What are the other Names for this Condition? (Also known as/Synonyms)

• ALEP (Acute Localized Exanthematous Pustulosis)
• Localized Pustular Drug Eruption
• Localized Toxic Pustuloderma

What is Acute Localized Exanthematous Pustulosis? (Definition/Background Information)

• Acute Localized Exanthematous Pustulosis (ALEP) is a skin condition that is caused by a reaction of the body to certain medications (such as antibiotics); the drug reaction causes rapid skin eruptions that are generally confined to a region of the body, usually the face
• ALEP may be described as the localized form of acute generalized exanthematous pustulosis (AGEP). AGEP is a rare type of allergic skin condition which presents with a skin eruption. It is believed to be caused by a reaction to certain medications
• Topical corticosteroids and moisturizers and oral antihistamines may be used to relieve the symptoms of Acute Localized Exanthematous Pustulosis. The prognosis of the condition is excellent following discontinuation of the offending medication

Who gets Acute Localized Exanthematous Pustulosis? (Age and Sex Distribution)

• Acute Localized Exanthematous Pustulosis is a highly uncommon condition that may affect individuals of all ages
• The condition affects both males and females. However, it is reported that many cases are reported in young girls and young adult women
• All racial and ethnic groups are at risk and the condition is observed worldwide

What are the Risk Factors for Acute Localized Exanthematous Pustulosis? (Predisposing Factors)

The primary risk factor for developing Acute Localized Exanthematous Pustulosis is the use of certain medications such as the following:

• Antibiotics (beta lactams and macrolides) - most commonly noted medication type
• Antifungal medications
• Antiulcer medications
• Calcium channel blockers
• Medications used in immunotherapy for cancer
• Non-steroidal anti-inflammatory drugs (NSAIDs)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acute Localized Exanthematous Pustulosis? (Etiology)

·Acute Localized Exanthematous Pustulosis develops from the use of certain medications/drugs that are administered for various health conditions. It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body 

·In many cases, the appearance of signs and symptoms due to the drug is observed immediately after starting the medication (such as within a few hours). In some cases, the skin lesions may arise after a longer period of time

What are the Signs and Symptoms of Acute Localized Exanthematous Pustulosis?

The signs and symptoms of Acute Localized Exanthematous Pustulosis may include the following:          

• Red and swollen skin with pus-filled blisters (erythematous pustules) 
• These blisters are collectively observed at a location, usually on the face, neck, chest, or upper back
• The blisters are whitish/yellowish and non-itchy
• The skin may appear tight and stretched
• Mild fever and malaise (feeling of illness) may be noted

The onset of the condition usually occurs within a few hours of exposure to certain medications.

How is Acute Localized Exanthematous Pustulosis Diagnosed?

The following tests and exams may be used in the diagnosis of Acute Localized Exanthematous Pustulosis:

• Complete physical examination and thorough medical history evaluation (including current and past medication use)
• Assessment of the presenting signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• A patch testing may also be performed to confirm an allergy
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms. This may include:

• Acne
• Eczema herpeticum
• Generalized pustular psoriasis
• Impetigo
• Perioral dermatitis
• Rosacea

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the Possible Complications of Acute Localized Exanthematous Pustulosis?

There are no major complications associated with Acute Localized Exanthematous Pustulosis, if the medication triggering the condition is discontinued as early as possible. In some individuals, post-inflammatory hypopigmentation or hyperpigmentation may be observed for several years.

How is Acute Localized Exanthematous Pustulosis Treated?

Acute Localized Exanthematous Pustulosis (ALEP) is treated best by discontinuing the medication triggering the condition. The affected individuals often experience a worsening of symptoms if they continue to use the medication that triggered ALEP.

Additionally, the use of the following medications may be recommended, to help reduce the symptoms of ALEP:

• Moisturizers
• Topical corticosteroids
• Oral antihistamines, if necessary

How can Acute Localized Exanthematous Pustulosis be Prevented?

• Currently, there are no known measures to prevent Acute Localized Exanthematous Pustulosis
• Avoiding medications that caused the condition can help prevent its recurrence

What is the Prognosis of Acute Localized Exanthematous Pustulosis? (Outcomes/Resolutions)

The prognosis for Acute Localized Exanthematous Pustulosis is good, since the condition typically resolves within a few weeks following discontinuation of the triggering/offending medication.

Additional and Relevant Useful Information for Acute Localized Exanthematous Pustulosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/