Pustular eruptions

Folliculitis caused by colonization with S. aureus or S. epidermidis on the face can be sometimes misdiagnosed as acne. The prominent lesions are superficial follicular pustules that are often distributed on the lateral cheeks, the chin and the temporal sites of the forehead. The rare folliculitis due to Candida may also present as multiple pustular eruptions. 

Conde-Salazar L, Guimaraens D, Romero LV, et al. 1983. Subcorneal pustular eruption and erythema from occupational exposure to trichloroethylene. Contact Dermatitis 9 235-237. 

Symptoms Onset of symptoms may be either abrupt or gradual. Inhalational exposure produces fever commonly in excess of 102 degrees F, rigors, sweats, myalgias, headache, pleuritic chest pain, cervical adenopathy, hepatosplenomegaly, and generalized papular/ pustular eruptions. Acute pulmonary disease can progress and result in bacteremia and acute septicemic disease. 

GambiUara E et al (2005) Severe pustular eruption associated with imatinib and voriconazole in a patient with chronic myeloid leukemia. Dermatology 211 363-365... 

Rosacea has characteristic clinical findings. These include an acneiform papular-pustular eruption associated with erythema and hypertrophic sebaceous glands. Typically, these changes appear on the cheeks, nose, and forehead, known as the fecial flush areas. The frontal area of the chest may also be involved. Infestation and possible inflammation caused by the hair follicle mites Demodex folUculorum and Demodex brevis have been linked to rosacea. Rosacea has no known relationship to previous juvenile acne. 

Prieto A, de Barrio M, Lopez-Saez P, Baeza ML, de Benito V, Olalde S. Recurrent localized pustular eruption induced by amoxicillin. Allergy 1997 52(7) 777-8. 

Fayol J, Bernard P, Bonnetblanc JM. Pustular eruption following administration of cefazolin a second case report. J Am Acad Dermatol 1988 19(3) 571. 

Kalb RE, Grossman ME. Pustular eruption following administration of cephradine. Cutis 1986 38(l) 58-60. 

Spencer JM, Silvers DN, Grossman ME. Pustular eruption after drug exposure is it pustular psoriasis or a pustular drug eruption Br J Dermatol 1994 130(4) 514-19. 

Generalized pustular eruptions, histologically presenting as leukocytoclastic vasculitis with neutrophils forming subcorneal pustules, have been reported with different cephalosporins, such as cefaclor (130), cefazolin (131,132), cefalexin (133), and cefradine (134). 

Stough D, Guin JD, Baker GF, Haynie L. Pustular eruptions following administration of cefazolin a possible interaction with methyldopa. J Am Acad Dermatol 1987 16(5 Pt l) 1051-2. 

Mancuso G, Berdondini RM, Passarini B. Eosinophilic pustular eruption associated with transdermal fentanyl. J Eur Acad Dermatol Venereol 2001 15(l) 70-2. 

Reversible skin eruptions have been described in occasional patients taking oral iron. One case presented with a generalized exanthematous pustular eruption following the use of ferrous fumarate (31), another with erythema... 

An acute exanthematous pustular eruption has been reported in a 56-year-old man who had taken mexiletine 300 mg/day for 1 month (39). There was mUd hver dysfunction. Patch tests with mexiletine 10 and 20% were subsequently positive, but a lymphocyte stimulation test was negative. 

A generalized pustular eruption was reported in a patient with acne treated with minocycline (28). Skin prick tests with minocycline were positive at 48 hours. 

Generalized rashes, fixed drug eruptions, toxic epidermolysis, and erythema exudativum multiforme have all been reported in association with terbinafine (45,46). Pustular eruptions can occur occasionally (45-49). 

A 62-year-old diabetic man on stable oral medication with glibenclamide, metformin, Zestoretic (lisino-pril + hydrochlorothiazide), gemfibrozil, and aspirin developed febrile generalized pustular eruptions after 44 days of therapy with oral terbinafine 250 mg/day (50). Withdrawal of terbinafine and symptomatic treatment with hydrotherapy and topical and systemic steroids resulted in complete resolution of fever and pustulosis within 4 days. The erythematous component responded more slowly, and mildly pruritic erythematous plaques persisted for more than 40 days. 

Bennett ML, Jorizzo JL, White WL. Generalized pustular eruptions associated with oral terbinafine. Int J Dermatol 1999 38(8) 596-600. 

Prolonged, recurring zinc oxide exposures to the skin may cause papular-pustular eruptions. This skin condition may be referred to as oxide pox. Studies of zinc refinery workers found no correlation between exposures and lung or other types of cancer. Chronic inhalation of zinc compounds has been implicated in cases of fatal liver damage. 

Follicular pustular eruption (1981) Kushimoto H +, Arch Dermatol I 17, 444 Jarisch-Herxheimer reaction... 

Alder bark (Alnus serrulata, A. rubra). The eclectic indications for alder bark are skin conditions with pustular eruptions, weakened vitality, and constipation. 

B. Clinical Features. Incubation period ranges from 10-14 days after inhalation. Inhalation exposure produces fever, rigors, sweating, myalgia, headache, pleuritic chest pain, cervical adenopathy, splenomegaly, and generalized papular/pustular eruptions. This disease is almost always fatal without treatment. 

A patient with chronic myeloid leukaemia developed a pustular eruption while taking imatinib 400 mg daily, increased to 800 mg daily 12 weeks after starting to take voriconazole for pulmonary aspergillosis. His imatinib plasma levels were approximately twice the predieted levels while taking both drugs. His eondition improved within 3 weeks of stopping both voriconazole and imatinib, and did not recur with voriconazole treatment alone. ... 

Pustular eruptions developed in two women taking methyldopa and cefradine or cefazolin. The use of methyldopa may have been coincidental. 

Kuwabara Y, Sato A, Abe H, Abe S, Kawai N, Takeshita T. Ritodrine-induced pustular eruptions distinctly resembling impetigo herpetiformis. J Nippon Med Sch 2011 78(5) 329-33. 

Pustular and acneiform ICD are results of exposure to certain irritants, such as croton oil, mineral oils, tars, greases and naphthalenes. This syndrome must always be considered in conditions in which acneiform lesions develop outside the typical acne age. Those most affected are atopies and patients with seborrhoea, macroporous skin conditions or prior acne vulgaris. The pustules are sterile and transient however, subcorneal pustular eruption may also be a manifestation of allergy to trichlorethylene, which has to be considered as a differential diagnosis in patients with appropriate history (Goh 1995). 

Conde-Salazar reported a subcorneal pustular eruption in a patient with trichloroethylene exposure (Conde-Salazar et al. 1983). The patient reacted system-ically upon cutaneous challenge test made by exposing only the right leg to an environment saturated with trichloroethylene (to avoid inhalation) with reappearance of erythema on the exposed area within a few hours and fleeting exanthema on the trunk and in the flexures. 

Salmonella dermatitis, caused by S. dubUuy produces an erythematous rash followed by a papular, pustular eruption. These pustules are contagious and infected humans can spread the disease. 

A. /.oca/—Trivalent arsenic compounds are corrosive to the skin. Brief contact has no effect but prolonged contact results in a local hyperemia and later vesicular or pustular eruption. The moist mucous membranes are most sensitive to the irritant action. Conjunctiva, moist and macerated areas of skin, the eyelids, the angles of the ears, nose, mouth, and respiratory mucosa are also vulnerable to the irritant effects. The wrists are common sites of dermatitis, as are the genitalia if personal hygiene is poor. Perforations of the nasal septum may occur. Arsenic trioxide and pentoxide are capable of producing skin sensitization and contact dermatitis. Arsenic is also capable of producing keratoses, especially of the palms and soles. 

---