Hydroxychloroquine-induced acute generalized exanthematous pustulosis with positive patch-testing

Charfi, Ons; Kastalli, Sarrah; Sahnoun, R.; Lakhoua, Ghozlane

doi:10.4103/0253-7613.169589

Cited by 20 publications

(18 citation statements)

References 8 publications

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“…The genetic and immunologic susceptibility to HCQinduced pustular cutaneous reaction may play an important role in this process or HCQ may induce a unique type of cutaneous reaction presented as AGEP-PP overlap. So regarding drug-induced nature, it is really in favor of AGEP, and regarding interval, it is really in favor of PP and about its course and management, it may be consistent with AGEP or PP (45% and 55%, respectively) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…There are many reports of unusual AGEPs after usage of HCQ, mainly in the setting of rheumatologic problems, which are somehow similar to PP clinical course and characteristics [16][17][18][19]. These types of HCQ-induced AGEPs usually have longer intervals from drug initiation, as well as a more severe, prolonged, and recalcitrant course [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Also, there are many reports of Stevens-Johnson/toxic epidermal necrolysis or drug reaction with eosinophilia and systemic symptoms-like AGEPs, especially as HCQ-induced AGEP [36][37][38][39][40].…”

Section: Introductionmentioning

confidence: 99%

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Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

et al. 2020

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Background: Pustular Psoriasis (PP) and Acute Generalized Exanthematous Pustulosis (AGEP) clinically resemble each other. There are many patients with generalized pustular presentations like hydroxychloroquine-induced pustular reaction who do not completely fall within PP or AGEP categories and needed to be more evaluated. So we examined a large series of these reactions to hydroxychloroquine (HCQ) and reviewed the literature in this regard. Materials and Methods: Records of 20 patients admitted to Razi Hospital, Tehran, Iran with acute onset of generalized pustular eruption following hydroxychloroquine therapy were retrieved, and their demographic and clinical features were reviewed. In the meantime, all related articles in PubMed and Google scholar databases were studied as well. Results: All 20 patients were female with an Mean±SD age of 48.35±13.76 years. The Mean±SD between the first dose and skin eruption was 3.62±1.42 weeks. HCQ was prescribed for them, mainly for rheumatologic conditions and joint problems other than psoriasis. Treatment was planned according to the first clinical judgment, pathological findings, and clinical behavior of the disease. Eleven patients were treated as PP and 9 as AGEP. Conclusion: No evident history of psoriasis, drug-related eruption, as well as rapid and complete response to steroids in some patients, favor AGEP diagnosis. However, the long interval of symptoms appearance, prolonged disease course, relapses despite discontinuation of the responsible drug, and no appropriate response to the steroid, favor PP. So, it could be a new entity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

et al. 2020

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“…Barbaud et al [8] in a multicenter study showed that 58% of patients with AGEP had positive patch tests; moreover, it was interesting that in one of those cases, a pustular eruption was re-induced after application of the patch test. Charfi et al [9] reported a case of AGEP induced by HCQ with positive patch test. In literature, few cases of relapse of AGEP after patch testing are described, even with a neg- ative patch test on the test side but cutaneous eruption in ectopic areas [10].…”

Section: Discussionmentioning

confidence: 99%

The First Pediatric Case of Acute Generalized Exanthematous Pustulosis Caused by Hydroxychloroquine

et al. 2019

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Introduction: Acute generalized exanthematous pustulosis (AGEP) is a generalized, non-follicular sterile pustular rash, categorized as a severe cutaneous adverse reaction, which usually has a favorable prognosis. In a majority of cases (90%), AGEP is drug induced and different drugs are reported as cause of AGEP. Hydroxychloroquine (HCQ) is an antimalarial drug that is also used in some dermatologic and rheumatic diseases due to its immunosuppressive actions. Some cases of AGEP induced by HCQ are reported in literature but only in adults. Materials, Methods and Results: We describe the first case of AGEP caused by HCQ in a child affected by juvenile Sjögren syndrome. After withdrawal of HCQ and subsequent administration, the patient experienced the same cutaneous reaction. An allergy work-up was performed and patch test showed an ectopic flare of AGEP eruption. Conclusion: Our patient represents the first pediatric case of AGEP to HCQ, posing such a drug as a possible trigger also in children. Therefore, an accurate drug medical history is mandatory in order to rule out potential drug reactions when facing a sudden rash.

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“…AGEP in association with administration of Hydroxychloroquine has been infrequently reported in the literature, with a total of twenty-one cases following a PubMed search using the terms 'Hydroxychloroquine' and 'Pustolosis.' Typically, this disease process is self-limited and requires basic supportive measures [7][8][9]. Rarely, AGEP can present in an atypical fashion with the development of blisters and vesicles that can coalesce, desquamate and form superficial erosions in an AGEP/SJS Overlap Syndrome [3,10,11].…”

Section: Discussionmentioning

confidence: 99%

AGEP overlap induced by hydroxychloroquine: a case report and literature review

Mercogliano

Lin

Mohanty

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Acute Generalized Exanthematous Pustulosis (AGEP) is a rare drug reaction manifesting as pustular lesions with surrounding erythema following exposure. The disease is often self-limited and treatment is supportive. It may present in an atypical variant with vesicles that desquamate into erosions, which classifies the disease as an AGEP/SJS Overlap. This overlap syndrome can carry a substantial mortality rate and necessitate elevation in the level of care. Hydroxychloroquine has been implicated in cases of AGEP, and we present a case of AGEP/SJS overlap attributed to this common medication. Given the prevalence of drug eruptions, it is critical for the physicians to recognize and not overlook this rare and potentially fatal dermatological emergency.

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Hydroxychloroquine-induced acute generalized exanthematous pustulosis with positive patch-testing

Cited by 20 publications

References 8 publications

Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

The First Pediatric Case of Acute Generalized Exanthematous Pustulosis Caused by Hydroxychloroquine

AGEP overlap induced by hydroxychloroquine: a case report and literature review

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