Acute Generalized Exanthematous Pustulosis
ICD-10 L08.0 · ICD-11 EH67.0

Treatment of AGEP in Adults Without Systemic Involvement or Severe Skin Lesions

This protocol addresses adults aged 18 years and older with acute generalized exanthematous pustulosis (AGEP) who do not have systemic organ involvement — no elevated liver enzymes, no kidney insufficiency, and no haemodynamic instability — and whose skin lesions have not reached the most severe presentation (no erythroderma, no disseminated pustules).

Clinical Scenario

The patient is an adult (18 years or older) with confirmed or suspected AGEP in the absence of systemic complications. This presentation is distinct from cases involving organ involvement or the most severe skin findings, and follows a dedicated management pathway.

Treatment Approach

The immediate priority is withdrawal of the suspected causative drug, followed by supportive care for all patients. Topical corticosteroids form the cornerstone of specific treatment, with the clinical goal of achieving complete or almost complete clearing of skin lesions.

Full regimen, agent selection, and application schedule are detailed in the complete protocol →
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References

DOI: 10.1111/jdv.20232

  1. In adults
  2. In the most severe cases, that is, with systemic involvement (e.g. liver or kidney abnormalities and haemodynamic instability) or very acute skin lesions (erythroderma and disseminated pustules), a short systemic corticosteroid therapy with prednisone 0.5 mg/kg/day for a duration of 5–7 days may be considered.
  3. The suspected causal drug(s) must be stopped immediately and the pharmacovigilance department should be advised as soon as possible.
  4. All patients should be placed on bed rest until significant improvement and receive supportive care including mild soap substitutes baths or showers, moisturizing cream and oral or intravenous hydration according to the clinical status and biological changes.
  5. Even if the pustules tend to resolve spontaneously within a few days, with a characteristic pattern of punctate desquamation, most experts recommend the possible use of topical corticosteroids as specific treatment of AGEP.
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