Clinicopathological Analysis of Patients with Acute Generalized Exanthematous Pustulosis

Jung, In Soon; Yun, Sook Jung; Lee, Jee Bum; Kim, Seong Jin; Lee, Seung Chul; Won, Young Ho

Abstract

BACKGROUND
Acute generalized exanthematous pustulosis (AGEP) is typically a medication-induced acute febrile eruption. Few large-scale studies have reported clinical data regarding AGEP in Korea.
OBJECTIVE
This study analyzed the clinical and histopathological features of AGEP in Koreans to identify recent trends in this context.
METHODS
This study retrospectively reviewed 31 patients with AGEP. Age, sex, clinical features, etiologies, laboratory findings, histopathological features, and treatment outcomes were obtained from patients' medical records and photographs.
RESULTS
The mean age of onset was 43.6 years, and the male:female ratio was 2.1:1. All patients showed non-follicular tiny pustules and erythema. Fever was reported in 13 patients and neutrophilia in 17 patients. Medications were considered the most common etiological contributors. Twenty patients showed drug-induced AGEP, and 11 of 20 patients showed antibiotic-induced AGEP. Serum C-reactive protein and lactate dehydrogenase levels increased in 93.8% and 77.8% of the patients, respectively. Histopathologically, all patients showed subcorneal or intraepidermal pustules, followed by exocytosis and neutrophilic dermal infiltrate. Twenty-five patients improved within a mean period of 7.5 days after the onset of the skin rash. The percentage of women in the drug-induced AGEP group was significantly higher than that in the non-drug-induced AGEP group.
CONCLUSION
This report describes a large-scale study that analyzed the clinical and histopathological features of AGEP in Koreans and seems to accurately reflect the recent trends in this context. Clinically, it is important to note that the percentage of women in the drug-induced AGEP group was higher than that in groups showing other etiologies of AGEP.