Erosive pustular dermatosis

Published on 16/03/2015 by admin

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Last modified 16/03/2015

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Erosive pustular dermatosis

Bhavnit K. Bhatia and Jenny E. Murase

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by pustular, erosive, and crusted lesions in areas of alopecia that tend to be atrophic, actinically damaged, or both. The condition primarily affects the elderly, and has been documented to follow trauma to the scalp. EPDS lesions tend to be chronic, progressive, and difficult to treat. Laboratory and histopathological findings are not diagnostic.

Management strategy

Traditionally, potent topical corticosteroids have been used in EPDS with a generally positive but variable response within a few months of use. Due to steroid-related cutaneous atrophy, tacrolimus 0.1% ointment, calcipotriol cream, oral zinc, and photodynamic therapy have been introduced as alternative therapies. A recent series has shown dapsone 5% gel to be effective in resolving EPDS. Oral dapsone was shown in one case report to result in initial improvement, but the patient had problems with recurrence. Retinoids and oral corticosteroids have also shown some promise when used in conjunction with other topical antibiotics, topical corticosteroids, topical tacrolimus, oral dapsone, and oral zinc therapy. Topical and systemic antibiotics and antifungals are essentially ineffective.

First-line therapy

High-potency topical corticosteroids

D

Three series and 13 case reports exist for high potency topical cortisones in the literature.

Chronic atrophic erosive dermatosis of the scalp and extremities: a recharacterization of erosive pustular dermatosis.

Patton D, Lynch PJ, Fung MA, Fazel N. J Am Acad Dermatol 2007; 57: 421–7.

Topical steroids, predominantly in the form of clobetasol, successfully treated 10 of 11 patients, with the last patient responding to topical tacrolimus. Nine of the 11 had scalp EPDS, and all but one patient were elderly.

Erosive pustular dermatosis of the scalp.

Pye RJ, Peachey RD, Burton JL. Br J Dermatol 1979; 100: 559–66.

Six case reports are presented in the first description of EPDS in the literature. Five of the six cases were resolved after use of potent topical steroids, specifically 0.025% triamcinolone with 0.75% halquinol, 0.1% betamethasone valerate with neomycin, and 0.05% clobetasol propionate, often used with neomycin or nystatin.

Second-line therapies

Topical 5% dapsone gel	E
Topical 0.1% tacrolimus ointment	E

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