Synopsis
Recognise the abrupt sterile pustular drug eruption of AGEP, distinguish it from pustular psoriasis and infection, withdraw the culprit, and monitor systemic complications.
- AGEP causes dozens to hundreds of tiny non-follicular sterile pustules on oedematous erythema, often beginning in face or folds and spreading rapidly.
- Onset is usually abrupt after a new medicine, commonly an antibiotic, and fever with neutrophilia is frequent.
- Bright erythema may be less visible in deeply pigmented skin; detect oedema, tenderness, pustular texture and later superficial desquamation.
Key red flags
Hypotension, lactate elevation, severe pain, mucosal injury, extensive detachment, oliguria, jaundice, hypoxia or diagnostic concern for sepsis or pustular psoriasis requires urgent multidisciplinary care.
Severe skin pain, extensive mucosal erosion, dusky targets or sheet detachment is not routine AGEP and needs emergency reclassification.
Investigation priorities
Identify rapid culprit latency and any infectious trigger or alternative.
Management branches
A new medicine is followed by abrupt non-follicular pustules, fever or neutrophilia without extensive necrolysis.
- Stop plausible non-essential culprits, document exact timing and obtain same-day dermatology or acute-medical assessment when disease is generalised.
- Check blood count, renal, liver and physiology, culture when infection is plausible and biopsy if psoriasis or necrolysis remains a significant alternative.
Key medicines
Betamethasone valerate 0.1% creamApply a thin film once or twice daily to limited intact inflamed areas for the shortest effective period, with a licensed maximum course of four weeks.