Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR).
BACKGROUND
Acute generalized exanthematous pustulosis (AGEP) is a disease characterized by the rapid occurrence of many sterile, nonfollicular pustules usually arising on an oedematous erythema often accompanied by leucocytosis and fever. It is usually attributed to drugs.


OBJECTIVE
To evaluate the risk for different drugs of causing AGEP.


METHODS
A multinational case-control study (EuroSCAR) conducted to evaluate the risk for different drugs of causing severe cutaneous adverse reactions; the study included 97 validated community cases of AGEP and 1009 controls. Results Strongly associated drugs, i.e. drugs with a lower bound of the 95% confidence interval (CI) of the odds ratio (OR) > 5 were pristinamycin (CI 26-infinity), ampicillin/amoxicillin (CI 10-infinity), quinolones (CI 8.5-infinity), (hydroxy)chloroquine (CI 8-infinity), anti-infective sulphonamides (CI 7.1-infinity), terbinafine (CI 7.1-infinity) and diltiazem (CI 5.0-infinity). No significant risk was found for infections and a personal or family history of psoriasis (CI 0.7-2.2).


CONCLUSIONS
Medications associated with AGEP differ from those associated with Stevens-Johnson syndrome or toxic epidermal necrolysis. Different timing patterns from drug intake to reaction onset were observed for different drugs. Infections, although possible triggers, played no prominent role in causing AGEP and there was no evidence that AGEP is a variant of pustular psoriasis.
Sidoroff
A
A
Department of Dermatology and Venereology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. alexis.sidoroff@i-med.ac.at
Dunant
A
A
Viboud
C
C
Halevy
S
S
Bavinck
J N Bouwes
JN
Naldi
L
L
Mockenhaupt
M
M
Fagot
J-P
JP
Roujeau
J-C
JC
D000890:Anti-Infective Agents / Q000009:adverse effects; D001317:Austria / Q000453:epidemiology; D002121:Calcium Channel Blockers / Q000009:adverse effects; D016022:Case-Control Studies; D004110:Diltiazem / Q000009:adverse effects; D003875:Drug Eruptions / Q000453:epidemiology / Q000209:etiology*; D005076:Exanthema / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects; D007557:Israel / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects; D009426:Netherlands / Q000453:epidemiology; D010406:Penicillins / Q000009:adverse effects; D025762:Pristinamycin / Q000009:adverse effects; D015363:Quinolones / Q000009:adverse effects; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects; D000077291:Terbinafine
D000890:Anti-Infective Agents; D002121:Calcium Channel Blockers; D009281:Naphthalenes; D010406:Penicillins; D025762:Pristinamycin; D015363:Quinolones; D013449:Sulfonamides; D006886:Hydroxychloroquine; D004110:Diltiazem; D000077291:Terbinafine