Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus

Abstract

Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of the elderly characterized by multiple pustular lesions with erosions and crusting that result in scarring alopecia. EPDS typically develops in aged or sun-damaged skin with a history of trauma. Histopathologically, EPDS is nonspecific, showing atrophic epidermis and chronic inflammation. Bacteriological and mycological investigations of EPDS are generally negative. Although herpes zoster is a common disorder in elderly people, previously reported cases of EPDS were rarely associated with herpes zoster. We present a rare case of EPDS following herpes zoster treated successfully with topical tacrolimus.

Erosive pustular dermatosis of the scalp: A review with a focus on dapsone therapy

“…2,23,25,29 The recent literature supports the efficacy of topical tacrolimus for management of EPDS. 7,9,21,27,28 The safety of topical dapsone along with efficacy demonstrated by our 4 patient cases suggests that topical dapsone should be considered in the treatment of EPDS. The efficacy of topical dapsone is likely related to its antineutrophilic and antiinflammatory properties.…”

“…18,20 Moreover, with concern for development of further atrophy, a variety of alternative treatments have been reported to be successful anecdotally (Table III), including oral zinc sulfate, isotretinoin, photodynamic therapy, calcipotriol cream, and topical tacrolimus. 7,9,[21][22][23][24][25][26][27][28] There is only one case report documenting the use of oral dapsone for EPDS, with initial response but problems with recurrence. 12 In patient 1 we had initially attempted oral dapsone for 2 months, but saw a much more dramatic improvement when topical dapsone was applied to the skin.…”

Chronic Crusted Scalp Lesion of an Elderly Male

“…The hyperkeratotic lesions are not painful and pruritus is rare [3]. Triggers have been reported to include imiquimod [4], ingenol mebutate [5], and herpes zoster [6]. Corticosteroids have been proven to be effective in the treatment of most of these cases.…”

Alopezien infolge von Medikamenten oder von anderen Haut- und systemischen Erkrankungen

“…Die Behandlung sollte antivirale Medikamente wie Aciclovir, Famciclovir oder Valaciclovir beinhalten. Auch über die Wirksamkeit von Tacrolimus bei erosiver pustulöser Dermatose der Kopfhaut nach Herpes-Zoster-Infektion ist berichtet worden [54,55]. …”