Pustular psoriasiform eruption with leukocytosis associated with terbinafine

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.…”

“…Adrenergic receptor agonists, as well as catecholamines themselves, are known to attenuate the proliferative response of human lymphocytes or other cells after activation by catecholamines (6). This long-term agonist-promoted downregulation is due to a decrease in the number of receptors by their internalization and is absent, when Glu is at position 27, thereby inhibiting the effects of catecholamines (8).…”

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

“…Acute generalized exanthematous pustulosis (AGEP) is a pustular reaction that has been given a number of different designations in the literature such as toxic pustuloderma, 1 pustular drug rash, 2 pustular psoriasiform eruption with leucocytosis, 3 or that has been classified as pustular psoriasis 4 or other diseases.…”

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

“…Für viele andere Substanzen liegen lediglich Einzelbeobachtungen vor. Bislang wurde lediglich über 4 Fälle von AGEP nach oraler Verabreichung von Terbinafin berichtet [5,8,14,24]. Eine Übersicht der in der Literatur mitgeteilten Fälle findet sich in Tabelle …”