key: cord-0701626-93cdvplt
authors: Suarez‐Valle, A.; Fernandez‐Nieto, D.; Melian‐Olivera, A.; Dominguez‐Santas, M.; Diaz‐Guimaraens, B.; Del Real, C.M Garcia; Jimenez‐Cauhe, J.
title: Comment on “Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine”: report of a COVID‐19 patient with particular findings
date: 2020-06-16
journal: Dermatol Ther
DOI: 10.1111/dth.13852
sha: 580c39d9a39796a043c1434f573b084c70b8148b
doc_id: 701626
cord_uid: 93cdvplt

nan

We read with great interest the article by Schwartz et al. 1 Widespread use of this medication is expected to be associated with an increased incidence of adverse effects. Histologically, a peculiar finding was the identification of neutrophilic eccrine ductitis, some of them coinciding on the subcorneal pustules. This could be explained by a concomitant miliaria pustulosa, a rare variant of miliaria rubra with neutrophilic infiltration 6 , favored by prolonged bedding. Other explanation is to be caused by the hydroxychloroquine. This seems improbable as neutrophilic eccrine hidradenitis present inflammation at the level of the glands 6 and it has not been described with this drug. Finally, considering the detection of SARS-CoV-2 in epithelial cells of eccrine glands by immunohistochemical techniques 7 , one possible hypothesis is that the neutrophilic inflammation of the AGEP spread through the eccrine ducts where the virus could be replicating. Since it is not possible to make conclusions with a single patient, more studies are needed.

The use of this medication has exponentially increased due to the pandemic. Although this is a rare adverse event with around twenty reported cases in the literature 1 , dermatologists must be aware of its existence given the current emergency health situation. The notification of new cases will allow a better characterization of the clinical presentation and management of these patients. 

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Acute generalized exanthematous pustulosis induced by hydroxychloroquine: a case with atypical clinical presentation