Background: Generalized pustular eruptions are characterized by acute onset of aseptic pustules in febrile patients with leukocytosis after exposure to the offending drug. They have been regarded as uncommon manifestations of adverse drug reactions. Until now few confirmation studies have been carried out.
Objective: Our purpose was to describe a series of patients with generalized pustular drug eruption. The diagnosis and etiological role of drugs in these cases was confirmed by two in vitro tests, namely the macrophage migration inhibitory factor (MIF) and the mast cell degranulation (MCD) tests.
Methods: The clinical, pathological and laboratory findings in six patients with generalized pustular eruption were studied prospectively. The MIF and MCD tests were performed with the drugs taken by the patients.
Results: The dermatological manifestations included numerous pustules on large erythematous areas, papules and erythema multiforme-like lesions. The pustular eruption developed between 12 h and 5 days after the administration of the provoking drug. The histopathological changes were characterized by subcorneal pustules, papillary edema and mixed cell inflammatory infiltrate. In two biopsies the infiltrate displayed numerous eosinophils. Laboratory investigations revealed leukocytosis with neutrophilia (4 of 6 patients) and eosinophilia and hyperimmunoglobulinemia E (2 of 6 patients). MCD tests with the suspected drugs (Ampicillin, Cefazolin, Tetracycline, Griseofulvin, Enalapril Maleate) were positive in all patients. Positive MIF results were seen in five of the six patients. Withdrawal of the drug led to fast recovery.
Conclusion: The diagnosis of pustular drug eruptions depends on circumstantial evidence, some characteristic clinicopathological findings and exclusion of alternative diagnoses of other disseminated pustular eruptions. In vitro tests, namely MIF and MCD tests, are a useful diagnostic aid in the identification of the offending drugs.
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Cureus
December 2024
Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, USA.
Rarely, tumor necrosis factor (TNF)-α inhibitors can paradoxically induce eruptions of psoriasis with generalized pustular psoriasis being among the least common presentations. We report a patient who presented with a generalized pustular eruption following adalimumab therapy for hidradenitis suppurativa (HS). The diagnosis of generalized pustular psoriasis was confirmed with a biopsy showing neutrophilic spongiosis and intraepidermal pustulosis.
View Article and Find Full Text PDFJ Dermatolog Treat
December 2025
Department of Dermatology, Children's Hospital Affiliated to Kunming Medical University, Kunming, China.
To evaluate the long-term efficacy and safety of secukinumab in pediatric patients with generalized pustular psoriasis (GPP). A retrospective study was conducted from July 2021 to July 2024, including 10 children with GPP. Patients were divided into two age groups: children aged 0-3 years received 75 mg of secukinumab, while those aged 3-12 years received 150 mg.
View Article and Find Full Text PDFSAGE Open Med Case Rep
January 2025
Memorial University of Newfoundland, St. John's, NL, Canada.
Erosive pustular dermatosis is a rare and chronic inflammatory condition of the scalp which can be mistaken for cutaneous malignancy, precancerous lesions, dermatitis or pyoderma gangrenosum. The recurrent and resistant characteristics of erosive pustular dermatosis of the scalp pose a challenge to successful management and remission of the condition. The purpose of this case report is to provide management options and treatment recommendations for refractory cases of erosive pustular dermatosis of the scalp.
View Article and Find Full Text PDFJ Eur Acad Dermatol Venereol
January 2025
Hospital for Skin Diseases, Shandong First Medical University, Shandong, China.
An Bras Dermatol
December 2024
Institute of Dermatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China. Electronic address:
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