Treatment of Acute Generalized Exanthematous Pustulosis in Children Under 18 Without Systemic Involvement
This protocol covers the management of AGEP in paediatric patients — children under 18 years of age — where the presentation is not complicated by systemic involvement or the most severe forms of skin lesions.
Clinical scenario
The patient is a child under 18 years of age presenting with AGEP, in the absence of systemic involvement — that is, no elevated liver enzymes, no kidney insufficiency, and no haemodynamic instability — and without the most severe skin manifestations such as erythroderma or disseminated pustules.
Approach overview
The first step is immediate discontinuation of the suspected causal drug. Supportive care — including gentle skin cleansing, moisturizing, and hydration adjusted to clinical status — forms the core of management.
A Grade III topical corticosteroid is incorporated into the treatment plan, applied to affected areas in a quantity guided by the extent of lesions. The full protocol specifies how to determine that quantity and what the complete treatment pathway looks like.
Goal: complete healing of skin lesions
References
DOI: 10.1111/jdv.20232Digital
- In children
- 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.
- The suspected causal drug(s) must be stopped immediately and the pharmacovigilance department should be advised as soon as possible.
- 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.
- 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.
- Grade III topical corticosteroids (e.g. betamethasone valerate and mometasone) can be used.
- As it is not a chronic disease, the most important is to use the quantity required for a complete healing of lesions.
- The fingertip unit (FTU) method can be proposed: 1 FTU, meaning 0.5g, covering a body surface area equivalent to two adult handprints.
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