Beltran C, Vergier B, Doutre M-S, Beylot C, Beylot-Barry M
Service de dermatologie, hôpital de Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France.
Ann Dermatol Venereol. 2009 Oct;136(10):709-12. doi: 10.1016/j.annder.2008.10.042. Epub 2009 Mar 17.
In most cases, acute generalized exanthematous pustulosis (AGEP) is a drug reaction. Even if several systemic drugs have been reported to be a causative agent, this clinical case has rarely been observed with a topical treatment. We report here a case of AGEP after topical application of Algipan.
A 51-year-old man consulted us for a skin rash with fever which started 72 h earlier. His personal history consisted only of lumbar pain and he was not under any oral medication. The skin rash was initially limited to the left hand and the back but quickly spread to the entire skin with multiple non-follicular pustules emerging on widespread and inflamed erythema. No systemic treatment was being taken prior the eruption. Nevertheless, 3 days before the skin rash appeared, the patient had applied Algipan to the lumbar area with his left hand. The whole clinical presentation leads us to diagnose Algipan-induced AGEP. The clinical signs improved rapidly. Patch tests performed 3 months later were positive for the whole product, thereby confirming our diagnosis.
AGEP is drug-induced in more than 90% of cases, mostly after antibiotics, especially beta-lactams and macrolides. Algipan is a topical treatment containing mephenesin used for its analgesic and anti-inflammatory properties in adult muscular pain. No severe skin drug reactions due to this drug have been reported to date. Cases of AGEP induced by topical agents are rarely reported and our case is the first involving mephenesin. Our study suggests that topical mephenesin should be noted as a drug that may cause AGEP.
在大多数情况下，急性泛发性脓疱性皮病（AGEP）是一种药物反应。即使已有多种全身性药物被报道为致病因素，但这种临床病例很少在局部治疗后出现。我们在此报告一例局部应用阿尔吉潘（Algipan）后发生的AGEP病例。
一名51岁男性因72小时前开始出现的伴有发热的皮疹前来就诊。他的个人病史仅包括腰痛，且未服用任何口服药物。皮疹最初局限于左手和背部，但很快蔓延至全身皮肤，在广泛的炎症性红斑上出现多个非毛囊性脓疱。出疹前未进行任何全身治疗。然而，在皮疹出现前3天，患者用左手在腰部涂抹了阿尔吉潘。整个临床表现使我们诊断为阿尔吉潘诱发的AGEP。临床症状迅速改善。3个月后进行的斑贴试验显示整个产品呈阳性，从而证实了我们的诊断。
在超过90%的病例中，AGEP是由药物引起的，大多发生在使用抗生素后，尤其是β-内酰胺类和大环内酯类抗生素。阿尔吉潘是一种含有美芬新的局部治疗药物，用于治疗成人肌肉疼痛，具有镇痛和抗炎特性。迄今为止，尚未有因该药物引起严重皮肤药物反应的报道。由局部用药引起的AGEP病例很少见，我们的病例是首例涉及美芬新的病例。我们的研究表明，局部用美芬新应被视为一种可能导致AGEP的药物。
