Rapid clearing of acute generalized exanthematous pustulosis after administration of ciclosporin

Clin Exp Dermatol. 2009 Dec;34(8):e757-9. doi: 10.1111/j.1365-2230.2009.03480.x. Epub 2009 Jul 29.

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder, usually drug-induced, and is clinically characterized by widespread, non-follicular aseptic pustules. Although spontaneous resolution usually occurs once the causative drug has been withdrawn, more severe cases often require treatment with systemic corticosteroids. We report a 63-year-old woman who developed AGEP after a 30-day course of hydroxychloroquine. Extensive re-exacerbation of AGEP after an 18-day course of methylprednisolone led us to switch the treatment to oral ciclosporin with a prompt and satisfactory improvement. Ciclosporin has many inhibitory effects on the main cell population (T cells) involved in AGEP. In particular, a significant reduction in production of interleukin-8 by T cells is a possible explanation of the rapid remission observed in this case. To our knowledge, this is the first reported case of AGEP successfully treated with ciclosporin.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Cyclosporine / therapeutic use*
  • Exanthema / chemically induced
  • Exanthema / drug therapy*
  • Female
  • Humans
  • Hydroxychloroquine / adverse effects*
  • Immunosuppressive Agents / therapeutic use*
  • Middle Aged
  • Skin Diseases, Vesiculobullous / chemically induced
  • Skin Diseases, Vesiculobullous / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunosuppressive Agents
  • Hydroxychloroquine
  • Cyclosporine