| • | (I like to think of it as "drug-induced pustular psoriasis") |
| • | acetaminophen, beta-lactam, and macrolide antibiotics |
| • | sulfonamides have not been reported to cause this reaction! |
clinical:
| • | acute onset; fever is universal with neutrophilia in 90% and eosinophilia in 30% (LFT’s usually normal) |
| • | widespread, nonfollicular pustules (<5mm) arising on erythematous, edematous skin |
| • | a relatively short temporal relationship to drug exposure (can be less than 24hrs) |
| • | also resolves rapidly (within two weeks) after cessation of the offending agent |
| • | ddx: should be distinguished from the generalized pustulation that occurs in the evolution of the anticonvulsant hypersensitivity syndrome |
histology:
| • | subcorneal or intraepidermal spongiform pustules |
| • | papillary dermal edema +/- LCV |
| • | eosinophils often present (a distinguishing feature from pustular psoriasis) |
ddx:
| • | acute generalized pustular psoriasis – typically have prior history of psoriasis; histologic features that favor AGEP include dermal edema, eosinophils, vasculitis, and single-cell keratinocyte necrosis |
| • | subcorneal pustular dermatosis – large flaccid pustules without associated fever; the classic histologic feature of SPD is a subcorneal neutrophilic pustule without intraepidermal spongiform pustules |
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