Localized acute exanthematous pustulosis

What is it acute located exanthematous pustulosis?

Localized acute exanthematous pustulosis (ALEP) is the localized form of acute generalized exanthematous pustulosis (AGEP). It can also be called localized pustular drug eruption or located toxic ALEP pustuloderma is a rare form of drug reaction. It can occur a few days after starting a medication and usually resolves within a week after stopping the medication that triggered it.

Who gets localized acute exanthematous pustulosis?

ALEP is very rare and has only been reported in a small number of patients. It has been suggested that younger patients may be at increased risk of developing ALEP, but there is currently not enough information available to confirm this.

What causes localized acute exanthematous pustulosis?

ALEP can be caused by various medications. Amoxicillin-containing antibiotics appear to be more commonly associated with ALEP. Other antibiotics, anti-steroids have also been reportedinflammatory drugs, antifungal agents, calcium antagonists, anti-ulcer drugs and pembrolizumab.

What are the clinical features of localized exanthematous pustulosis?

ALEP has a sudden onset, presenting as localized clustered white or yellow pustules on the surface of a patch swollen red (edematous) skin, usually on the face. The pustules are usually superficial and flaccid and they have a similar appearance to a localized area of AGEP.

ALEP patients generally describe the eruption like feeling tight or uncomfortable, but the rash is not usually particularly itchy. Some ALEP patients report feeling tired or ill; Mild fevers have been reported in a small number of patients.

What are the complications of localized acute exanthematous pustulosis?

ALEP can lead to post-inflammatory pigmentation in the affected area It is not known if ALEP can lead to serious Adverse reactions to drugs.

How is localized acute exanthematous pustulosis diagnosed?

A dermatologist You can make the diagnosis of ALEP by recognizing the appearance of the rash and the time frame of its development in relation to a medication, such as an antibiotic. Typically, the patient has previously taken the same medication without an adverse response.

Resolution of the rash within days of stopping the triggering medication can help confirm the diagnosis.

• Microbiology culture of pus does not normally reveal bacteria.

• Surgical skin biopsy it can sometimes be used to help confirm the diagnosis, but is not necessarily required.
• Histological features are not ALEP specific but include intraepidermal and subcorneal pustules with dermal papillary edema which contains a neutrophilic and eosinophilic infiltrate.
• The results of the triggering medication patch test are positive in approximately half of patients with ALEP.

Which is the differential diagnosis for localized acute exanthematous pustulosis?

Possible differential diagnoses may include:

• Infections, including impetigo (bacterial skin infection because Staphylococcus aureus) or eczema herpeticum (herpes simplex virus)

• Early stages of acute generalized exanthematous pustulosis

• Generalized pustular psoriasis.

• Acne
• Newspaper dermatitis
• Rosacea

What is the treatment for localized acute exanthematous pustulosis?

Elimination of the trigger medication usually leads to a rapid improvement in the rash. Moisturizers (emollients) can help calm the skin, but no specific treatment is required.

Skin can heal with residue pigment changes (post-inflammatory hyperpigmentation or post-inflammatory hypopigmentation) which generally improves after months or years.

Once the diagnosis of ALEP is confirmed, the patient should be advised to avoid further use of the trigger medication.