Acute localized exanthematous pustulosis: Clinical features, pathophysiology, and therapy

Abstract

Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non‐follicular, pinhead‐sized pustules. ALEP is considered a localized form of acute generalized exanthematous pustulosis but its pathogeny is not well identified. We performed a systematic review of the literature of all publications regarding ALEP cases using the term “acute localized exanthematous pustulosis,” to provide an update on this disease and its management. Results and conclusion ALEP is an uncommon skin condition attributed primarily to a hypersensitivity reaction to a systemic drug (classical or herbal); though a contact mechanism has been reported. It may be misdiagnosed as infectious or inflammatory disease but the clinico‐pathological correlation in addition to the rapid response to withdrawal of the culprit agent supports this diagnosis. The pathogenesis of ALEP is still unclear, and there are no standardized treatment guidelines to manage this disease. Both AGEP and ALEP have a good prognosis if an early diagnosis is made.

Acute localized exanthematous pustulosis because of cefixime in a child: case report and review of pediatric cases

“…3 Penicillins (most common), levofloxacin, trimethoprim-sulfamethoxazole, clindamycin, nimesulide, allopurinol, paracetamol, ibuprofen, docetaxel, finasteride, infliximab, bemiparin, and heparin are among the drugs that have been reported as triggers. 3 Two pediatric cases triggered by drug, in which the responsible agents were lamotrigine and amoxicillin-clavulanic acid, have been reported in the literature. 5,6 Only one adult case who developed ALEP after taking cephalosporin has been described in the literature, 8 but in that case, the agent was administered in the form of a combination preparation with sodium sulbactam.…”

“…3 The time of onset of the clinical picture, the morphology, distribution, and course of the lesions, and the absence of growth in the culture prepared from the pustule are helpful in making the diagnosis. 3 ALEP has an excellent prognosis and regresses spontaneously within a few days. 3 The basis of treatment is the elimination of the causative agent.…”

“…3 ALEP has an excellent prognosis and regresses spontaneously within a few days. 3 The basis of treatment is the elimination of the causative agent. While topical corticosteroids can be used to relieve itching and inflammation, systemic steroids can be added to treatment over a longer period of time.…”

“…Although the pathophysiology is not clearly known, it is thought to be a reaction initiated by a drug‐specific process mediated by T cells, similar to AGEP. Drugs are the trigger in more than 80% of cases 3 . Penicillins (most common), levofloxacin, trimethoprim‐sulfamethoxazole, clindamycin, nimesulide, allopurinol, paracetamol, ibuprofen, docetaxel, finasteride, infliximab, bemiparin, and heparin are among the drugs that have been reported as triggers 3 .…”

“…The mean age at onset of clinical presentation, in which females predominate, is 38 (9-78 years), and the number of pediatric cases reported in the literature is quite limited. [3][4][5][6] Although drugs are the trigger in most cases, herbal products applied topically or systemically can also cause a reaction. 4 In this study, we report an 11-year-old female patient with localized involvement of the neck and axilla diagnosed with ALEP according to the Euro-SCAR criteria 7 and the definitions of Prange et al 2 and review the literature on pediatric cases.…”