Herbal does not mean harmless: A case of turmeric-associated AGEP

Turmeric is generally regarded as safe, although rare cutaneous hypersensitivity reactions have been reported. Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction most often triggered by medications. Only three prior reports describe hypersensitivity reactions associated with ingested turmeric. We report an 86-year-old woman who developed a pruritic pustular eruption three days after initiating an over-the-counter turmeric supplement at a dose of 4,500 mg daily. Examination showed resolving monomorphic, nonfollicular pustules on an erythematous base involving the thighs and abdomen. Histopathology revealed subcorneal pustular dermatitis with neutrophilic infiltrate, consistent with AGEP. The eruption improved after discontinuation of turmeric and treatment with corticosteroids and antihistamines. This case highlights turmeric as a trigger of AGEP and the importance of obtaining a supplement history when evaluating pustular eruptions.