Do the Physical and Histologic Features and Time Course in Acute Generalized Exanthematous Pustulosis Reflect a Pattern of Cytokine Dysregulation?

Abstract

The histologic features seen in AGEP and the disease associations suggest that patients who develop this eruption may have an underlying tendency for development of a pattern of immune dysregulation characterized by a T helper-1 cytokine pattern.

Acute generalized exanthematous pustulosis induced by high-dose prednisolone in a young woman with optic neuritis owing to disseminated encephalomyelitis

“…multiple sclerosis, psoriasis, inflammatory bowel disease, etc.) suggest an underlying tendency for a Th1‐dominated immune response pattern 6 . Here, previous reports provide evidence for a key role of drug‐specific T cells in AGEP 7 .…”

Risk factors for acute generalized exanthematous pustulosis (AGEP)—results of a multinational case–control study (EuroSCAR)

“…pristinamycin) the reaction arises so rapidly after intake, it may be assumed that different mechanisms may be involved in the development of this clinical type of reaction. These mechanisms have to be elucidated further by immunological studies whereas ongoing pharmaco‐epidemiological surveillance will help to deepen the knowledge on risks for existing drugs and to detect the potential risk of drugs that have been marketed recently 54–59 …”

“…These mechanisms have to be elucidated further by immunological studies whereas ongoing pharmaco-epidemiological surveillance will help to deepen the knowledge on risks for existing drugs and to detect the potential risk of drugs that have been marketed recently. [54][55][56][57][58][59] Due to the characteristic clinical features, the pathogenesis, and the clinical course and consequences with respect to treatment it makes sense for the clinician to regard AGEP as an independent entity, at least until its pathomechanisms have been clarified.…”

The spectrum of histopathological features in acute generalized exanthematous pustulosis: a study of 102 cases

“…Differences between the histopathological features of AGEP reported in various case reports and clinical studies might be attributed to case definition or different stages in the evolution of the skin lesions analysed. It was shown in a study of 21 AGEP cases 26 that the histopathological features vary in relation to the age of the skin lesion. Thus, biopsies of early lesions showed marked to moderate papillary dermal oedema and a mixed dermal inflammatory infiltrate, often with erythrocyte extravasation, and some leucocytoclasia.…”

“…22,23 Knowledge of the histopathology of AGEP is based primarily on case reports and a few clinical studies. 1,3,4,13,[24][25][26][27][28][29] The aim of the present study was to characterize the histopathological features in a large series of cases with a validated diagnosis of AGEP.…”