History:

 A 30-year-old male patient recently married presented with acute skin rash limited to the left side of the face. The patient has neither systemic diseases nor regular medications. The patient reported intake of tramadol as a presumed sexual enhancer and to delay ejaculation at the wedding day. Seven days later, he reported fever, burning sensation on the left side of the face with development of a well-defined erythematous patch studded with tiny 1-2 mm , monomorphic, non-follicular pustules . No significant laboratory abnormalities. The patient instructed to avoid the culprit drug with topical clobetasol propionate 0.05%. cream twice/day for 1 week and 5 mg desloratadine once/day. For our best knowledge, tramadol has not been reported as a culprit of Acute Localized Exanthematous Pustulosis (ALEP).

This case is presented by Dr. Ayman Abdelmaksoud, MD, Egypt.