Dermatosis neglecta: a dermatosis of dirty appearance

of generalized eruptions (one of maculopapular exanthema and two of AGEP). In addition, angioedema, multiform exudative erythema, and Stevens–Johnson syndrome are listed on the product specification sheet. Acute generalized exanthematous pustulosis is a severe induced eruption characterized by the sudden onset of generalized, sterile, non-follicular, millimeter-sized, and monomorphic pustules, which cause itching and burning. Sometimes the condition may present with fever or leukocytosis. In the present patient, the principal differential diagnosis was generalized pustular psoriasis, but the clear relationship between the occurrence of disease and the recent introduction of the drug, the patient’s good response to treatment with no recurrences, and the absence of any personal or family history of psoriasis favored a diagnosis of AGEP, and findings indicated a score of 10 out of 12 according to the diagnostic criteria for AGEP proposed by the EuroSCAR group. The two reported cases of AGEP resolved without recurrence after the discontinuation of varenicline. Patch tests were performed in only one of these cases and were negative, as in the present patient. However, this result does not refute the culpability of varenicline because nearly 50% of epicutaneous tests are negative in AGEP patients. In conclusion, the present patient represents the third case of AGEP related to varenicline. Prescriptions for this drug are increasing because it is one of the few medical ways of quitting smoking. Dermatologists should be aware of its potential mucocutaneous adverse effects and should discontinue the treatment as soon as the first symptoms emerge. Dolores Caro Guti errez, MD Enrique G omez de la Fuente, MD Rosa A. Feltes Ochoa, MD Jos e Luis L opez Estebaranz, MD Department of Dermatology University Hospital Fundaci on Alcorc on Madrid Spain E-mail: mdcaro@fhalcorcon.es, carogutierrezd@gmail.com