Treatment of AGEP with Systemic Involvement or Erythroderma
Clinical Scenario
This protocol addresses the most severe presentations of acute generalized exanthematous pustulosis: patients with systemic involvement — elevated liver enzymes, kidney insufficiency, or haemodynamic instability — and those presenting with very acute skin findings such as erythroderma or disseminated pustules.
Conditions Present
Elevated liver enzymes
Kidney insufficiency
Haemodynamic instability
Erythroderma
Disseminated pustules
Treatment Approach
Management centres on immediate withdrawal of the suspected causal drug and comprehensive supportive care; in the most severe presentations with systemic involvement or extensive cutaneous findings, a short course of systemic corticosteroid therapy may also be indicated.
References
DOI: 10.1111/jdv.20232
- 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.
- For the most severe patients (extensive skin lesions and pseudo-Nikolsky sign), supportive care could be based on the existing recommendations for epidermal necrolysis.
- 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.
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