Objective

Acute generalized exanthematous pustulosis (AGEP) is a severe skin pustular drug reaction that can lead to life-threatening consequences. In this study, we have investigated the characteristics and outcomes of patients with AGEP in a tertiary skin hospital.

Methods

From March 2007 to December 2019, medical records of all patients diagnosed with AGEP, were assessed. Demographic data, culprit drug, past medical history, laboratory tests, recurrence, and systemic organ involvement were all documented as well.

Results

Seventy-four patients, including 54 women (73%) and 20 men (27%), with a mean age of 44.3 ± 16.5 years were evaluated. The most common comorbidities among the patients were rheumatoid arthritis and diabetes. In addition, hydroxychloroquine, cephalosporin, and amoxicillin were found as the three most common medications associated with AGEP induction. Among the study group, seventeen (23%) patients had systemic organ involvement (nine (12.2%), six (8.1%), and five (6.8%) had hepatic, renal and pulmonary involvement, respectively). All patients responded to oral prednisolone within a median of five days (IQR = 4; ranged 2–14). The median duration of treatment was significantly longer in hydroxychloroquine group compared to other drugs (8 versus 5 days; HR 0.57,95%CI 0·35–0.91). Likewise, the median duration of treatment was significantly longer in febrile patients compared to the afebrile ones (7 versus 4 days; HR 0.46, 95%CI 0.25–0.85). Recurrence occurred in six patients after resuming treatment with the same medication. The mean Naranjo score was 7.6 ± 0.9 denoting a probable causal relationship.

Conclusion

In this study, we found that using hydroxychloroquine and presence of fever are the risk factors potentially leading to a prolonged treatment duration of AGEP.

中文翻译：

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急性全身性皮疹性脓疱病，以羟氯喹为重点：在皮肤病医院有10年的工作经验

目的

急性全身性皮疹性脓疱病（AGEP）是一种严重的皮肤脓疱药物反应，可导致危及生命的后果。在这项研究中，我们调查了第三级皮肤病医院AGEP患者的特征和结局。

方法

从2007年3月到2019年12月，评估了所有诊断为AGEP的患者的病历。还记录了人口统计数据，罪魁祸首药物，既往病史，实验室检查，复发和全身器官受累。

结果

评估了74位患者，其中54位女性（73％）和20位男性（27％），平均年龄为44.3±16.5岁。患者中最常见的合并症是类风湿关节炎和糖尿病。此外，发现羟氯喹，头孢菌素和阿莫西林是与AGEP诱导相关的三种最常见药物。在研究组中，有17名（23％）患者患有全身器官受累（分别有9名（12.2％），6名（8.1％）和5名（6.8％）有肝，肾和肺部受累）。所有患者均在五天内对口服泼尼松龙有反应（IQR = 4；范围为2-14）。与其他药物相比，羟氯喹组的中位治疗时间明显更长（8天比5天； HR 0.57,95％CI 0·35–0.91）。同样 与发热患者相比，发热患者的中位治疗时间明显更长（7天比4天； HR 0.46，95％CI 0.25-0.85）。用相同的药物恢复治疗后，有6例患者复发。Naranjo平均得分为7.6±0.9，表明可能存在因果关系。

结论

在这项研究中，我们发现使用羟氯喹和发烧是可能导致AGEP治疗时间延长的危险因素。