T cell–mediated acute localized exanthematous pustulosis caused by finasteride Sandra Tresch, MD, Antonio Cozzio, MD, PhD, Jivko Kamarashev, MD, Thomas.

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Presentation transcript:

T cell–mediated acute localized exanthematous pustulosis caused by finasteride Sandra Tresch, MD, Antonio Cozzio, MD, PhD, Jivko Kamarashev, MD, Thomas Harr, MD, Peter Schmid-Grendelmeier, MD, Lars E. French, MD, Laurence Feldmeyer, MD, PhD Journal of Allergy and Clinical Immunology Volume 129, Issue 2, Pages 589-594 (February 2012) DOI: 10.1016/j.jaci.2011.07.033 Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Patient at presentation with multiple erythematous nonfollicular papules partially confluent to plaques on his breast and lower abdomen (A), as well as pustules under the right breast (B). Detailed view of a papular lesion on the back (C). Journal of Allergy and Clinical Immunology 2012 129, 589-594DOI: (10.1016/j.jaci.2011.07.033) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Histology (hematoxylin and eosin) showing a slight psoriasiform acanthosis in association with spongiosis and infiltration of both the epidermis and dermis by neutrophils and eosinophils, resulting in formation of subcorneal (a), intraepidermal (b), and subepidermal (c) pustules. Journal of Allergy and Clinical Immunology 2012 129, 589-594DOI: (10.1016/j.jaci.2011.07.033) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Presentation 6 weeks later. Within 4 weeks after withdrawal of finasteride, the rash resolved slowly, without any specific therapy. At day 20, slight residual hyperpigmentation and scaling were present. At 6 weeks, complete resolution could be seen. Journal of Allergy and Clinical Immunology 2012 129, 589-594DOI: (10.1016/j.jaci.2011.07.033) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Clinical pictures of a patient presenting with AGEP of unclear origin (the patient took ciprofloxacin, amiloride, and hydrochlorothiazide). General view of the back (A) and detailed view showing pustules (B). Journal of Allergy and Clinical Immunology 2012 129, 589-594DOI: (10.1016/j.jaci.2011.07.033) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Clinical pictures of a patient presenting with toxic epidermal necrolysis while taking metamizole. Right upper arm at day 1 (A); left upper arm at day 7 (B). Journal of Allergy and Clinical Immunology 2012 129, 589-594DOI: (10.1016/j.jaci.2011.07.033) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions