Acute Generalized Exanthematous Pustulosis Presented by

1. ACUTEACUTEACUTEACUTEACUTEACUTEACUTEACUTE
GENERALIZEDGENERALIZEDGENERALIZEDGENERALIZEDGENERALIZEDGENERALIZEDGENERALIZEDGENERALIZED
EXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUSEXANTHEMATHOUS
PUSTULOSISPUSTULOSISPUSTULOSISPUSTULOSISPUSTULOSISPUSTULOSISPUSTULOSISPUSTULOSIS
CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.

2. OutlineOutline
•• EpidemiologyEpidemiology
•• Clinical featuresClinical features
•• DiagnosisDiagnosis•• DiagnosisDiagnosis
•• TreatmentTreatment

3. EpidemiologyEpidemiology
•• UnreliableUnreliable
•• 11--5 cases per million per year5 cases per million per year
AlexisAlexis SidoroffSidoroff ChemChem ImmunolImmunol Allergy 2012;97:139Allergy 2012;97:139––148148

4. Clinical FeaturesClinical Features
•• Numerous, small nonNumerous, small non--follicular,follicular,
intraepidermalintraepidermal oror subcornealsubcorneal pustulespustules
(<5 mm) on an(<5 mm) on an erythematouserythematous backgroundbackground
•• TypicalTypical histopathologicalhistopathological changeschanges
•• Fever (> 38Fever (> 38 °°C)C)•• Fever (> 38Fever (> 38 °°C)C)
•• BloodBlood neutrophilneutrophil counts > 7counts > 7 ×× 101099/L/L
•• Acute evolution with spontaneousAcute evolution with spontaneous
resolution of pustules < 15 daysresolution of pustules < 15 days
MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J Dermatol 2010; 20 : 425Eur J Dermatol 2010; 20 : 425--3333

5. AlexisAlexis SidoroffSidoroff ChemChem ImmunolImmunol Allergy 2012;97:139Allergy 2012;97:139––148148

6. MajaMaja MockenhauptMockenhaupt JDDG 2009 ;7:142JDDG 2009 ;7:142––162162

7. www.regiscar.uniwww.regiscar.uni--freiburg.de/diseases/agepfreiburg.de/diseases/agep

8. Differential diagnosisDifferential diagnosis
•• PustularPustular psoriasispsoriasis
•• SubcornealSubcorneal pustularpustular dermatosisdermatosis
•• PustularPustular vasculitisvasculitis•• PustularPustular vasculitisvasculitis
AlexisAlexis SidoroffSidoroff et alet al JJ CutanCutan PatholPathol 2001; 28:1132001; 28:113––119119

9. PustularPustular psoriasispsoriasis
www.dermis.netwww.dermis.net

10. SubcornealSubcorneal pustularpustular dermatosisdermatosis
www.uptodate.comwww.uptodate.com

11. PustularPustular vasculitisvasculitis
YoshihideYoshihide Asano et alAsano et al ActaActa DermDerm VenereolVenereol 2010;90:4202010;90:420--421421

12. HistopathologyHistopathology
MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J DermatolEur J Dermatol 20102010;;2020::425425--3333

13. EtiologyEtiology
•• DrugsDrugs ((9090 %%))
•• InfectionsInfections
•• Other factors (spider bite, mercury,Other factors (spider bite, mercury,
chemotherapy, herbal medicationschemotherapy, herbal medications))chemotherapy, herbal medicationschemotherapy, herbal medications))
AlexisAlexis SidoroffSidoroff ChemChem ImmunolImmunol AllergyAllergy 20122012;;9797::139139––148148
SuranSuran L Fernando Australasian Journal of DermatologyL Fernando Australasian Journal of Dermatology 20122012;; 5353:: 8787––9292
MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J DermatolEur J Dermatol 20102010;;2020::425425--3333
SimaSima HalevyHalevy CurrCurr OpinOpin AllergyAllergy ClinClin ImmunolImmunol 20092009;;99::322322––328328

14. AlexisAlexis SidoroffSidoroff et al British Journal of Dermatology 2007;157: 989et al British Journal of Dermatology 2007;157: 989––996996

15. AlexisAlexis SidoroffSidoroff et al British Journal of Dermatology 2007;157: 989et al British Journal of Dermatology 2007;157: 989––996996

16. AlexisAlexis SidoroffSidoroff et al British Journal of Dermatology 2007;157: 989et al British Journal of Dermatology 2007;157: 989––996996

17. AlexisAlexis SidoroffSidoroff et al British Journal of Dermatology 2007;157: 989et al British Journal of Dermatology 2007;157: 989––996996

18. AlexisAlexis SidoroffSidoroff et alet al JJ CutanCutan PatholPathol 2001; 28:1132001; 28:113––119119

19. MinMin JeeJee ChoiChoi et al Annet al Ann DermatolDermatol 20102010;;2222::163163--169169

20. DiagnosisDiagnosis
•• Not standardized diagnostic toolsNot standardized diagnostic tools
AlexisAlexis SidoroffSidoroff ChemChem ImmunolImmunol Allergy 2012;97:139Allergy 2012;97:139––148148
SuranSuran L Fernando Australasian Journal of Dermatology 2012; 53: 87L Fernando Australasian Journal of Dermatology 2012; 53: 87––9292

21. TreatmentTreatment
•• SelfSelf--limited diseaselimited disease
•• Discontinue causative drugDiscontinue causative drug
•• Systemic corticosteroid not necessarySystemic corticosteroid not necessary
•• Antibiotics if indicateAntibiotics if indicate
SuranSuran L Fernando Australasian Journal of Dermatology 2012; 53: 87L Fernando Australasian Journal of Dermatology 2012; 53: 87––9292
AlexisAlexis SidoroffSidoroff et alet al JJ CutanCutan PatholPathol 2001; 28:1132001; 28:113––119119

22. THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU

23. PathophysiologyPathophysiology
MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J DermatolEur J Dermatol 20102010;; 2020 :: 425425--3333

24. MajaMaja MockenhauptMockenhaupt JDDGJDDG 20092009 ;;77::142142––162162

25. MajaMaja MockenhauptMockenhaupt JDDG 2009 ;7:142JDDG 2009 ;7:142––162162

26. MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J DermatolEur J Dermatol 20102010;;2020::425425--3333

27. MarijnMarijn M.M. SpeeckaertSpeeckaert et alet al Eur J DermatolEur J Dermatol 20102010;;2020::425425--3333