Diagnostic and Management Challenges of Erosive Pustular Dermatosis of the Scalp

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• In this retrospective analysis, 23 patients with erosive pustular dermatosis of the scalp (EPDS) were analysed for treatment response at 4-week intervals. Almost all (22/23) were initially treated with topical steroids and 63.6% demonstrated complete response. After stopping treatment, 18 of 23 patients developed recurrence at a median of 8 weeks. Those with recurrence were treated with additional topical calcineurin inhibitor or acitretin for maintenance therapy. Repeat recurrence rates were higher for those treated with topical calcineurin inhibitors (71.4%) compared with those treated with acitretin (22.2%).

• Erosive pustular dermatosis of the scalp is often responsive to topical steroids, but relapses appear common. Systemic retinoids appear to be superior in treating recurrent disease compared with topical calcineurin inhibitors.

–  Kelly B. Scarberry, MD

Written by

 

 

Melissa Piliang MD, FAAD

Erosive pustular dermatosis of the scalp (EPDS) is a challenging disease with a prolonged time to diagnosis and frequent recurrence. The authors report a study examining the clinical characteristics and response to treatment in 24 patients with EPDS. The study patients fit the classic profile of EPDS—more than 90% were males over the age of 66 years with photodamage and history of nonmelanoma skin cancer. 

Patients were initially treated with topical steroids (TS) under occlusion with 21/22 patients achieving complete or partial response. A single patient treated with topical calcineurin inhibitor (TCi) achieved partial response. One patient was not treated. Of the 23 patients who received treatment, 18 had recurrence of their disease. For those patients requiring additional treatment, 3 protocols were used: acitretinoin with either a second cycle of TS or continuous TCi or a second cycle of TS followed by continuous TCi. Despite long-term treatment, further recurrences were observed in 2/9 receiving acitretin and in 5/7 receiving TCi. The authors avoided prolonged use of TS in EPDS patients due to concerns for further atrophy in an eroded, actinically damaged scalp.

Although the study design and small sample size are limitations, this study highlights the challenges in diagnosing EPDS and the need for safe, long-term treatment as recurrence is common. Most patients responded to a cycle of TS and a limited number of patients did not experience recurrence, suggesting a course of TS is a good first-line option. For those patients who require long-term treatment, acitretinoin appears more effective than TCi.

Abstract

Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis, characterized by erosions, pustules and crusts.1–7 Risk factors include elderly age, actinic damage, androgenetic alopecia and preceding trauma.1–7

Journal of the European Academy of Dermatology and Venereology: JEADV

Diagnostic and Management Challenges of Erosive Pustular Dermatosis of the Scalp: A Retrospective Study in Greek Population

J Eur Acad Dermatol Venereol 2021 Jun 18;[EPub Ahead of Print], S Siskou, A Lallas, K Theodoropoulos, D Sgouros, M Trakatelli, A Patsatsi, A Trigoni, M Manoli, C Papageorgiou, K Liopyris, A Katoulis, A Stratigos, D Ioannides, E Lazaridou, Z Apalla 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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