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Case Reports
. 2025 Aug 8;13(8):e7052.
doi: 10.1097/GOX.0000000000007052. eCollection 2025 Aug.

Acute Localized Exanthematous Pustulosis After Face and Neck Rhytidectomy: A Case of Locus Minoris Resistentiae

Liliana Fort  1 , Lucia Seminario-Vidal  2 , Amber N Pepper  3 , Alicia Billington  4
Affiliations
Case Reports

Acute Localized Exanthematous Pustulosis After Face and Neck Rhytidectomy: A Case of Locus Minoris Resistentiae

Liliana Fort et al. Plast Reconstr Surg Glob Open. .

Abstract

We report a case of a 52-year-old woman who developed acute localized exanthematous pustulosis, a rare drug reaction, after cefazolin administration for a face and neck surgery. The rash was confined to the surgical areas, suggesting a locus minoris resistentiae, a phenomenon where a site of previous injury becomes more vulnerable to a subsequent insult. The rash resolved with corticosteroids. We review the clinical features, causes, and management of acute localized exanthematous pustulosis.

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Conflict of interest statement

Dr. Seminario-Vidal is an employee and shareholder of Eli Lilly and Company. Dr. Billington is a consultant for Becton Dickinson. The other authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Left side of the face preoperatively.
Fig. 2.
Fig. 2.
Three days postoperatively, pinpoint nonfollicular pustules on an erythematous base with scattered ecchymoses localized to the left flap, consistent with ALEP.
Fig. 3.
Fig. 3.
Fifteen days postoperatively (12 d after the start of the prednisone taper) the erythematous base is almost resolved on the left side of the face.
Fig. 4.
Fig. 4.
Two months postoperatively, no signs of ALEP.
See this image and copyright information in PMC

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