Acute generalised exanthematous pustulosis

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.
• Construct exact drug start, stop and dose dates because a short latency supports AGEP but varies by culprit and previous exposure.
• Culture representative pustules when infection is a real alternative, yet recognise that colonisation does not explain a classic sterile pattern.
• Most cases improve quickly after drug withdrawal and supportive topical care, but monitor renal, hepatic, respiratory and fluid status.
• Acute generalised exanthematous pustulosis must be assessed by lesion duration, onset, distribution, symptoms, mucosal findings, systemic physiology and the full medicine timeline rather than by colour alone.
• For Acute generalised exanthematous pustulosis, document the working diagnosis, excluded emergencies, uncertain culprit or trigger, treatment response and the exact safety-net given.