Acute Localized Exanthematous Pustulosis Caused by Topical Application of Minoxidil

This case report documents the first instance of Acute Localized Exanthematous Pustulosis (ALEP) caused by topical minoxidil in a 31-year-old female with androgenetic alopecia. The patient developed pruritic pustules on her scalp, forehead, and neck 48 hours after using a compounded foam with minoxidil and 17-a-estradiol. Positive patch tests for minoxidil and symptom resolution after discontinuation confirmed the diagnosis. This case underscores a contact-induced hypersensitivity reaction to minoxidil, suggesting the involvement of minoxidil-specific T-cells and expanding the understanding of ALEP's pathophysiology.