugs. RESULTS: 1. The highest incidence of drug eruptions was observed in the third and forth decades(44.2%) and there was no sexual prodominence. 2. The most frequent latent peroid was 4 hours to 1 week(49.2%). 3. The common morphological features were exanthematous eruptions(57.3%), urticaria(14.8%) and fixed drug eruptoins(11.5%). 4. The major causative drugs were antibiotics(cephalosporin, ampicillin), antipyretics/anti-inflammatory analgesics(aspirin, piroxicam) and CNS depressants(diphenylhydantoin). 5. Clinical manifestations according to possible causative drugs were as follows; exanthematous eruptions by antibiotics, antipyretics/analgesics, herbs, CNS depressants, propylthiouracil and captopril; urticaria by antibiotics and herbs; fixed drug eruption by sulfonamide, antipyretics/analgesics and phenobarbital; acneiform eruptions by diphenylhydantoin and isoniazid; Stevens-Johnson syndrome by ampicillin, sulfonamide, aspirin and piroxicam, erythema nodosum by sulfonamide, and lichenoid drug eruptions by propylthiouracil. 6. Positivity to patch and prick tests was shown in 2 of the 18 patients and in 1 of 18 patients, respectively. CONCLUSIONS: The most frequent clinical feature of the drug eruptions were exanthematous in nature and the most common causative drugs were antibiotics, as suspected. To search for the causative drug of the drug eruption, the only usual methods of patch and prick tests were not sufficient in our study.
Acneiform Eruptions ; Ampicillin ; Anti-Bacterial Agents ; Aspirin ; Captopril ; Central Nervous System Depressants ; Diagnosis ; Drug Eruptions* ; Erythema Nodosum ; Humans ; Incidence ; Inpatients ; Isoniazid ; Outpatients ; Patch Tests ; Phenobarbital ; Phenytoin ; Piroxicam ; Propylthiouracil ; Skin Tests* ; Skin* ; Stevens-Johnson Syndrome ; Urticaria

Acute generalized exanthematous pustulosis (AGEP) is a severe and rare disease usually related to drug eruption. AGEP is induced by drugs in over 90% of cases with antibiotics being the most common. It is characterized by a fever and a pustular eruption on erythematous skin with acute onset and without follicular localization. Acetaminophen is commonly used as an antipyretic and analgesic. Acetaminophen has been reported to be an uncommon cause of AGEP. We report a 79-year-old woman presenting with fever and erythematous maculopapular eruptions on the trunk with sterile pustules arising upon the use of acetaminophen for back pain. Leukocytosis and elevated C-reactive protein levels were noted on the laboratory examination. The histopathological examination of the skin biopsy specimen showed intraepidermal pustule formation with superficial perivascular lymphocytic infiltration, including eosinophils, and extensive red blood cell extravasation. The lesions were resolved with discontinuation of acetaminophen and use of systemic corticosteroid. We report a case of AGEP probably caused by acetaminophen.
Acetaminophen* ; Acute Generalized Exanthematous Pustulosis* ; Aged ; Anti-Bacterial Agents ; Back Pain ; Biopsy ; C-Reactive Protein ; Drug Eruptions ; Eosinophils ; Erythrocytes ; Female ; Fever ; Humans ; Leukocytosis ; Rare Diseases ; Skin

Generalized pustular skin eruptions as a form of drug eruption is a rare entity. Recently this unique pustular dermatosis has been termed as acute generalized exanthematous pustulosis. We report on a 19-year-old man with acute generalized exanthematous pustulosis probably induced by ampicillin. The patient presented with erythematous and pinhead-sized subcorneal pustules after taking ampicillin for abdomimal pain. The patient complained of high fever and malaise. On further review of his history, generalized skin eruptions had been noted on at least three other occasions. Each episode occured following oral administration of antibiotics. A histological examination of a skin biposy specimen showed a subcorneal pustules with a few neutrophils, dermal edema and necrotic keratinocytes. After discontinuation of ampicillin, the eruption cleared within 4 days.
Acute Generalized Exanthematous Pustulosis* ; Administration, Oral ; Ampicillin* ; Anti-Bacterial Agents ; Drug Eruptions ; Edema ; Fever ; Humans ; Keratinocytes ; Neutrophils ; Skin ; Skin Diseases ; Young Adult

Acute generalized exanthematous pustulosis (AGEP) has symptoms of abrupt onset of a widespread pustular eruption on an erythematous. base. Most cases appear to be related to drug reactions, mainly antibiotics, but viral infections and hypersensitivity to mercury may cause AGEP. The essential features of AGEP include. (1) numerous (several dazen) small((5mm), mostly non follicular pustules arising on a widespread erythema:purpura and target-like lesions may be associated; (2) histology showing intraepidermal or subcorneal pustules associated with one or more of the following.clermal edema, vasculitis, perivascular eosinophils, or focal necrosis of keratinocytes; (3) fever (over 38C); (4) neutrophilia, and (5) acute evolution with spontaneous resulotion of pustules within 15 days. We report a case of AGEP which presented with widespread tiny pustules on the whole body except the face, palms and soles. There were petechia, purpura, and vesiculobullous lesions on the axilla, popliteal fossa and upper abdomen. A biopsy specimen from a pustule showed subcorneal pustules with perivascular polymorphous cellular infiltration, marked dermal edema and necrotic keratinocytes. There was complete resolution of the lesions within 10 days.
Abdomen ; Acute Generalized Exanthematous Pustulosis* ; Amoxicillin ; Anti-Bacterial Agents ; Axilla ; Biopsy ; Drug Eruptions ; Edema ; Eosinophils ; Fever ; Hypersensitivity ; Keratinocytes ; Necrosis ; Purpura ; Vasculitis

drug eruptions include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). One class of medications that has been highly associated with such drug eruptions is antiepileptic drugs (AEDs). We attempt to investigate drug eruptions associated with AEDs as a class, as well as with individual AEDs, in Korea.METHODS: We used the Korea Institute of Drug Safety and Risk Management - Korea Adverse Event Reporting System (KIDS-KAERS) database, a nationwide database of adverse events reports, between January 2008 and December 2017 to investigate the reporting count of all drug eruptions and calculated the ratio of DRESS/SJS/TEN reports for each AED.RESULTS: Among a total of 2,942 reports, most were of rash/urticaria (2,702, 91.8%), followed by those of DRESS (109, 3.7%), SJS (106, 3.6%), and TEN (25, 0.85%). The common causative AEDs were lamotrigine (699, 23.8%), valproic acid (677, 23%), carbamazepine (512, 17.4%), oxcarbazepine (320, 10.9%), levetiracetam (181, 6.2%), and phenytoin (158, 5.4%). In limited to severe drug eruptions (DRESS, SJS, and TEN; total 241 reports), the causative AEDs were carbamazepine (117, 48.8%), lamotrigine (57, 23.8%), valproic acid (20, 8.3%), phenytoin (15, 6.3%), and oxcarbazepine (10, 4.2%). When comparing aromatic AED with non-aromatic AED, aromatic AEDs were more likely to be associated with severe drug eruption (aromatic AEDs: 204/1,793 versus non-aromatic AEDs: 37/1,149; OR, 3.86; 95% CI, 2.7–5.5). Death was reported in 7 cases; DRESS was the most commonly reported adverse event (n = 5), and lamotrigine was the most common causative AED (n = 5).CONCLUSION: Although most cutaneous drug eruptions in this study were rash or urticaria, approximately 8% of reports were of severe or life-threatening adverse drug reactions, such as SJS, TEN, or DRESS. When hypersensitivity skin reactions occurred, aromatic AEDs were associated with 4 fold the risk of SJS/TEN/DRESS compared with non-aromatic AEDs. Our findings further emphasize that high risk AEDs should be prescribed under careful monitoring, and early detection and prompt interventions are needed to prevent severe complications.]]>
Anticonvulsants ; Carbamazepine ; Drug Eruptions ; Drug Hypersensitivity Syndrome ; Drug-Related Side Effects and Adverse Reactions ; Exanthema ; Hypersensitivity ; Korea ; Pharmacovigilance ; Phenytoin ; Risk Management ; Skin ; Stevens-Johnson Syndrome ; Urticaria ; Valproic Acid

No abstract available.
Drug Eruptions*

No abstract available.
Drug Eruptions*