Overview

Acute Generalized Exanthematous Pustulosis, or AGEP, is a rare and sudden skin reaction. It mainly shows up as many tiny, sterile (non-infectious) pus-filled bumps, called pustules, that appear on top of a widespread red rash.

AGEP is most often caused by a reaction to medications, though sometimes infections or other factors can be involved. It can affect anyone at any age, but it's typically seen in adults who have recently started a new medication. Importantly for parents and everyone, AGEP is not contagious. You cannot catch it from someone else, nor can you pass it on. Living with AGEP can be very uncomfortable and distressing due to the sudden onset of the rash, fever, and itching, often requiring medical attention and disrupting daily life until it resolves.

Symptoms

You might notice a combination of the following if AGEP is developing:

• A widespread, bright red rash that appears suddenly, often starting on the face or in skin folds (like armpits or groin) and then spreading quickly over hours to days.
• The development of numerous small, pinhead-sized, pus-filled bumps (pustules) on top of the red rash. These pustules are a key feature and are not caused by infection.
• Fever, which can often be high (above 100.4°F or 38°C), is a very common early symptom.
• Intense itching or sometimes a burning sensation in the affected skin.
• The skin may feel tender or painful to the touch.
• In some cases, mild swelling of the face (facial edema) may occur.
• After the pustules resolve (usually within 1-2 weeks), the skin often peels or flakes off (this is called desquamation).
• Symptoms typically begin within hours to a few days after exposure to a trigger, most commonly a new medication.

Management & Treatment

Dealing with a sudden and widespread rash like AGEP can be alarming, but we want to walk you through the steps to get you on the path to healing. The good news is that for most people, AGEP resolves on its own once the trigger is identified and removed.

The most important first step is to stop the medication that caused the reaction. Never stop a prescribed medication without first speaking with your healthcare provider, but it is critical to seek medical advice immediately if you suspect a drug reaction.

Home Care and Self-Management

While your body heals, the goal is to keep you comfortable and prevent any complications.

• Soothing the Skin: Applying cool compresses can help calm irritated skin. Once the pustules have resolved and the skin begins to peel, using a gentle, fragrance-free moisturizer can help with dryness and healing.
• Managing Discomfort: Over-the-counter (OTC) antihistamines can help relieve itching, and pain relievers like acetaminophen can be used to manage fever or discomfort. Always follow the package directions.
• Gentle Hygiene: It's important to keep the skin clean to prevent secondary infections. Use a mild, soap-free cleanser and gently pat the skin dry.

Medical Treatments

In many cases, stopping the trigger and providing supportive home care is all that is needed. However, your doctor may recommend other treatments.

• Topical Corticosteroids: Your doctor might prescribe a steroid cream or ointment to apply to the skin. This helps to reduce inflammation and itching.
• Systemic Medications: For severe or widespread cases, a doctor may prescribe oral corticosteroids. In rare, very serious instances that require hospital care, other systemic medications might be used to calm the immune system. These are typically reserved for the most challenging cases.

The rash and pustules of AGEP usually clear up within one to two weeks after stopping the offending medication. You may notice some skin peeling as the final stage of healing.

Important Safety Considerations:

• The most crucial step is identifying and discontinuing the trigger medication under a doctor's supervision.
• Keep an eye out for signs of a secondary skin infection, such as increased pain, swelling, warmth, or pus.

If the rash is extremely widespread, painful, accompanied by a high fever, or if you are not seeing improvement after stopping the suspected medication, it is essential to seek medical care.

Diagnosis

Diagnosing AGEP usually involves a careful look at your skin and a discussion about your recent health.

• A doctor often diagnoses AGEP based on the sudden appearance of the characteristic rash and pustules, especially if you've recently started a new medication.
• Your doctor will ask about your medical history, paying close attention to any new drugs you've taken in the days or weeks before the rash appeared.
• Sometimes, a skin biopsy might be performed. This involves taking a tiny sample of your skin for examination under a microscope to confirm the diagnosis and rule out other conditions that can look similar.
• Blood tests may also be done to check for signs of inflammation in the body.

Duration & Outlook

Understanding how long AGEP might last and what to expect can be reassuring.

• AGEP is an acute condition, meaning it starts suddenly but usually resolves relatively quickly once the triggering cause (often a medication) is identified and stopped.
• The rash and pustules typically begin to clear up within 1 to 2 weeks after the trigger is removed.
• The skin peeling (desquamation) that often follows can last for another week or two after the rash itself has gone.
• Most people make a full recovery from AGEP without long-term complications, provided the triggering medication is identified and discontinued promptly.
• Warning signs for complications: While rare, it's important to watch for signs of a more severe reaction. These can include a very high fever that doesn't improve, difficulty breathing, widespread blistering beyond the small pustules, or signs of organ involvement (like changes in urination or yellowing of the skin/eyes). If you notice any of these, please seek medical help immediately.

Prevention

Preventing AGEP primarily involves being aware of potential triggers, especially medications.

• The most effective way to prevent AGEP is to avoid any medications that have previously caused you to have this reaction. Make a note of any such drug.
• If you have ever had AGEP, it's very important to inform all your healthcare providers (doctors, dentists, pharmacists) about the specific drug that triggered it. This helps ensure it won't be prescribed to you again.
• Always tell your doctor about any drug allergies or previous adverse drug reactions you've experienced before starting any new medication.
• While it's not always possible to predict a first-time reaction, being cautious with new medications, especially those known to be more commonly linked to AGEP, is a sensible approach.

Causes & Triggers

Understanding what might cause AGEP can help in managing and preventing it.

• The most common cause of AGEP is an adverse reaction to a medication. While many different drugs can potentially trigger it, some of the most frequent culprits include:
  • Antibiotics (especially penicillins, cephalosporins, and macrolides)
  • Antifungal medications
  • Calcium channel blockers (used for blood pressure)
  • Anti-malarial drugs
• Less commonly, AGEP can be triggered by viral infections. In some rare instances, the exact trigger may not be identified.
• Anyone can develop AGEP if they are exposed to a trigger they are sensitive to. It's not usually related to a person's underlying general health.
• The main risk factor is a history of a previous AGEP reaction to a specific drug; re-exposure to that drug will very likely cause AGEP again, often more quickly and severely. Having a known allergy to a class of drugs often implicated in AGEP can also be a risk factor.

When to see a doctor

It's important to know when to seek medical advice for a rash like this.

• You should see a doctor as soon as possible if you or your child develops a sudden, widespread red rash with small pus-filled bumps, especially if it's accompanied by a fever.
• If you've recently started a new medication (even over-the-counter ones or supplements) and then develop these symptoms, it's very important to seek medical advice promptly. Do not stop prescribed medication without talking to your doctor first, but do make them aware of the rash immediately.
• A dermatologist is a specialist in skin conditions. They can help confirm the diagnosis of AGEP, distinguish it from other skin problems, and guide you on the next steps. Your primary doctor may refer you, or you can seek a dermatologist if you are concerned.
• Seek immediate medical attention (go to an emergency department or call emergency services) if you experience severe symptoms such as:
  • Difficulty breathing or swallowing
  • Swelling of the face, lips, or tongue
  • Widespread blistering or large areas of skin peeling
  • Feeling very unwell, dizzy, or faint
  • High fever that doesn't respond to usual measures

Frequently Asked Questions (FAQs):

• Q: Is AGEP an infection? My skin has pustules, which look like pus.
  A: No, AGEP is not an infection, even though it causes pus-filled bumps (pustules). These pustules are "sterile," meaning they don't contain bacteria or other infectious agents. AGEP is an inflammatory reaction of the skin, usually to a medication.
• Q: If I had AGEP once from a medication, will I get it again if I take that medication?
  A: Yes, if you are re-exposed to the same medication (or sometimes a closely related one) that triggered AGEP previously, you are very likely to develop it again. The reaction can often be faster and more severe the next time. It's crucial to avoid known triggers.
• Q: Can AGEP affect my internal organs?
  A: In most cases, AGEP primarily affects the skin. However, in some severe instances, there can be systemic inflammation, and rarely, involvement of other organs like the liver or kidneys. This is one reason why medical evaluation is so important.
• Q: Will AGEP leave scars on my skin?
  A: Typically, AGEP heals without scarring, especially if it's managed appropriately and secondary skin infections (from scratching, for example) are avoided. Some temporary changes in skin color (darker or lighter patches) may occur where the rash was, but these usually fade over time.
• Q: How will my doctor know which drug caused my AGEP?
  A: Your doctor will carefully review your medication history, looking for any new drugs started in the days to few weeks before the rash appeared. This is often the most important clue. Sometimes, if it's unclear, specialized allergy testing called patch testing might be considered later on, once the rash has resolved, to help identify the trigger.

Sources

• American Academy of Dermatology Association. (n.d.). Acute generalized exanthematous pustulosis. Retrieved from https://www.aad.org/public/diseases/a-z/acute-generalized-exanthematous-pustulosis-treatment
• DermNet NZ. (n.d.). Acute generalized exanthematous pustulosis. Retrieved from https://dermnetnz.org/topics/acute-generalized-exanthematous-pustulosis