Three patients with acute generalized exanthematous pustular dermatitis (AGEPD) are presented. This new clinical entity comprises generalized erythema, erythema multiforme, amicrobial pustules, fever and spontaneous healing over a 10-day period. Histologically, there are a mixed neutrophilic and eosinophilic vasculitis and an eosinophilic subcorneal and spongiform pustule. All the patients experienced pharyngitis 1 week before the onset of the rash. Two of them had high-titered IgM-neutralizing antibodies to enteroviruses and 1 had an enterovirus in stool and urine. AGEPD may be related to a viral infection and may occur in patients with a genetic predisposition to psoriasis. The diagnosis of AGEPD should be made early enough so that the patients are not given the often aggressive therapy of pustular psoriasis.