ImportanceErosive pustular dermatosis (EPD) is a rare chronic inflammatory condition of the scalp and legs that is often difficult to manage. Currently, there are no treatment guidelines.ObjectiveTo systematically assess the existing literature on various treatment modalities and their efficacies when used in the management of EPD.Evidence reviewWe searched PubMed, Cochrane Libraries, Scopus, and clicnialtrial.gov databases for articles in the English language with no limited time frame. Emphasis was placed on articles that reported on treatment for EPD.FindingsOf the 168 articles identified by the literature search, 92 met eligibility criteria and were included for qualitative analysis. Efficacious topical treatments included clobetasol, betamethasone, and tacrolimus. Ninety‐three and 88% of cases utilizing clobetasol and betamethasone respectively demonstrated improvement or resolution. All 32 cases utilizing tacrolimus reported improvement. Efficacious systemic treatments included oral steroids such as prednisone, methylprednisolone, and dexamethasone. Topical dapsone, photodynamic therapy, systemic steroids, cyclosporine, and oral zinc derivatives were also described with some success.Conclusions and relevanceAccording to available data, limited solely to case reports and case series, potent topical steroids are an effective treatment option for EPD. Topical tacrolimus may also be considered in cases that require long‐term use or maintenance. Other treatment modalities shown to be successful based on high reported efficacy and low rates of recurrence after treatment include topical dapsone, systemic steroids, zinc derivatives, and cyclosporine. Further studies are needed to compare treatment modalities and to establish treatment protocols.
BACKGROUND
Dermal necrosis is a rare yet serious risk associated with cosmetic filler injections, and although current consensus recommends the use of hyaluronidase injections in cases of hyaluronic acid filler, the efficacy of topical nitroglycerin as a treatment has not yet been fully investigated.
OBJECTIVE
To review the literature on tissue necrosis resulting from soft tissue augmentation and to highlight the use of topical nitroglycerin as a first-line treatment.
METHODS
A review of the literature was performed with no time limitations resulting in 35 articles and 66 patients who experienced tissue necrosis secondary to injectable fillers. Articles were reviewed for pertinent information and presented.
RESULTS
Only 7 of the 66 reported cases (10%) used topical nitroglycerin as a treatment. Six of 7 (85%) were successful in halting the impending necrosis. Fifty-nine patients received alternative treatments, with hyaluronidase injection being the most common. Few reports of novel treatments for necrosis included the use of topical growth factors and injection of adipose-derived stem cells.
CONCLUSION
Topical nitroglycerin is a potentially effective and underused treatment for tissue necrosis from soft tissue augmentation, but because data are very limited, topical nitroglycerin should be used in conjunction with hyaluronidase injections in cases of hyaluronic acid filler dermal necrosis.
Although most cases of extramammary Paget's disease (EMPD) are localized to the intraepidermal, the extensive subclinical extension can lead to high rates of marginal recurrence with wide local excisions and topically destructive treatments. Recurrence rates of EMPD treated with Mohs micrographic surgery (MMS) without immunohistochemical staining are better but variable. Here, we describe our multidisciplinary approach for treating large EMPD tumors of the anogenital region involving critical anatomy using MMS for peripheral margin clearance (moat method) and intraoperative CK7 immunostaining. Our clinical pearls for the management of anogenital EMPD are based on 53 multidisciplinary cases treated at the author's institution between 2014 and 2020.
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