Cutaneous reactions pustulosis

Another subdivision of type IV hypersensitivity reactions has categories distinguished by the effector cells and mediators involved together with the resulting associated cutaneous reactions. Four subdivisions are defined type IVa, mediated by monocytes with IFN-y as dominant cytokine type IVb, mediated by eosinophils with IL-5 and IL-4 involvement type IVc, mediated by T cells with perforin and granzyme B as important effector molecules and type IVd, mediated by neutrophils with IL-8 involvement. Representative skin reactions for the so-called types IVa, b, c, and d are, respectively, maculopapular rash, maculopapular rash with eosinophilia, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP). 

Delayed-type cutaneous reactions to clindamycin include pruritus, exanthematous rash, generalized maculopapular exanthema, erythroderma, generalized exanthematous pustulosis, and Stevens-Johnson syndrome. 

SED-13, 513) (SEDA-18, 215) (SEDA-22, 216). Three cases of skin reactions (hypersensitivity syndrome reaction, pruritic exanthematous eruption, and acute generalized exanthematous pustulosis) possibly induced by diltiazem have been described and the literature on skin reactions associated with calcium antagonists has been reviewed. The number of diltiazem-induced cutaneous events was significantly greater than those induced by either nifedipine or verapamil. However, there was no difference in the proportion of serious cutaneous adverse events due to any of these three drugs (11). 

Sidoroff A, Htilevy S, Bavinck JNB, et al. Acute generalized exanthematous pustulosis (AGEP) - a clinical reaction pattern. J Cutan Pathol. 2001 28 113-9. 

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction, mostly drug related or associated with viral infections. It can also manifest as a reaction to dapsone therapy in the setting of HTV infection when used as prophylaxis for pneumocystis jirovecii pneumonia [75 ]. 

Paradoxical inflammation such as psoriasis is a well-known phenomenon of anti-TNFa therapy approved for the treatment of autoimmxme diseases such as rheumatoid arthritis, Crohn s disease, ulcerative colitis and psoriasis. Likewise, infliximab is used to treat refractory sarcoidosis but recently a case of infliximab-induced cutaneous sarcoidosis was reported in a patient with ulcerative colitis [150 ]. The induction of psoriasis and other clinical presentations like psoriasiform exanthema and palmoplantar pustulosis as side effects of infliximab treatment is not xmderstood and the pathogenesis of such reactions has been further obscured by the finding of a patient with Crohn s disease who developed arthritis as well as the skin manifestations cf psoriasis after the administration of infliximab [151 ]. 

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