Acute generalized exanthematous pustulosis induced by hydroxychloroquine successfully treated with etretinate

Matsuda‐Hirose, Haruna; Sho, Yuriko; Yamate, Tomoko; Nakamura, Yusuke; Saito, Kanami; Takeo, Naoko; Nishida, Haruto; Ishii, Koji; Sugiura, Kazumitsu; Hatano, Yutaka

doi:10.1111/1346-8138.15185

Cited by 9 publications

(5 citation statements)

References 3 publications

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“…Treatments have been varied 11‐21,24‐26 . The first line therapy is topical and systemic steroids, which may be followed by cyclosporine if GPFE is not responsive 13,14,21 .…”

Section: Figurementioning

confidence: 99%

“…The first line therapy is topical and systemic steroids, which may be followed by cyclosporine if GPFE is not responsive 13,14,21 . Other options include potent topical steroids with oral dapsone or etretinate 25 . Additional experience with GPFE and its treatment can be anticipated to surge as hydroxychloroquine becomes widely utilized in the COVID‐19 pandemic.…”

Section: Figurementioning

confidence: 99%

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Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine

Schwartz

Jänniger

2020

Dermatologic Therapy

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A severe cutaneous drug reaction resembling acute generalized exanthematous pustulosis resulting from ingestion of hydroxychloroquine has been documented. It is distinguishable by its longer incubation period, more varied morphology with initially urticarial and later targetoid and arcuate plaques, recalcitrance to therapy and longer duration. Given the anticipated surge in the use of hydroxychloroquine due to its reported benefits in those with coronavirus disease 2019, specific recognition of this entity is pivotal. We delineate it as generalized pustular figurate erythema. K E Y W O R D S acute generalized exanthematous pustulosis,

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“…Treatments have been varied 11‐21,24‐26 . The first line therapy is topical and systemic steroids, which may be followed by cyclosporine if GPFE is not responsive 13,14,21 .…”

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine

Schwartz

Jänniger

2020

Dermatologic Therapy

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“…Of the remaining 2770 articles, an additional 2516 were excluded for the content eligibility reasons described above (eligibility criteria are summarised in Table S3 of Supplementary Material ). The full selection process yielded a final set of 254 studies for this systematic review ( Figure 1 ) [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , ...…”

Section: Resultsmentioning

confidence: 99%

“…A total of 99 articles reporting 123 cases were found [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ,…”

Section: Resultsmentioning

confidence: 99%

“…A total of 41 cases of mild to severe dermatological adverse effects, including 2 cases of fatal toxic epidermal necrolysis, were described in patients treated with HCQ for autoimmune diseases [ 31 , 34 , 35 , 36 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 59 , 60 , 62 , 63 , 64 , 65 ]. A smaller number of cases were reported in patients treated with CQ for autoimmune conditions or malaria although one fatal case was reported [ 27 , 28 , 29 , 30 , 32 , 33 , 37 , 39 , 49 , 54 , 58 , 61 ].…”

Section: Resultsmentioning

confidence: 99%

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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

et al. 2023

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Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.

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Acute generalized exanthematous pustulosis induced by hydroxychloroquine successfully treated with etretinate

Cited by 9 publications

References 3 publications

Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine

Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

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