Management of Acute Generalized Exanthematous Pustulosis (AGEP)

Initial Assessment and Diagnosis

• Evaluate the extent of skin involvement using body surface area (BSA): mild to moderate (10-30% BSA) or severe (>30% BSA) 1
• Rule out other causes of pustular eruptions by obtaining bacterial cultures if infection is suspected 2, 1

First-Line Management

• Provide supportive care including gentle skin care with emollients 1

Treatment Based on Severity

• Apply topical low to moderate potency corticosteroids to affected areas in mild to moderate AGEP (10-30% BSA) 2, 1
• Consider systemic corticosteroids (prednisone 0.5-1 mg/kg body weight for 7 days with tapering over 4-6 weeks) in severe AGEP (>30% BSA or with systemic symptoms) 2
• Hold any immune checkpoint inhibitor therapy if AGEP is related to immunotherapy until resolution to grade 1 3

Management of Complications

• Obtain bacterial cultures before starting antimicrobial therapy for suspected secondary infection 2, 1
• Administer appropriate antibiotics based on culture sensitivities for at least 14 days for suspected secondary infection 2
• Consider oral antihistamines for severe pruritus 2
• Consider gabapentin or pregabalin for refractory severe pruritus 3

Follow-up and Monitoring

• Reassess after 2 weeks of initial therapy 2, 1
• If no improvement or worsening, consider alternative diagnoses or escalate treatment 1
• Consider dermatology consultation for persistent or severe cases 3