Acute Generalized Exanthematous Pustulosis (AGEP)

AGEP

Overview

Acute generalized exanthematous pustulosis (AGEP) is a severe, acute drug reaction characterized by the rapid development of widespread, small, non-follicular sterile pustules on a background of diffuse erythema. It is most commonly triggered by antibiotics (particularly aminopenicillins and macrolides) and typically develops within 1-5 days of starting the causative medication. AGEP is self-limiting once the offending drug is discontinued.

Key Symptoms

  • Rapid onset of dozens to hundreds of small (less than 5 mm), non-follicular sterile pustules
  • Pustules arise on a background of widespread, bright red, edematous skin
  • Typically begins in skin folds (axillae, groin) and spreads rapidly
  • High fever (often above 38°C / 100.4°F)
  • Burning or itching sensation in affected areas
  • Facial edema and purpura may occur; mucous membrane involvement is uncommon

Affected Areas

Skin folds (axillae, groin — often initial site), Trunk, Face, Arms, Legs

Care Instructions

  1. Immediately discontinue the suspected causative medication.
  2. Seek urgent medical evaluation — hospitalization may be needed for severe cases.
  3. Supportive care with topical corticosteroids and emollients to soothe the skin.
  4. Antipyretics for fever management.
  5. The eruption typically resolves within 1-2 weeks after drug withdrawal, with characteristic desquamation (peeling).
  6. Patch testing can be performed after resolution to identify the causative drug and prevent future reactions.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult a qualified dermatologist for diagnosis and treatment.

Prevalence: Rare; estimated incidence of 1-5 cases per million per year