Evidence for a role of local trauma in the pathogenesis of erosive pustular dermatosis of the scalp

Abstract

Eleven of 12 cases with erosive pustular dermatosis ofthe scalp gave a history of antecedent physical or infective trauma. We propose that this clinical disorder may be a non-specific inflammatory response to injury of ageing and sun-damaged scalps.Erosive pustular dermatosis ofthe scalp was described by Pye, Peachey and Burton in 1979.' They reported six cases, all elderly women, who presented with persistent erosions, pustulation and scarring confined to thc scalp. Histology showed a spectrum of changes including epidermal erosions, follicular destruction and chronic inflammatory infiltrates rich in plasma cells although none of these features were diagnostic in themselves. Response to antibiotics was poor, hut the condition was suppressed by potent topical steroids, suggesting an inflammatory rather than an infective aetiology. Since the original report we have collected a further 12 cases from clinics in Avon, Somerset and the Midlands and wish to draw attention to the high incidence of antecedent loca! trauma, which we feel is important in the pathogenesis of the disorder. PatientsSeven ofthe patients were men, five were women. Their mean age at presentation was 75 years, range 59-90. All presented with well defined areas of persistent crusting and adherent keratinous debris in the scalp, removal of which revealed moist superficial erosions and, often, pus.Discrete pustules and open erosions were sometimes evident. Scarring and loss of hair from the affected scalp were common. Six ofthe men and one ofthe women had longstanding physiological baldness prior to the onset of Ccorrespondence: I3r C^.

Erosive Pustular Dermatosis of the Scalp

“…Histologic features are not specific, with a spectrum of inflammatory changes involving epidermis and dermis, ulceration, atrophy, or hyperkeratosis and reduced number or absence of hair follicles. 8 Microorganisms found in EPDS probably represent a secondary colonization rather than primary infection. 3 It should be noted that an erosive pustular eruption has also been reported on legs of patients with atrophic skin associated with chronic venous insufficiency.…”

Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus

“…In our patient, we consider that the tissue damage caused by herpes zoster might have induced subsequent EPDS. According to previous reports [3][4][5] , EPDS following herpes zoster outbreak begins in the same area as the initial injury, and remains unilateral. These published reports, along with our case, provide reliable evidence to support the assertion that herpes zoster can be a causative factor in EPDS.…”

“…Although the pathogenesis is not well known, predisposing factors such as actinic damage and recent or past local trauma have been reported 5 . Moreover, autoimmune disorders have been described in association with EPDS.…”

“…Various microorganisms have been identified in the lesions. However, these organisms represent secondary colonization rather than primary infection 5 .…”

“…To our knowledge, only 3 cases of EPDS were associated with herpes zoster [3][4][5] . We report a case of EPDS following herpes zoster successfully treated with topical tacrolimus.…”