Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by sterile pustules, erosions, and crusted lesions on the scalp of elderly patients. This inflammatory disorder has an unknown origin and it could develop into areas of alopecia that tend to be atrophic. An 84-year-old Caucasian man presented with a several months history of painful erythematous erosions and crusts on his scalp. The lesions appeared after treatment with imiquimod cream for actinic keratoses. Previous therapies included topical antibiotics and topical steroids. Physical examination revealed the presence of extensive erosions and crusts on the scalp, with minute pustules on the sides. The clinical features and the medical history led us to the diagnosis of EPDS. Treatment with systemic steroid was administered with improvement observed after ten days. The clinical manifestations of EPDS completely resolved after 2 months, without clinical relapses.
BACKGROUND: Imiquimod is a topical synthetic immune response modifier recently used for treating basal cell carcinoma. CASE REPORTS: We report the cases of 5 patients treated for basal cell carcinomas on their back with Imiquimod 5% topical cream. Each patient developed numerous inflammatory papules in the skin surrounding the treatment site between two to four weeks after beginning treatment. One of these patients histological exam revealed inflammatory infiltrate predominantly containing lymphocytes and macrophages, but no carcinoma cells. The lesions spontaneously disappeared even though the therapy with Imiquimod was continued. CONCLUSION: We hypothesize that the reactions surrounding the treated area were due to the absorption of the active ingredient that induces an inflammatory response along the lymphatics draining the treatment site
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