Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management

Abstract

Erosive pustular dermatosis (EPD) is a chronic inflammatory skin disorder that usually affects mature individuals. It predominantly affects the scalp and can lead to scarring alopecia. Risk factors include actinic damage and androgenetic alopecia. A traumatic insult to the skin is considered a vital trigger of the condition. EPD is a diagnosis of exclusion; thus, several neoplastic, infectious, vesiculobullous, and inflammatory conditions should be ruled out. Biopsy and clinicopathologic correlation are required to differentiate between EPD and these entities. A dysregulated, chronic immune response is considered central to the etiopathogenesis of EPD. We performed an evidence-based systematic review of the management options. There were predominantly studies with level IV and V evidence and only two with level III. Despite the responsiveness of EPD to potent topical steroids, such as clobetasol propionate, recurrence occurs after treatment withdrawal. With the available data, tacrolimus 0.1%, curettage-assisted aminolevulinic acid-photodynamic therapy, and systemic retinoids can be considered second-line options for EPD with a role in maintenance regimens. However, controlled data and more powerful studies are needed to make solid recommendations.

Erosive Pustular Dermatosis of the Scalp in a Patient With Vitiligo Successfully Treated With Topical Antibiotics

“…Erosive pustular dermatosis is a rare skin disorder [ 1 ]. It was first described in 1977 by Dr. Burton [ 2 ]. Predisposing factors include sun damage and epidermal atrophy [ 1 ].…”

“…There is no gold standard treatment for erosive pustular dermatosis; however, high-potency topical steroids have been shown to have the best results [ 1 , 2 , 4 , 5 ]. Topical steroids lead to significant improvement within one to two months of use.…”

“…Topical steroids lead to significant improvement within one to two months of use. However, it is well known that long-term use of topical steroids leads to skin atrophy, which leaves the patient with weaker skin and serves as a predisposing factor for this condition [ 1 , 2 , 4 ].…”

“…The mainstay treatment for erosive pustular dermatosis is high-potency topical steroids [ 1 , 2 , 4 ]. This report describes a rare case of erosive pustular dermatosis of the scalp developing in a patient with vitiligo that healed following the use of topical antibiotics.…”

“…Erosive pustular dermatosis is an uncommon chronic inflammatory skin disorder [1]. The lesions typically present on the scalp of elderly patients with sun-damaged skin and hair loss [1][2][3][4]. It develops over months to years, presents as asymptomatic erosions covered with a yellow-crusted discharge, and is frequently associated with pustules, skin atrophy, and scarring alopecia [1][2][3][4].…”