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#AGEP (ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS)!
A #medtwitter #dermtwitter #tweetorial! #MedEd #FOAMEd
This is a drug reaction that we can see on inpatients, with an exam full of pustules!
Let's start with a question - How long after drug exposure does AGEP appear?
#AGEP (ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS)!
A #medtwitter #dermtwitter #tweetorial! #MedEd #FOAMEd
This is a drug reaction that we can see on inpatients, with an exam full of pustules!
Let's start with a question - How long after drug exposure does AGEP appear?
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The correct answer is 24-48 hours!
The other answers are typical time frames for other types of reactions.
Urticaria usually manifests minutes to hours after drug exposure.
Morbilliform drug eruptions occur 4-14 days after drug exposure.
DRESS occurs 2-6 weeks afterward!
The correct answer is 24-48 hours!
The other answers are typical time frames for other types of reactions.
Urticaria usually manifests minutes to hours after drug exposure.
Morbilliform drug eruptions occur 4-14 days after drug exposure.
DRESS occurs 2-6 weeks afterward!
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Unlike DRESS and morbilliform eruptions, AGEP doesn't require repeated exposure of drug. So one single dose can definitely cause AGEP. A typical place we see this is with perioperative antibiotics!
Common culprits are Penicillins, quinolones, sulfa, antifungals, and CCBs!
Unlike DRESS and morbilliform eruptions, AGEP doesn't require repeated exposure of drug. So one single dose can definitely cause AGEP. A typical place we see this is with perioperative antibiotics!
Common culprits are Penicillins, quinolones, sulfa, antifungals, and CCBs!
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Let's discuss the name. AGEP a great example of how #dermatology is just a bunch of descriptions.
ACUTE - All of a sudden
GENERALIZED - all over
EXANTHEMATOUS - a rash - obvi
PUSTULOSIS - pustules
So AGEP literally means - All of a sudden, pustules appear all over!
Let's discuss the name. AGEP a great example of how #dermatology is just a bunch of descriptions.
ACUTE - All of a sudden
GENERALIZED - all over
EXANTHEMATOUS - a rash - obvi
PUSTULOSIS - pustules
So AGEP literally means - All of a sudden, pustules appear all over!
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Clinically, the constant is NONFOLLICULAR pustules everywhere!
The underlying skin tone is important: lighter skin (pic 1) will have an erythematous plaque underlying the pustules, whereas in darker skinned individuals (pic 2), all you see are the pustules!
pc: @dermnetnz
Clinically, the constant is NONFOLLICULAR pustules everywhere!
The underlying skin tone is important: lighter skin (pic 1) will have an erythematous plaque underlying the pustules, whereas in darker skinned individuals (pic 2), all you see are the pustules!
pc: @dermnetnz
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AGEP & pustular psoriasis can be indistinguishable on exam & on pathology. Because of that, asking about a history of psoriasis is important (in addition to a drug history).
Small pustules can coalesce into "lakes of pus" in both dxs! When healing, it can look scaly only!
AGEP & pustular psoriasis can be indistinguishable on exam & on pathology. Because of that, asking about a history of psoriasis is important (in addition to a drug history).
Small pustules can coalesce into "lakes of pus" in both dxs! When healing, it can look scaly only!
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Importantly, AGEP can be severe, and is considered a severe cutaneous adverse reactions (SCARs). Culprit drugs shouldn't be given again, and patients should be monitored for cross-over with DRESS or SJS!
30% of patients can get mucosal symptoms!
What labs would you check?
Importantly, AGEP can be severe, and is considered a severe cutaneous adverse reactions (SCARs). Culprit drugs shouldn't be given again, and patients should be monitored for cross-over with DRESS or SJS!
30% of patients can get mucosal symptoms!
What labs would you check?
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Yes! All of the above. Patients should be treated based on how severe they look. If they're fine, topical steroids is adequate, but any concern for a more severe process should prompt close monitoring & consideration of steroids or immunosuppressants!
Mortality rate is 5%!
Yes! All of the above. Patients should be treated based on how severe they look. If they're fine, topical steroids is adequate, but any concern for a more severe process should prompt close monitoring & consideration of steroids or immunosuppressants!
Mortality rate is 5%!
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And you'll notice I didn't say anything about biopsy. This reaction is so characteristic on exam, that a biopsy is usually unnecessary!
The pathology is what you'd expect. A ton of neutrophils in the epidermis. Again, AGEP and pustular psoriasis can both look like this!
And you'll notice I didn't say anything about biopsy. This reaction is so characteristic on exam, that a biopsy is usually unnecessary!
The pathology is what you'd expect. A ton of neutrophils in the epidermis. Again, AGEP and pustular psoriasis can both look like this!
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If you'd like to do some reading, this was a nice review of AGEP, including underlying pathophysiology! Some of the path and clinical photos are from this paper! https://www.sciencedirect.com/science/article/abs/pii/S0190962215019313?via%3Dihub
If you'd like to do some reading, this was a nice review of AGEP, including underlying pathophysiology! Some of the path and clinical photos are from this paper! https://www.sciencedirect.com/science/article/abs/pii/S0190962215019313?via%3Dihub
11/ SUMMARY:
AGEP is a drug reaction that can be severe!
Exam = non-follicular pustules 24-48 hours after drug exposure (which can be 1 dose).
Treatment is based on severity.
It can be hard to distinguish from pustular psoriasis
Anti-infectives are common culprits!
AGEP is a drug reaction that can be severe!Exam = non-follicular pustules 24-48 hours after drug exposure (which can be 1 dose).Treatment is based on severity.It can be hard to distinguish from pustular psoriasisAnti-infectives are common culprits!
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Hope this #medthread was helpful! AGEP is rare, but when you see it, it's hard to miss it!
Until our next #dermatology #tweetorial, bye for now!
Hope this #medthread was helpful! AGEP is rare, but when you see it, it's hard to miss it!
Until our next #dermatology #tweetorial, bye for now!
