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

Dermatol Ther. 2021 Sep;34(5):e15087. doi: 10.1111/dth.15087. Epub 2021 Aug 25.


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.

Keywords: acute generalized exanthematous pustulosis; acute localized exanthematous pustulosis; cutaneous drug reaction; pustule.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acute Generalized Exanthematous Pustulosis* / diagnosis
  • Acute Generalized Exanthematous Pustulosis* / etiology
  • Acute Generalized Exanthematous Pustulosis* / therapy
  • Humans