Syringocystadenocarcinoma papilliferum (SCACP) is a rare adenexal carcinoma with only 21 cases reported in the literature. Most patients describe a long-standing mass with recent change, supporting the idea that SCACP arises from malignant transformation of pre-existing syringocystadenoma papilliferum (SCAP). Syringocystadenocarcinoma papilliferum is generally treated with wide surgical excision of the lesion and patients do exceeding well and require no systemic therapy. Case synopsisFigure 1. A 65 year-old Hispanic male presented with a flesh-colored, exophytic 3x3 cm tumor on the right posterior scalp with serosanguinous exudate.

Acute generalized exanthematous pustulosis (AGEP) is an abrupt cutaneous adverse reaction usually in response to medications. It is generally a self-limiting disease if diagnosed promptly and the offending agent discontinued. Cetirizine, a commonly used anti-histamine medication for the treatment of allergic diseases has few reported side effects and is normally welltolerated and effective. Herein, the first reported case of cetirizine induced AGEP is presented, followed by a discussion of the clinical and pathological aspects of this adverse cutaneous reaction to a widely used drug. Awareness of this reaction is vital owing to the extensive use of cetirizine and the importance of drug cessation once the reaction is identified. Lastly, other pustular cutaneous reactions may present similarly and therefore accurate identification of this disease can prevent unnecessary diagnostic testing.