Erosive pustular dermatosis of the scalp: a multicentre study

Abstract

Background Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. Objectives and Methods We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease. Results Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus. Conclusion The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.

Cutaneous T-cell lymphoma in erythrodermic cases may be suspected on the basis of scalp examination with dermoscopy

“…Visible anagen bulbs were previously described in aplasia cutis congenita 25 , lichen planopilaris 26 , and erosive pustular dermatosis of the scalp 27 . These all conditions belong to cicatricial alopecia group.…”

Erosive pustular dermatosis of the scalp induced by gefitinib: case and review of the literature

“…All these cases were treated with high-potency topical corticosteroids and tacrolimus 0.1% ointment during the active phase. These topical medications are effective and safe and considered first line therapy in EPDS [27]. In particular, clobetasol is the most used topical corticosteroid with a 93% rate of improvement or resolution [28].…”

“…In one case, topical medication was implemented with the use of salicylic acid to thin the hyperkeratotic plaques, whereas another required oral corticosteroids. Oral corticosteroids and dapsone have been proposed as second line treatment; they are sometimes needed to accelerate the healing process and reduce the risk of recurrence [27].…”

Erosive pustular dermatosis: not only scalp

“…7,8 It is useful for suggesting an EPD diagnosis, as it assists with differentiating EPD from other scalp disorders and therefore avoiding biopsies in many cases. 7,9 The differential diagnosis based on the clinical presentation is broad and includes pemphigus, cicatricial pemphigoid, squamous cell carcinoma, decalvans folliculitis, impetiginized eczema, pustular dermatosis, temporal arteritis and dermatitis artifacta. 8,10 In the actinic field damage background, EPD and non-melanoma skin cancer may coexist presenting difficult clinical scenario 1 so long-term follow-up is indicated to monitor any morbidity such as scarring or cutaneous malignancies.…”

“…S100A8 (calgranulin A) stimulates activation of keratinocytes and is involved in interactions between keratinocytes and other immune cells. [7][8][9][10] The objective of the current study was to investigate the expression of S100A15 and S100A8 in lesional and perilesional HS skin as well as healthy skin. Study group consisted of individuals with HS (n = 14), aged from 23 to 59 years (mean, 39.4), and healthy individuals (n = 12), matched by age and gender.…”