Acute localized exanthematous pustulosis (ALEP), introduced in 2005 by Prange et al, is a rare variant of acute generalized exanthematous pustulosis (AGEP). The lesions of ALEP have the characteristics of AGEP but are localized typically to the face, neck or chest. ALEP characteristically presents with acute onset of multiple nonfollicular, pinhead-sized, sterile pustules, developed on an erythematous and edematous background in a localized form. A 70-year-old woman presented with multiple pustules on an erythematous patch on her face and neck. She was diagnosed as NSCLC (stage IV) and started on gefitinib three and a half months before admission. One week prior to admission, a stinging rash had developed on her neck and was accompanied by fever (up to 37.8˚C). Laboratory investigations showed increased white blood cell counts (13,700/mm3) with segmented form accounting for 86.5%. A lesional biopsy specimen showed subcorneal and intraepidermal pustules and spongiosis in association with infiltration of both the epidermis and dermis by neutrophils. She discontinued gefitinib and was admitted and received IV steroids. Within 10 days after withdrawal of gefitinib and treatments, the rash resolved with residual hyperpigmentation. After that, she was rechallenged with gefitinib daily and the skin lesions were aggravated, so she took gefitinib every other day. Herein, we report an interesting case of ALEP induced by gefitinib.