Acute generalized exanthematous pustulosis secondary to Valproate: An uncommon cutaneous reaction of a common drug

Abstract

Objective: There are various adverse drug reaction (ADR) associated with pharmacological therapy that differ in clinical presentation, prognosis and therapy. Among these, cutaneous eruptions are the most common type of all ADRs.Theclinical presentation of cutaneous drug eruptions ranges from common transient and benign erythema to the most severe forms such as Steven-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN). Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous drug reaction accounting for 1-5 cases/1,000,000 per year. Antibiotics like β-lactams and macrolides are the usual offending agents. Among anticonvulsants-carbamazepine, phenobarbital and phenytoin are commonly associated with AGEP. Sodium valproate is relatively free from cutaneous drug reaction. Thus, we hereby, report a rare case of AGEP in a 24 years old male, reaction following valproate intake used to control post traumatic seizure.Key words: Acute generalized exanthematous pustulosis, Valproate, Adverse drug reaction.Key message: Now-a-days valproate is being widely used in patients of neurosurgery, neurology and psychiatry. AGEP is a quite rare adverse drug reaction produced by valproate. Thus, patients taking valproate if develops fever along with non-follicular pustules then, AGEP should be kept as a differential diagnosis and the offending agent to be replaced with some safer drug immediately to avoid unnecessary morbidity.

Reversible bilateral postauricular adult seborrheic dermatitis due to sodium valproate-valproic acid combination

“…Cutaneous drug eruptions associated with SV-VPA can range from hyperpigmentation [9] to severe Stevens-Johnson syndrome [10]. Localized morphea [11], Rowell's syndrome [12], acute generalized exanthematous pustulosis [13], cutaneous pseudolymphoma [14], and Henoch-Schönlein purpura [15] are some rare cutaneous side effects due to VPA. Psoriasiform eruption due to VPA has been reported relatively more frequently [16].…”