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Patient Care Outcomes in Hospitalized Patients with Acute Generalized Exanthematous Pustulosis: A Cross-Sectional Database Study

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Abstract

Background

Current understanding of the etiology, natural history, and outcomes of acute generalized exanthematous pustulosis (AGEP) has been limited, with most available studies consisting of small or heterogenous cohorts.

Objectives

The aim of this study was to further characterize associated factors and disease outcomes of AGEP.

Methods

A cross-sectional study design was employed with formal inclusion and causality criteria. Patients were identified from an inpatient database at an academic medical center, including 65 patients with AGEP and a control group of 61 patients with non-severe cutaneous adverse reactions.

Results

Increased age and body mass index (BMI) were associated with higher risk of AGEP (p < 0.001). Length of stay was longer for both the overall AGEP cohort (13.1 days) and a subcohort with a primary discharge diagnosis of AGEP (9.7 days) compared with the control group (3.6 days) [p < 0.001]. Patients with AGEP were more likely to be discharged to a long-term care facility compared with control patients (p < 0.001).

Conclusions

AGEP was associated with longer length of hospitalization, higher rates of discharge to long-term care facilities, and higher mortality compared with non-severe cutaneous adverse drug reaction (SCAR) medication reactions. Future research should examine the association between morbid obesity and this particular drug reaction, and the possibility of decreasing hospitalization length given the relatively low risk of mortality among patients with AGEP.

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References

  1. Sidoroff A, Halevy S, Bavinck JNB, et al. Acute generalized exanthematous pustulosis (AGEP)—a clinical reaction pattern. J Cutan Pathol. 2001;28:113–9.

    Article  CAS  PubMed  Google Scholar 

  2. Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): a review and update. J Am Acad Dermatol. 2015;73:843–8.

    Article  PubMed  Google Scholar 

  3. Oh DAQ, Yeo YW, Choo KJL, et al. Acute generalized exanthematous pustulosis: Epidemiology, clinical course, and treatment outcomes of patients treated in an Asian academic medical center. JAAD Int. 2021;3:1–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)—results of a multinational case-control study (EuroSCAR). Br J Dermatol. 2007;157:989–96.

    Article  CAS  PubMed  Google Scholar 

  5. Thienvibul C, Vachiramon V, Chanprapaph K. Five-year retrospective review of acute generalized exanthematous pustulosis. Dermatol Res Pract. 2015;2015: 260928.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bhat YJ, Akhtar S, Ahmad M, et al. Etiopathological and clinical study of acute generalized exanthematous pustulosis: experience from a tertiary care hospital in North India. Indian Dermatol Online J. 2020;11:391.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Loo C, Tan W, Khor Y, et al. A 10-year retrospective study on severe cutaneous adverse reactions (SCARs) in a tertiary hospital in Penang Malaysia. Med J Malaysia. 2018;73:73–7.

    CAS  PubMed  Google Scholar 

  8. Hadavand MA, Kaffenberger B, Cartron AM, et al. Clinical presentation and management of atypical and recalcitrant acute generalized exanthematous pustulosis (AGEP). J Am Acad Dermatol. 2020;87(3):632–9.

    Article  PubMed  Google Scholar 

  9. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.

    Article  CAS  PubMed  Google Scholar 

  10. Goldenberg M, Amigo M, Krishna S, et al. Validation of generalized drug-related rash diagnoses using International Classification of Diseases 9th and 10th revision codes. Br J Dermatol. 2022;186(3):583–5.

    Article  CAS  PubMed  Google Scholar 

  11. Yoshikawa TT, Norman DC. Geriatric infectious diseases: current concepts on diagnosis and management. J Am Geriatr Soc. 2017;65:631–41.

    Article  PubMed  Google Scholar 

  12. Crossley KB, Peterson PK. Infections in the elderly. Clin Infect Dis. 1996;22(2):209–15.

    Article  CAS  PubMed  Google Scholar 

  13. Zarb P, Amadeo B, Muller A, et al. Antimicrobial prescribing in hospitalized adults stratified by age. Drugs Aging. 2012;29:53–62.

    Article  PubMed  Google Scholar 

  14. Pea F. Pharmacokinetics and drug metabolism of antibiotics in the elderly. Expert Opin Drug Metab Toxicol. 2018;14:1087–100.

    Article  CAS  PubMed  Google Scholar 

  15. Cojutti P, Arnoldo L, Cattani G, et al. Polytherapy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: are the very elderly at higher risk of PIPs? Pharmacoepidemiol Drug Saf. 2016;25:1070–8.

    Article  CAS  PubMed  Google Scholar 

  16. Modesto ACF, Silveira EA, Rodrigues APDS, et al. Prevalence of adverse drug events in severely obese adults and associated factors: clinical trial baseline results. Sci Pharm. 2020;88:41.

    Article  CAS  Google Scholar 

  17. Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J Clin Investig. 2011;121:2111–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bremmer S, Van Voorhees AS, Hsu S, et al. Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;63:1058–69.

    Article  PubMed  Google Scholar 

  19. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007;56:901–16.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Kelsey B. Nusbaum & Sonia Himed

  2. College of Medicine, The Ohio State University, Columbus, OH, USA

    Trent D. Walker

  3. Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA

    John Christopher Trinidad, Natalie Spaccarelli, Catherine Chung & Benjamin H. Kaffenberger

  4. Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Catherine Chung

Authors
  1. Kelsey B. Nusbaum
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  2. Trent D. Walker
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  3. Sonia Himed
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  4. John Christopher Trinidad
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  5. Natalie Spaccarelli
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  6. Catherine Chung
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  7. Benjamin H. Kaffenberger
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Corresponding author

Correspondence to Benjamin H. Kaffenberger.

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Funding

BHK was supported by funding from the Dermatology Foundation.

Conflict of interest

Benjamin H. Kaffenberger was supported by the Dermatology Foundation. Kelsey B. Nusbaum, Trent D. Walker, Sonia Himed, John Christopher Trinidad, Natalie Spaccarelli, and Catherine Chung have no conflicts of interest to report.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KBN, TDW, SH and BHK. The first draft of the manuscript was written by KBN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Data availability statement

Data used for this project contain patient health information and thus cannot be made available for public use.

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Nusbaum, K.B., Walker, T.D., Himed, S. et al. Patient Care Outcomes in Hospitalized Patients with Acute Generalized Exanthematous Pustulosis: A Cross-Sectional Database Study. Am J Clin Dermatol 24, 299–304 (2023). https://doi.org/10.1007/s40257-022-00737-5

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  • DOI: https://doi.org/10.1007/s40257-022-00737-5

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