Review article
Generalized Pustular Figurate Erythema in Patients with COVID-19 Treated with Hydroxychloroquine: A Systematic Review
Fatimah Al Muqarrab
; King Saud University, King Khalid University Hospital, Dermatology Department, Riyadh, Saudi Arabia
Robert A. Schwartz
; New Jersey Medical School, Rutgers University, Englewood, United States
Amer A. Almohssen
; Alfardan Medical and Northwestern Medicine, Doha, Qatar
Abstract
A severe distinctive cutaneous drug reaction, generalized pustular figu-
rate erythema, closely linked with hydroxychloroquine (HCQ), has been documented.
It is distinguishable from AGEP by its longer incubation, more varied morphology
(initially urticarial and later targetoid, arcuate plaques), recalcitrance to therapy and
longer disease course.
Aim of the article is to review the recognized entity associated with ingestion of hy-
droxychloroquine in patients infected with COVID-19.
A systematic review using electronic search was performed. Inclusion criteria: n pa-
tients with COVID-19 demonstrated by PCR, with typical clinical features of AGEP/
GPFE or atypical features associated with typical histopathology. We used the (JBI)
Critical Appraisal Checklist for Case Reports for the qualitive assessment.
We included 13 publications. Their overall quality was good to moderate. Only 27.3%
of the patients had a severe COVID-19 course. The mean lag time between trigger
exposure and rash development was 24 days. Only 15.38% of the reported AGEP were
clinically typical, while the remaining 69.23 % were suggestive of GPFE. Unfortunate-
ly, 2 patients died secondary to massive pulmonary embolism.
In COVID-19 infection, we suggest reconsidering treating established COVID-19 em-
pirically with HCQ, as both triggers can augment the subsequent cytokine storm, in-
ducing a severe drug reaction and possibly increasing the risk of thrombo-embolic
events.
Keywords
drug eruption; generalized pustular figurate erythema; Schwartz-Janniger syndrome; acute generalized exanthematous pustulosis; hydroxychloroquine; Steven-Johnson syndrome; toxic epidermal necrolysis; COVID-19; hydroxychloro- quine
Hrčak ID:
299671
URI
Publication date:
14.12.2022.
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