Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity

Abstract

SummaryErosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site -as observed in four of our patients -is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti-inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue-like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.

Erosive pustular dermatosis of the scalp – an Australian perspective: Insights to aid clinical practice

“…Erosive pustular dermatosis of the scalp (EPDS) has a mean age of onset of 60–70 years . Although common in the elderly, occurrences have also been reported from infancy to 95 years . Internationally, a female propensity is observed, with an estimated female to male preponderance of 2:1 .…”

“…Predisposing trauma can be iatrogenic or pre‐existing. Reported triggers include laser treatment, radiation therapy, photodynamic therapy, cryotherapy, surgery and hair transplants . Topical therapies such as minoxidil, latanoprost, tretinoin, ingenol mebutate, 5‐fluorouracil and imiquimod have also been associated with EPDS .…”

“…Reported triggers include laser treatment, radiation therapy, photodynamic therapy, cryotherapy, surgery and hair transplants . Topical therapies such as minoxidil, latanoprost, tretinoin, ingenol mebutate, 5‐fluorouracil and imiquimod have also been associated with EPDS . Pre‐existing aplasia cutis congenita, burns, contact dermatitis and herpes zoster have also been reported to precede EPDS .…”

“…Autoimmune diseases occur in 25% of EPDS patients, including rheumatoid arthritis, Takayasu arteritis, autoimmune hepatitis and Hashimoto thyroiditis . Malignancy and metabolic disorders including diabetes, hypertension and cardiovascular disease have also occurred in increased rates in EPDS patients …”

Erosive pustular dermatosis of the scalp: Therapy is the diagnosis

“…EPD is an inflammatory dermatosis first described by Burton (Burton, 1977) in 1977. Clinically, it is characterized by yellow-brown crusts, erosion, pustules and lakes of pus on the scalp that ends in scarring alopecia subsequent to hair follicle destruction secondary to chronic inflammation (Wilk, Zelger, Hauser, Höpfl, & Zelger, 2018). The scalp is an area involved by various disorders such as pemphigus vulgaris, severe fungal or bacterial infections, pyoderma gangrenosum or more frequently BCC, AKs or SCC.…”