The Journal of the American Dental Association
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J Am Dent Assoc, Vol 139, No 9, 1200-1203.
© 2008 American Dental Association
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CLINICAL PRACTICE

Acute Localized Exanthematous Pustulosis

A Cutaneous Drug Reaction in a Dental Setting



Jennifer L. Vickers, BS, Ryan J. Matherne, MD, Elgene G. Mainous, DDS and Brent C. Kelly, MD

Background. Acute generalized exanthematous pustulosis is a severe cutaneous eruption caused most commonly by antibiotics. Rarely, a localized variant of this pustular reaction called "acute localized exanthematous pustulosis" has been described.

Case Description. A 29-year-old woman sought treatment at the authors’ dermatology clinic for an outbreak of numerous superficial, nonfollicular pustules with an underlying erythematous base that was accompanied by subjective fever. The lesions appeared two days after the patient began taking amoxicillin prescribed for endocarditis prophylaxis before she underwent a dental cleaning. Cultures were negative for bacteria, and the eruption resolved within four days after the patient discontinued the drug therapy.

Clinical Implications. Newly revised guidelines for antibiotic prophylaxis for endocarditis indicate that adverse reactions far outweigh the benefits in most cases. It is important that general dentists and oral surgeons recognize this rare pustular eruption, because antibiotics, particularly amoxicillin, are the primary inciting agents. In addition, health professionals should make clinical choices based on evidence, weigh the risks of any treatment plan against its benefits and practice caution when prescribing any drug.

Key Words: Acute generalized exanthematous pustulosis; acute localized exanthematous pustulosis; amoxicillin; endocarditis prophylaxis

Abbreviations: AAOS: American Academy of Orthopedic Surgeons. • ADA: American Dental Association. • AGEP: Acute generalized exanthematous pustulosis. • AHA: American Heart Association. • ALEP: Acute localized exanthematous pustulosis.






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