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Erosive pustular dermatosis of the scalp
Erosive pustular dermatosis of the scalp
Other names	Erosive pustular dermatosis of the scalp
Specialty	Dermatology

Erosive pustular dermatitis of the scalp presents with pustules, erosions, and crusts on the scalp of primarily older Caucasian females, and on biopsy, has a lymphoplasmacytic infiltrate with or without foreign body giant cells and pilosebaceous atrophy.^[2]^: 650^[3]^: 761

The exact cause of erosive pustular dermatitis of the scalp is unknown. Risk factors include actinic damage, epidermal atrophy, topical drugs and agent, surgery, and infections. Trauma and tissue injury are other potential triggers.

A skin biopsy can be used to help rule out potential differential diagnoses but histopathology is unspecific.

Treatment includes topical corticosteroids and topical tacrolimus 0.1% ointment.

Signs and symptoms

Atrophic skin with a mixture of superficial erosions, crusts, and pustules is the characteristic clinical appearance of erosive pustular dermatitis of the scalp. There might be a wide range in the quantity of pustules, and occasionally none at all. They frequently didn't get better over several months or even years as they grew. Secondly, cicatrical alopecia may occur. It hurts not to have the lesions. Having pruritus is rare. It's a progressive course. There are no unplanned remissions.^[4]

Causes

It's unclear what causes erosive pustular dermatitis of the scalp. It is believed that actinic damage and epidermal atrophy are risk factors. Many other factors, such as different topical drugs, infections, surgical operations, or topical agents, have been linked to the beginning of the illness; their direct role in the etiology is unknown.^[5]

Tissue injury and trauma are important erosive pustular dermatitis triggers.^[6] The following have been linked to erosive pustular dermatitis: preceding of herpes zoster,^[7] positioning of cochlear implants,^[8] iatrogenic injury from cryotherapy, topical chemotherapy, excisional surgery, imiquimod,^[9] grafting following nonmelanoma skin cancer surgery,^[10] topical methyl aminolevulinate photodynamic therapy,^[11] and carbon dioxide laser therapy.^[12]

Diagnosis

The histopathology is unspecific and does not provide much support for the diagnosis. To rule out some differential diagnoses, though, which would require a different course of treatment, a biopsy is crucial. Subcorneal pustules, epidermal hypertrophy, or atrophy and erosions are seen in the histopathology.^[4]

Treatment

Although there isn't a recognized treatment guideline for erosive pustular dermatitis of the scalp due to its rarity and unclear origin, topical treatments are typically the first line of treatment utilized. In order to limit permanent hair loss, therapy aims to reduce inflammation, cure erosions, and stop the progression of scarring alopecia. Treatment should begin as soon as feasible.^[5]

In the majority of documented cases, high-potency topical corticosteroids have been utilized with notable success and relative safety.^[13]

With comparable efficacy observed, topical tacrolimus 0.1% ointment has emerged as a viable substitute for topical steroids.^[14]^[15]

References

^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
^ ^a ^b Wollina, Uwe; Semkova, Kristina; Tchernev, Georgi (2013). "Erosive pustular dermatosis (chronic atrophic dermatosis of the scalp and extremities)". Clinical, Cosmetic and Investigational Dermatology. 6. Informa UK Limited: 177–182. doi:10.2147/ccid.s47019. ISSN 1178-7015. PMC 3712665. PMID 23874115.
^ ^a ^b Starace, Michela; Alessandrini, Aurora; Baraldi, Carlotta; Piraccini, Bianca Maria (2019). "Erosive pustular dermatosis of the scalp: challenges and solutions". Clinical, Cosmetic and Investigational Dermatology. 12. Informa UK Limited: 691–698. doi:10.2147/ccid.s223317. ISSN 1178-7015. PMC 6747878. PMID 31571969.
^ Grattan, C.E.H.; Peachey, R.D.; Boon, A. (1988). "Evidence for a role of local trauma in the pathogenesis of erosive pustular dermatosis of the scalp". Clinical and Experimental Dermatology. 13 (1): 7–10. doi:10.1111/j.1365-2230.1988.tb00639.x. ISSN 0307-6938. PMID 3061689. S2CID 45032377.
^ Kim, Kyu Ri; Lee, Ji Yeoun; Kim, Mi Kyeong; Yoon, Tae Young (2010). "Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus". Annals of Dermatology. 22 (2). Korean Dermatological Association and The Korean Society for Investigative Dermatology: 232–234. doi:10.5021/ad.2010.22.2.232. ISSN 1013-9087. PMC 2883436. PMID 20548924.
^ Marzano, A. V.; Ghislanzoni, M.; Zaghis, A.; Spinelli, D.; Crosti, C. (2009). "Localized erosive pustular dermatosis of the scalp at the site of a cochlear implant: successful treatment with topical tacrolimus". Clinical and Experimental Dermatology. 34 (5). Oxford University Press (OUP): e157 – e159. doi:10.1111/j.1365-2230.2008.03054.x. ISSN 0307-6938. PMID 19094119. S2CID 38786778.
^ Corradin, Maria Teresa; Forcione, Marina; Giulioni, Erika; Fiorentino, Renzo; Ferrazzi, Anna; Alaibac, Mauro (2012). "Erosive Pustular Dermatosis of the Scalp Induced by Imiquimod". Case Reports in Dermatological Medicine. 2012. Hindawi Limited: 1–2. doi:10.1155/2012/828749. ISSN 2090-6463. PMC 3521406. PMID 23259090.
^ Mehmi, Manjeet; Abdullah, Anthony (2004). "Erosive pustular dermatosis of the scalp occurring after partial thickness skin graft for squamous cell carcinoma". British Journal of Plastic Surgery. 57 (8). Elsevier BV: 806–807. doi:10.1016/j.bjps.2004.06.019. ISSN 0007-1226. PMID 15544786.
^ Guarneri, Claudio; Vaccaro, Mario (2009). "Erosive pustular dermatosis of the scalp following topical methylaminolaevulinate photodynamic therapy". Journal of the American Academy of Dermatology. 60 (3). Elsevier BV: 521–522. doi:10.1016/j.jaad.2008.09.006. ISSN 0190-9622. PMID 19231656.
^ Tavares-Bello, Rui (2009). "Erosive Pustular Dermatosis of the Scalp". Dermatology. 219 (1): 71–72. doi:10.1159/000210430. ISSN 1018-8665. PMID 19339769. S2CID 36775554.
^ Van Exel, Corrie E.; English, Joseph C. (2007). "Erosive pustular dermatosis of the scalp and nonscalp". Journal of the American Academy of Dermatology. 57 (2). Elsevier BV: S11 – S14. doi:10.1016/j.jaad.2006.07.009. ISSN 0190-9622. PMID 17637361.
^ Cenkowski, Marta J.; Silver, Shane (2007). "Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp". Journal of Cutaneous Medicine and Surgery. 11 (6). SAGE Publications: 222–225. doi:10.2310/7750.2007.00027. ISSN 1203-4754. PMID 18042336. S2CID 23741228.
^ Tardio, Nicole B.; Daly, Theodore J. (2011). "Erosive pustular dermatosis and associated alopecia successfully treated with topical tacrolimus". Journal of the American Academy of Dermatology. 65 (3). Elsevier BV: e93 – e94. doi:10.1016/j.jaad.2011.05.008. ISSN 0190-9622. PMID 21839311.