Erosive pustular dermatosis of the leg: report of three cases

Abstract

Erosive pustular dermatosis of the leg is a distinct form of spongiform amicrobial pustulosis. The disorder typically affects the lower limbs of elderly patients presenting with chronic venous insufficiency and stasis dermatitis, and has a chronic course. Three elderly patients with chronic venous ulcers are described, who developed pustules and moist eroded lesions on the leg. The clinical and histological features were typical for erosive pustular dermatosis. The lesions rapidly responded to topical treatment with either tacrolimus or corticosteroids. Of note, this condition was associated with a diverticular disease in two patients, while in another patient an epidermoid carcinoma of the tongue was present. Erosive pustular dermatosis of the leg is an uncommon but distinct skin disorder typically associated with trophic changes of the lower limbs. Our observations raise the question of the relation of erosive pustular dermatosis of the leg with the group of neutrophilic dermatoses. Topical immunotherapy with tacrolimus may constitute a novel therapeutic option for this frequently recalcitrant condition.

Update on primary cicatricial alopecias

“…373,383 Development of secondary carcinoma with squamous and basal cell features has been reported in a long-standing case. 375 Reports of a variant of erosive pustular dermatosis affecting the leg 388 have been attributed to other diseases by some. 389 Differential diagnosis.…”

Chronic atrophic erosive dermatosis of the scalp and extremities: A recharacterization of erosive pustular dermatosis

“…The single patient of ours who responded poorly to topical steroids cleared nicely with topical tacrolimus as have several previously reported patients. 16,20,23 The calcineurin inhibitors such as tacrolimus might have a theoretic advantage over topical steroids in as much as atrophy seems so important in the pathogenesis of EPD. Thus, it might be desirable to avoid the atrophy-inducing effect of long-term topical steroid therapy.…”

“…Since then, 17 additional cases occurring on the legs have been reported. [22][23][24][25] EPD is generally stated to be encountered only rarely and, in fact, no US patients have been described. However, one of the authors (P. J. L.) suspected that the disorder was actually quite common in the United States and that the correct diagnosis was simply overlooked.…”

Induction of Rosaceiform Dermatitis During Treatment of Facial Inflammatory Dermatoses With Tacrolimus Ointment

“…3 Therefore, it is increasingly used for the treatment of inflammatory dermatoses in sensitive areas such as the face and mucosal areas. 4,5 Recent reports suggest that the treatment is also effective in inflammatory pustular dermatoses such as erosive pustular dermatosis, 6 eosinophilic folliculitis, 4 pyoderma gangrenosum. 7 A recent article documents successful management of steroid-induced rosacea and perioral dermatitis with tacrolimus ointment.…”