Therapeutic options for erosive pustular dermatosis of the scalp: a systematic review*

Abstract

Summary Background Erosive pustular dermatosis of the scalp (EPDS) is a chronic condition characterized by erosive plaques and subsequent scarring alopecia as a result of local trauma or inflammation. A number of therapeutic approaches have been described in the literature but there is no consensus of opinion on optimal treatment of the disease. Objectives To provide evidence‐based recommendations for topical and systemic treatment of adult patients with EPDS by performing a systematic review. Methods The MEDLINE, MEDLINE In‐Process, Embase and Cochrane databases were searched from inception to 26 June 2019 in accordance with the PRISMA guidelines for studies involving adult patients treated for EPDS with at least one reported response to treatment. The study was registered on PROSPERO. Texts were reviewed independently by two authors. The risk of bias and quality of the studies were assessed using the Quality Appraisal Checklist for Case Series Studies. Results In total 75 studies were included, involving 168 patients. Many treatments have been reported in the literature, with varying degrees of therapeutic success. The results were highly heterogeneous and methodological quality was very low. We were unable to perform a meta‐analysis on the data. Conclusions The limited available evidence supports use of topical corticosteroids, with or without oral zinc, followed by maintenance therapy with topical calcineurin inhibitors as being effective in managing this condition. Topical photodynamic therapy is also potentially beneficial in the management of EPDS. Prospective, comparative, randomized controlled trials are required in order to provide further evidence to guide treatment.

Diagnostic and management challenges of erosive pustular dermatosis of the scalp: a retrospective study in Greek population

“…Editor, Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis, characterized by erosions, pustules and crusts. [1][2][3][4][5][6][7] Risk factors include elderly age, actinic damage, androgenetic alopecia and preceding trauma. [1][2][3][4][5][6][7] We retrospectively analysed data of clinically and histologically diagnosed EPDS patients, to assess disease characteristics and efficacy of different therapies and to explore various associations.…”

“…4,5,8,9 Furthermore, our results conform with previous publications reporting topical treatments for NMSCs as risk factors of EPDS. 4,6,7,10 Considering that EPDS often develops in the background of field cancerization, presence of actinic damage in the skin specimen may act as a misleading feature for the pathologist too, who may ultimately report the lesion just as actinically damaged skin. The latter may result in further topical/destructive therapies that maintain the vicious circle of 'inflammationimpaired healing'.…”

Nivolumab‐induced erosive pustular dermatosis of the scalp

“…According to a recent systematic review, topical corticosteroids represent the most effective treatment for EPDS and should be regarded as a first line option, followed by topical calcineurin inhibitors during maintenance. However, several other therapeutic options, including dapsone, oral zinc, tetracyclines, and photodynamic therapy, have been shown to be of some benefit 3 . The pathogenesis of EPDS is far less clear until now.…”

A pediatric case of corticosteroid‐resistant erosive pustular dermatosis of scalp‐like alopecia treated successfully with oral indomethacin, doxycycline, and topical tacrolimus

“…A pediatric case of corticosteroid-resistant erosive pustular dermatosis of scalp-like alopecia treated successfully with oral indomethacin, doxycycline, and topical tacrolimus Dear Editor, Erosive pustular dermatosis of the scalp (EPDS) is a rare condition commonly affecting elderly women after local trauma. 1,2 The typical clinical course of EPDS is slow growth, but poor response to treatment. 1 The treatment of EPDS is challenging, especially for corticosteroid-resistant cases.…”

“…1,2 The typical clinical course of EPDS is slow growth, but poor response to treatment. 1 The treatment of EPDS is challenging, especially for corticosteroid-resistant cases. An 8-year-old Japanese boy visited our outpatient clinic with a 2-month history of painful purulent alopecia on the scalp.…”