Localized acute exanthematous pustulosis, a rare reaction on eyelids
Luca Manuel Bueno Borghi, Cristina Calvo Simón, Carla Sánchez Remacha, Javier Ramos Duarte, Ana María Abad Pascual, Pablo Tejada González, Edurne de la Cámara Sahuquillo, Inma Herrero Sánchez, Miguel Castillo Fernández, Marta Suñer Martínez, Julia Aramburu Clavería, Pablo Cisneros Arias, Marta Orejudo de Rivas, Eva Josefina Nuñez Moscarda, Javier Ascaso PuyueloAims/Purpose: The aim of this study is to present a case of localized acute exanthematous pustulosis (ALEP) on the eyelids, a rare adverse cutaneous reaction primarily induced by drugs, with a focus on its clinical features, diagnosis, and management.
Methods: We describe the case of a 21‐year‐old female patient who presented with multiple painful vesicles and pustules on the eyelids, predominantly on the right upper eyelid, with no other body involvement. Initially, she did not report any contact with new cosmetics or other treatments. The initial treatment involved doxycycline and Terramycin. During a second visit, when symptoms worsened, the patient reported that she had used a new cosmetic product. The treatment was modified to topical hydrocortisone, mupirocin, and cefadroxil, and withdrawal of the previous treatment. The patient's progress was monitored.
Results: At the follow‐up visit conducted three weeks later, both the cutaneous lesions and palpebral edema had completely resolved. Mild palpebral hyperpigmentation persisted; however, the symptoms of pruritus and pain had entirely disappeared.
Conclusions: ALEP is a rare, drug‐induced condition that can be effectively managed with proper diagnosis and treatment. This case highlights the importance of having a high suspicion of adverse effects of local treatments and makeup, even when they are not recounted by the patient. Early recognition and intervention are crucial to prevent complications and ensure favorable outcomes.
References
1. Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, et al. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol [Internet]. 2023 Jul 1 [cited 2024 May 29];24(4):1. Available from: /pmc/articles/PMC10166469/
2. Momin S, Rosso J Del, Michaels B, Cutis NM‐, 2009 U. Acute generalized exanthematous pustulosis: an enigmatic drug‐induced reaction. cutis [Internet]. 2009 [cited 2024 Jun 1]; Available from: