Acute generalized exanthematous pustulosis: 15-year retrospective multicenter experience

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition often triggered by medications. Many case reports have been published but a few studies on large cohorts have been reported to date. Objectives: The aim of the current study is to provide correlation between AGEP EuroSCAR score and clinical, laboratory findings and histopathologic examination in a large cohort. Methods: This retrospective, multicenter study analyzed 51 AGEP cases across four academic institutions. Results: The study found that the majority of cases were drug-induced, particularly by antibiotics such as amoxicillin. The average time from drug exposure to symptom onset was 10.7 days, with hospitalization lasting an average of 14.5 days and recovery averaging 33.3 days. Key features included widespread itching, fever, and elevated inflammatory markers. Histopathological analysis frequently revealed spongiform pustules and eosinophilic infiltration. Importantly, this study is the first to demonstrate a significant association between higher EuroSCAR scores and elevated LDH levels, suggesting a more intense inflammatory response in cases with higher EuroSCAR scores. The findings underscore the need for early diagnosis and management of AGEP, with a particular focus on discontinuing the offending drug and administering corticosteroids. Conclusions: Despite its retrospective design, this study contributes valuable insights into the systemic implications and histopathological characteristics of AGEP, highlighting the possible role of LDH, and the importance of further research to refine diagnosis, treatment protocols and improve patient outcomes.