Pediatric emergency medicine trisk 1310 1310
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FIGURE 68.4 This morbilliform eruption presented several days after starting ampicillin
therapy. (Reprinted with permission from Elder DE, Elenitsas R, Rubin AI, et al. Atlas and
Synopsis of Lever’s Histopathology of the Skin . 3rd ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2012.)
The most important treatment for DHR is stopping the culprit medication. Oral
steroids can typically quickly stop progression of the disease by treating systemic
inflammation. Steroids should be tapered over several weeks to prevent a rebound
of the reaction.
PUSTULAR
Acute generalized exanthematous pustulosis (AGEP) is a less commonly seen
drug eruption in children. It presents with widespread erythema overlaid with
numerous pinpoint, superficial, sterile pustules ( Fig. 68.5 ). The pustules are
fragile and easily ruptured, leaving superficial areas of desquamation over the
background of erythema. The eruption frequently starts on the face or within skin
folds before rapidly spreading to the rest of the body. Fever is usually present,
while mucous membrane involvement is not seen.
AGEP presents within a few days of starting the triggering medication, usually
an antibiotic. In one study, pristinamycin, aminopenicillins, and quinolones were
the most common causes of AGEP, but cephalosporins, macrolides, clindamycin,
tetracycline, and terbinafine are other causes.
The differential diagnosis for AGEP includes DHR and pustular psoriasis.
Careful inspection for pustules or for areas of desquamation, indicating ruptured
