Acute Generalised Exanthematous Pustulosis


Last updated: August 2023

Also known as: Pustular eruption, toxic pustuloderma

What is acute generalised exanthematous pustulosis?

Acute Generalised Exanthematous Pustulosis (AGEP) is a rare skin condition caused by medications. It is characterised by a rash that causes sudden swelling and redness of the skin and the development of small white pus-filled spots (pustules).

It typically starts on the face or on the inner elbows, behind the knees, armpits, groin and neck (flexural areas).

Who gets acute generalised exanthematous pustulosis?

AGEP is mainly seen in adults but can occur in children.

The estimated incidence of AGEP is 1 to 5 cases per 1,000,000 people per year.(1)

What causes acute generalised exanthematous pustulosis?

Medications are the cause of AGEP in more than 90% of cases.(2-3)

Antibiotics are the main cause, but other drugs may cause AGEP, such as paracetamol, oral antifungals and hydroxychloroquine.

AGEP usually develops 1 to 5 days after starting the medication. However, it can take as long as 11 days after exposure to the medication.

Other causes of AGEP may include vaccinations and viral infections.

What does acute generalised exanthematous pustulosis look like?

AGEP starts on the face or on the inner elbows, behind knees, armpits, groin and neck, before rapidly spreading to other areas of the skin.

The rash begins within hours or up to 11 days after starting a medication with areas of the skin becoming red and swollen with small (less than 5 mm) whitish, yellow pus-filled spots that burn and itch.

Individuals with AGEP may feel unwell and have a fever.  

How is acute generalised exanthematous pustulosis diagnosed?

AGEP is diagnosed clinically. In some cases, a blood test, skin swab, sample of the skin (biopsy) and patch testing may be needed to diagnose AGEP.

How is acute generalised exanthematous pustulosis treated?

Treatment options will vary depending on the individual and their needs.

AGEP usually gets better when the medication causing the reaction is stopped. Treatment of AGEP aims to relieve symptoms, and may include moisturisers, topical corticosteroids, oral antihistamines and analgesics until the rash resolves. Systemic treatment, such as oral prednisolone is rarely indicated.

Most individuals with AGEP can be managed at home. Those who are older or more severely affected may be admitted to hospital for a few days.  

What is the likely outcome of acute generalised exanthematous pustulosis?

The rash of AGEP usually peels off and resolves within 15 days of stopping the medication. It is unlikely to recur unless the same medication that caused the first episode is taken again.

  1. Roujeau JC, Bioulac-Sage P, Bourseau C, Guillaume JC, Bernard P, Lok C, Plantin P, Claudy A, Delavierre C, Vaillant L, et al. Acute generalized exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol. 1991 Sep;127(9):1333-8.
  2. Roujeau J, Bioulac-Sage P, Bourseau C, et al. Acute generalized Exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol 1991; 127(9): 1333-8.
  3. Chang SL, Huang YH, Yang CH, Hu S, Hong HS. Clinical manifestations and characteristics of patients with acute generalized exanthematous pustulosis in Asia. Acta Derm Venereol. 2008;88(4):363-5. doi: 10.2340/00015555-0438. PMID: 18709306.
Dr Sara TrittonAugust 2023
Dr Sara TrittonJuly 2022


2019 © Australasian College of Dermatologists.

You may use for personal use only. Please refer to our disclaimer.