Abstract:Erosive pustular dermatosis (EPD) is a rare condition of the scalp and legs that is marked by crusted erosions or superficial ulcerations that may result in scarring alopecia and chronic wounds. The condition predominantly affects elderly female as compared to male patients. Its pathogenesis remains poorly understood. The majority of the cases in the literature are from the United Kingdom and continental Europe. In this series, we present 8 North American patients with EPD of the scalp, one of whom also had in… Show more
“…Impaired immunity and microcirculation may play a role in the pathogenesis of this disease . Recently, a new definition termed as ‘immunosenescence’ has been used to describe the decline of immune system in fidelity and efficiency with ageing; this may result in an increased susceptibility to pathological conditions related to inflammation or autoreactivity . The hair follicle is site of immune privilege, where factors such as loss of normal epidermal barrier and ultraviolet damage may induce a reaction of immune dysregulation.…”
Section: Discussionmentioning
confidence: 99%
“…3 EPDS can also rarely enter into differential diagnosis with solitary lesions of pyoderma gangrenosum. 4 Some Authors 5,6 report also EPDS as localized in other body areas other than scalp, such as the face and, more frequently, the extremities.…”
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.
“…Impaired immunity and microcirculation may play a role in the pathogenesis of this disease . Recently, a new definition termed as ‘immunosenescence’ has been used to describe the decline of immune system in fidelity and efficiency with ageing; this may result in an increased susceptibility to pathological conditions related to inflammation or autoreactivity . The hair follicle is site of immune privilege, where factors such as loss of normal epidermal barrier and ultraviolet damage may induce a reaction of immune dysregulation.…”
Section: Discussionmentioning
confidence: 99%
“…3 EPDS can also rarely enter into differential diagnosis with solitary lesions of pyoderma gangrenosum. 4 Some Authors 5,6 report also EPDS as localized in other body areas other than scalp, such as the face and, more frequently, the extremities.…”
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.
“…Physical examination of scalp reveals multiple erythematous large, erosive, and crusted patches with overlying and surrounding pustules and serum exudate involving the bald areas of the scalp with a predominance of the vertex (Figure 3). Excessive granulation tissue may cover the erosion 16. Affected areas undergo a continuous cycle of healing and recurrence, resulting in atrophic skin with new areas of pustules and erosions, in the center or in the borders of the initial lesion.Figure 3A severe case of EPDS large, erosive, and crusted patches with overlying and surrounding pustules and serum exudate involving the bald areas of the scalp at the vertex. Abbreviation: EPDS, erosive pustular dermatosis of the scalp.…”
Erosive pustular dermatosis of the scalp is a rare chronic inflammatory disorder defined. It usually affects elderly people and is characterized by extensive pustular lesions, erosions, and crusts located on the scalp. The pathogenesis of this disease is not completely understood, but a known predisposing factor is skin trauma. Autoimmune disorders including rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis, and Takayasu aortitis are associated diseases reported. The clinical examination reveals erythema, erosions, crusts, follicular pustules, and in advanced stages, scarring alopecia. A scalp biopsy is recommended but not specific, founding epidermal atrophy, focal erosions, and a mixed inflammatory infiltrate consisting of neutrophils, lymphocytes, and plasma cells. Bacterial cultures, fungal and viral stains are not necessary and are usually negative. . Topical high-potency corticosteroids, retinoids, calcipotriol, dapsone, and topical tacrolimus are reported treatments, while photodynamic therapy has been effective in some patients, but has induced the disease in others. All the findings are suggestive but not specific, so it is an excluding diagnosis. The combination of predisposing factors is very important for a correct diagnosis, such as elderly age, sun-damaged skin, presence of androgenetic alopecia, together with clinical manifestations, non-specific histology and laboratory investigations negative for other disease. In our opinion, this scalp disease is a challenge for the dermatologist. We review all the literature to better define the possible solutions in case of suspected erosive pustular dermatosis of the scalp.
“…EPDS is characterized clinically by chronic scalp pustules, erosive patches, and thick yellow-brown crusts that lead to destruction of hair follicles and scarring alopecia. Because the exact pathogenesis of EPDS is unknown, previous studies have described the associations between EPDS and various predisposing factors, including trauma, actinic damage, immunosenescence, and autoimmune diseases [2]. However, EPDS arising on childhood burn scars has rarely been reported.…”
<b><i>Introduction:</i></b> Erosive pustular dermatosis of the scalp (EPDS) is a rare and recalcitrant condition in which chronic scalp pustules and erosive patches are diagnosed by nondiagnostic laboratory tests and histopathological tests. Although various precipitating factors including trauma have been reported, erosive pustular dermatosis arising on the long-standing burn scars is rare. <b><i>Case Presentation:</i></b> We report three cases of EPDS arising on long-standing burn scars. Based on clinical and histological findings, erosive pustular dermatosis was diagnosed and successfully treated with topical steroid ointment. <b><i>Conclusion:</i></b> We propose that chronic burn scar is another precipitating factors for EPDS and clinicians should consider EPDS in differential diagnoses of erosive pustular dermatosis in long-standing burn scars on the scalp.
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