A case of erosive pustular dermatosis of the scalp in a pediatric patient

LaCour, Matthew; Allen, Timothy Craig; Wilkerson, Michael G.; Nguyen, Adam

doi:10.1016/j.jdcr.2018.11.001

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…It usually occurs in older individuals; however, there are cases of children and younger individuals being affected. 6,7 In the presented cases, all patients were mature (65-92 years old) and predominantly males, which is consistent with previous reports. 8,9 EPDS most commonly affects Caucasian patients.…”

Section: Discussionsupporting

confidence: 92%

“…EPDS is a chronic inflammatory condition of the scalp that often causes a scarring alopecia. It usually occurs in older individuals; however, there are cases of children and younger individuals being affected 6,7 . In the presented cases, all patients were mature (65–92 years old) and predominantly males, which is consistent with previous reports 8,9 .…”

Section: Discussionsupporting

confidence: 91%

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Nonmelanoma skin cancer in the setting of erosive pustular dermatosis of the scalp: A case series and comment on management implications

Negbenebor

Shayegan

Cohen³

et al. 2022

Dermatologic Therapy

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Background Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory cutaneous disorder typically affecting sun‐damaged skin of mature individuals. Clinical features of EPDS include sterile pustules and chronic crusted erosions that can be hyperkeratotic and lead to scarring alopecia, atrophy, and telangiectasia. While the condition occurs on sun‐damaged skin, a relationship with non‐melanoma skin cancer (NMSC) has not been investigated. Objectives Here we attempted to identify cases of NMSC developing in the setting of EPDS. Methods Retrospective review of EPDS cases in a dermatology practice. Results Six patients with mean (range) age 82 (65–92) years that developed NMSC in the setting of EPDS are reported. Five patients had skin phototype I or II associated with substantial solar elastosis. Four patients had history of NMSC. Four patients developed squamous cell carcinoma and two patients basal cell carcinoma on the scalp in the setting of EPDS. A morphologic change in an EPDS lesion, such as a crusted plaque becoming nodular and/or growing significantly within a relatively short period of time, prompted a biopsy that revealed NMSC. Conclusions NMSC may develop in the setting of EPDS. Possible mechanisms underlying this association include the chronic inflammation associated with EPDS and ultraviolet light exposure. It is crucial to promptly obtain a biopsy in EPDS cases showing signs suspicious for NMSC. Further studies are required to confirm whether NMSC shows a higher prevalence in the setting of EPDS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Nonmelanoma skin cancer in the setting of erosive pustular dermatosis of the scalp: A case series and comment on management implications

Negbenebor

Shayegan

Cohen³

et al. 2022

Dermatologic Therapy

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“…EPDS typically affects bald areas of the scalp of elderly individuals but, rarely, young individuals and even children may be affected [2][3][4]. In fact, despite the mean age being higher than that in other studies [9,10], in our study, four patients (42,46,47,50) were under the age of thirty at diagnosis, and, notably, one of them had familiarity (46), suggesting a genetic predisposition.…”

Section: Discussioncontrasting

confidence: 59%

“…The disorder typically occurs on the scalp of elderly males and predisposing factors include androgenetic alopecia or sun-damaged skin and/or a history of scalp trauma. However, some cases of EPDS have been reported in younger individuals [2] or even children [3,4]. This dermatosis may also affect other skin sites, including the face [5,6] and extremities [7].…”

Section: Introductionmentioning

confidence: 99%

Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study of Fifty Cases

et al. 2021

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Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder.

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“…A history of trauma to the scalp before the onset of the disease is common as well as severe androgenetic alopecia and scalp chronic actinic damage, but a few cases of EPDS in children have been reported 3. Usually, these rare cases have been linked to prolonged labor and caput succedaneum or surgical procedures 4…”

Section: Textmentioning

confidence: 99%

<p>Erosive pustular dermatosis of the scalp: challenges and solutions</p>

Starace

Alessandrini

Baraldi

et al. 2019

CCID

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Erosive pustular dermatosis of the scalp is a rare chronic inflammatory disorder defined. It usually affects elderly people and is characterized by extensive pustular lesions, erosions, and crusts located on the scalp. The pathogenesis of this disease is not completely understood, but a known predisposing factor is skin trauma. Autoimmune disorders including rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis, and Takayasu aortitis are associated diseases reported. The clinical examination reveals erythema, erosions, crusts, follicular pustules, and in advanced stages, scarring alopecia. A scalp biopsy is recommended but not specific, founding epidermal atrophy, focal erosions, and a mixed inflammatory infiltrate consisting of neutrophils, lymphocytes, and plasma cells. Bacterial cultures, fungal and viral stains are not necessary and are usually negative. . Topical high-potency corticosteroids, retinoids, calcipotriol, dapsone, and topical tacrolimus are reported treatments, while photodynamic therapy has been effective in some patients, but has induced the disease in others. All the findings are suggestive but not specific, so it is an excluding diagnosis. The combination of predisposing factors is very important for a correct diagnosis, such as elderly age, sun-damaged skin, presence of androgenetic alopecia, together with clinical manifestations, non-specific histology and laboratory investigations negative for other disease. In our opinion, this scalp disease is a challenge for the dermatologist. We review all the literature to better define the possible solutions in case of suspected erosive pustular dermatosis of the scalp.

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A case of erosive pustular dermatosis of the scalp in a pediatric patient

Cited by 7 publications

References 9 publications

Nonmelanoma skin cancer in the setting of erosive pustular dermatosis of the scalp: A case series and comment on management implications

Nonmelanoma skin cancer in the setting of erosive pustular dermatosis of the scalp: A case series and comment on management implications

Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study of Fifty Cases

<p>Erosive pustular dermatosis of the scalp: challenges and solutions</p>

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