Arzneimittelreaktion auf Terbinafin unter dem Bild einer akuten generalisierten exanthematischen Pustulose (AGEP)

Abstract

Oral terbinafine (Lamisil) is a widely used and effective therapy of dermatophyte infections. A 20-year-old patient was treated with oral terbinafine for an inguinal-scrotal fungal infection and developed an acute generalized exanthematic pustulosis (AGEP) and fever. Histological examination of skin biopsy revealed subcorneal and spongiform pustules. The diagnosis of an AGEP induced by terbinafine was established based on the history, clinical manifestations, and laboratory findings. Clinical features, differential diagnosis, causative drugs, and the therapy of AGEP are discussed and the literature on cases of terbinafine-induced AGEP is reviewed.

Oral Prednisolone Induced Acute Generalized Exanthematous Pustulosis due to Corticosteroids of Group A Confirmed by Epicutaneous Testing and Lymphocyte Transformation Tests

“…The sensitivity of patch testing to drugs in AGEP has been reported to be approximately 50% [12, 13]. Previous reports have indicated that the LTT may be helpful in determining drug allergy in AGEP despite negative skin testing [14,15,16,17]. To our knowledge a significant lymphocyte stimulation to corticosteroids has not been reported previously in AGEP.…”

Oral Corticosteroids did not Prevent AGEP due to Terbinafine

“…Sideroff et al (2) stated that the course of AGEP is self-limiting with the pustulosis tending to resolve within 15 days. Steroid use was associated with those cases where the drug eruption was prolonged and tended to last for longer that the stated 15 days (Table II) (4,(6)(7)(8)(9)(10)(11). Given this prolonged temporal association and the fact that our patient developed AGEP despite concurrent oral corticosteroids, we question the therapeutic value of glucocorticoids, in the management of AGEP.…”

“…In 9 out of 13 reported cases oral corticosteroids were used for the treatment of AGEP (4)(5)(6)(7)(8)(9)(10)(11)(12). The phenomenon of severe cutaneous adverse drug reactions developing in patients receiving corticosteroids for the treatment of chronic diseases has been described before.…”

“…Stress, which is known for triggering AD eruptions, exerts an adjuvant effect on dendritic cells, resulting in increased primary and memory antigen-specific T-cell immune responses and inhibits skin barrier recovery. These effects are mediated by P2 agonists (9,10) and are important in AD pathophysiology. The presence of Gln27Glu polymorphism could enhance sensitivity to stress in patients with IAD, Sir, Terbinafine is the most common antimycotic agent that can result in acute generalized exanthematous pustulosis (AGEP).…”

Terbinafine-Induced Subacute Cutaneous Lupus Erythematosus

“…Benign side effects are observed in about 10% of patients, usually affecting the digestive tract and the skin (ageusia, nausea, diarrhea, erythema, pruritus, urticaria), occurring in 4.9 and 2.3% of patients, respectively [19, 20]. In rare cases, there have been reports of hepatitis, severe hematological abnormalities, and serious cutaneous side effects have been reported, such as bullous pemphigoid [21], acute generalized exanthematous pustulosis [22,23,24], toxic epidermal necrolysis [25, 26], hypersensitivity reaction (‘DRESS syndrome’) [27], erythema multiforme [26, 28], pustular psoriasis [29] or SCLE [11,12,13,14,15,16,17]. …”