Allergic contact dermatitis from a topical corticosteroid mimicking acute generalized exanthematous pustulosis.

Sir, Acute generalized exanthematous pustulosis (AGEP) designates an uncommon, cutaneous reaction characterized by an acute eruption of numerous, small, mostly non-follicular sterile pustules arising on a widespread oedematous erythema; fever above 38 C̊; blood neutrophil count above 7610/l and spontaneous resolution of pustules within 15 days. Typical histopathological findings are subcorneal and/or intra-epidermal pustules, dermal oedema and perivascular infiltrates of neutrophils and eosinophils. Vasculitis and focal necrosis of keratinocytes may be present. AGEP is mostly a systemic drug reaction, often due to antibiotics. Other possible aetiological factors include infections and mercury (1–4). We present here a case of an AGEPlike skin eruption as a manifestation of allergic contact dermatitis to hydrocortisone-17-butyrate. To our knowledge, this has never been reported before.