Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, and severe cutaneous adverse reaction, primarily associated with drug exposure. AGEP is characterized by the rapid onset of edema and erythema, followed by the appearance of numerous non-follicular, sterile pustules, which subsequently evolve into desquamation. The reaction typically develops within 1 to 11 days after drug exposure and resolves spontaneously within approximately 15 days. Acute localized exanthematous pustulosis (ALEP) is a localized variant of AGEP, in which pustular lesions are confined to one or more specific areas of the skin.

In this article, we present three pediatric cases with rare manifestations of AGEP and ALEP, diagnosed based on the EuroSCAR criteria. The cases include a male neonate with localized pustular involvement of the scalp and forehead triggered by phenobarbital, a 7-year-old male diagnosed with AGEP following anti-thymocyte globulin (ATG) administration with back and arm involvement, and a 15-yearold female with a diagnosis of ALEP after postoperative use of amoxicillin-clavulanic acid. These cases highlight the diverse clinical spectrum of AGEP and ALEP in pediatric patients and underscore the importance of early diagnosis and appropriate management.

In conclusion, while AGEP and ALEP are rare in pediatric patients, they should be considered in children of all ages presenting with characteristic pustular eruptions following suspected drug exposure. Early recognition and differentiation from other pustular dermatoses are essential for timely and appropriate management.