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Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study of Fifty Cases. Dermatopathology (Basel) 2021; 8:450-462. [PMID: 34698128 PMCID: PMC8544368 DOI: 10.3390/dermatopathology8040048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 12/25/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder.
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Deb PQ, Cai D, Bhate C. Erosive pustular dermatosis of the scalp may not be mutually exclusive with other dermatoses. Clin Dermatol 2021; 39:489-492. [PMID: 34518008 DOI: 10.1016/j.clindermatol.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Erosive pustular dermatosis of the scalp is an uncommon neutrophilic process representing a diagnostic and therapeutic challenge. It often occurs in older patients with prior sun exposure and manifests with hyperkeratosis and crust that may be difficult to distinguish from other inflammatory or neoplastic processes. Although erosive pustular dermatosis of the scalp may respond effectively to high potency topical steroids or other antiinflammatory regimens, caution is advised to avoid overlooking differential diagnoses that may not be mutually exclusive, especially squamous cell carcinoma.
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Affiliation(s)
- Pratik Q Deb
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Donghong Cai
- Department of Pathology and Laboratory Medicine, Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, USA
| | - Chinmoy Bhate
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Division of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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3
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Karanfilian KM, Wassef C. Erosive pustular dermatosis of the scalp: causes and treatments. Int J Dermatol 2020; 60:25-32. [PMID: 32516510 DOI: 10.1111/ijd.14955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/02/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Abstract
Erosive pustular dermatosis of the scalp is a rare condition which primarily affects older women after local trauma and has historically been treated with topical steroids. As it is a rare entity and resembles other dermatologic conditions, it may easily be misdiagnosed. Identifying the causes and evaluating the efficacy of treatments of erosive pustular dermatosis of the scalp (EPDS) is of great importance to both avoid misdiagnosis and ensure optimal treatment of this rare condition. There are numerous causes. In addition to surgeries and physical injuries, topical and procedural treatments for actinic keratoses and androgenetic alopecia can trigger the development of lesions. There are also documented associations with several autoimmune and systemic conditions. Besides corticosteroids, topical tacrolimus and photodynamic therapy were the most commonly used treatments for EPDS. They were effective with few recurrences and adverse effects. Other successful treatment options were topical dapsone, silicone gels, calcipotriol, acitretin, and isotretinoin. Oral dapsone can be used in cases of disseminated disease. Zinc sulfate should be considered with low-serum zinc levels. While cyclosporine was effective, there were adverse effects that may limit its use. It is important for dermatologists to be aware of the wide array of potential causes of erosive pustular dermatosis and include it on their differential. Additionally, although high-potency topical steroids have been historically used as the first-line treatment, there are many other effective treatments that may avoid recurrence and skin atrophy, particularly in the elderly population.
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Affiliation(s)
| | - Cindy Wassef
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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4
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Junejo MH, Kentley J, Rajpopat M, Tan XL, Mohd Mustapa MF, Harwood CA. Therapeutic options for erosive pustular dermatosis of the scalp: a systematic review. Br J Dermatol 2020; 184:25-33. [PMID: 32163590 DOI: 10.1111/bjd.19026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- M H Junejo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Kentley
- Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - M Rajpopat
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - X L Tan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - C A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
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5
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Starace M, Iorizzo M, Trüeb RM, Piccolo V, Argenziano G, Camacho FM, Gallyamova Y, Rudnicka L, Umbert I, Lyakhovitsky A, Vañó-Galván S, Goren A, Alessandrini A, Bruni F, Piraccini BM. Erosive pustular dermatosis of the scalp: a multicentre study. J Eur Acad Dermatol Venereol 2020; 34:1348-1354. [PMID: 31954062 DOI: 10.1111/jdv.16211] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- M Starace
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - M Iorizzo
- Private Dermatology Practice - Lugano & Bellinzona, Bellinzona, Switzerland
| | - R M Trüeb
- Center for Dermatology and Hair Disease Professor Trüeb, Zürich-Wallisellen, Switzerland
| | - V Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F M Camacho
- Department of Dermatology, University of Seville, Seville, Spain.,Doctor Honoris Causa from University of Cadiz, Cadiz, Spain
| | - Y Gallyamova
- State Budget Educational Institution of Additional Professional Education "Russian Medical Academy of Postgraduate Education Studies" of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - I Umbert
- Instituto de Dermatologia Ignacio Umbert (Private Research Institute), Barcelona, Spain
| | - A Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel
| | - S Vañó-Galván
- Department of Dermatology - Trichology Unit, Ramon y Cajal Hospital, Madrid, Spain
| | - A Goren
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy
| | - A Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - F Bruni
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - B M Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
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6
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Starace M, Alessandrini A, Baraldi C, Piraccini BM. Erosive pustular dermatosis of the scalp: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:691-698. [PMID: 31571969 PMCID: PMC6747878 DOI: 10.2147/ccid.s223317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Michela Starace
- Department of Experimental, Diagnostic and Specialty Medicine, Division of
Dermatology, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of
Dermatology, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of
Dermatology, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of
Dermatology, University of Bologna, Bologna, Italy
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Yeh R, Polcz M, Wong D. Erosive pustular dermatosis of the scalp – an Australian perspective: Insights to aid clinical practice. Australas J Dermatol 2019; 60:e272-e278. [DOI: 10.1111/ajd.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/02/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Rudy Yeh
- Department of Dermatology Prince of Wales Hospital Randwick New South Wales Australia
| | - Margit Polcz
- Department of Dermatology Prince of Wales Hospital Randwick New South Wales Australia
| | - David Wong
- Department of Dermatology Prince of Wales Hospital Randwick New South Wales Australia
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Magri F, Pranteda G, Federico A, Muscianese M, Pigliacelli F, D'arino A, Paolino G, Bottoni U, Pranteda G. Kerion mimicking an erosive pustular dermatosis of the scalp. GIORN ITAL DERMAT V 2019; 154:96-98. [PMID: 30616337 DOI: 10.23736/s0392-0488.17.05673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesca Magri
- Department of Dermatology (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Guglielmo Pranteda
- Department of Dermatology (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Alessandro Federico
- Department of Dermatology (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marta Muscianese
- Department of Dermatology (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Flavia Pigliacelli
- Department of Dermatology (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea D'arino
- Unit of Dermatology, Faculty of Medicine and Psychology, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giovanni Paolino
- Unit of Dermatology, Faculty of Medicine and Psychology, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ugo Bottoni
- Department of Health Sciences, University of Catanzaro Magna Græcia, Catanzaro, Italy
| | - Giulia Pranteda
- Unit of Dermatology, Faculty of Medicine and Psychology, Umberto I Hospital, Sapienza University, Rome, Italy
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9
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Tomasini C, Michelerio A. Erosive pustular dermatosis of the scalp: A neutrophilic folliculitis within the spectrum of neutrophilic dermatoses: A clinicopathologic study of 30 cases. J Am Acad Dermatol 2018; 81:527-533. [PMID: 30617027 DOI: 10.1016/j.jaad.2018.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/04/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND It is general opinion that histopathology is nonspecific and of little value in diagnosing erosive pustular dermatosis of the scalp (EPDS). OBJECTIVES Clinicopathologic correlation of erosive pustular dermatosis of the scalp. METHODS We reviewed the clinical and pathologic records of patients with a clinicopathologic diagnosis of EPDS between 2011 and 2016 at the Dermatopathology Unit of Turin University. RESULTS Thirty elderly patients with EPDS were identified (22 men and 8 women). Androgenetic alopecia was present in 19 of 30 patients. Triggering factors included mechanical trauma in 10 of 30 cases, surgical procedures in 4 of 30 cases, and herpes zoster in 1 of 30 cases. Three patients were affected by autoimmune disorders. The vertex was the most common location. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum. The pathologic changes differed according to lesion type and disease duration. Interestingly, a spongiotic and suppurative infundibulo-folliculitis was observed in 8 of 30 cases. LIMITATIONS This was a retrospective study. CONCLUSIONS We believe that the primary lesion of erosive pustular dermatosis of the scalp is a spongiotic, pustular superficial folliculitis. The clinicopathologic similarities with other neutrophilic dermatoses, such as pustular pyoderma gangrenosum, suggest this condition should be included in this spectrum, where pathergy plays a pathogenetic role.
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Affiliation(s)
- Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic, and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic, and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Terziroli Beretta-Piccoli B, Invernizzi P, Gershwin ME, Mainetti C. Skin Manifestations Associated with Autoimmune Liver Diseases: a Systematic Review. Clin Rev Allergy Immunol 2017; 53:394-412. [DOI: 10.1007/s12016-017-8649-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cenkowski MJ, Silver S. Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp. J Cutan Med Surg 2016; 11:222-5. [DOI: 10.2310/7750.2007.00027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation. Case History: A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth. Conclusion: This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.
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Affiliation(s)
- Marta J. Cenkowski
- From the Faculty of Medicine and the Division of Dermatology, University of Manitoba, Winnipeg, MB
| | - Shane Silver
- From the Faculty of Medicine and the Division of Dermatology, University of Manitoba, Winnipeg, MB
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Shahmoradi Z, Abtahi-Naeini B, Pourazizi M. Erosive pustular dermatosis of the scalp following hair transplantation. Adv Biomed Res 2014; 3:176. [PMID: 25250290 PMCID: PMC4166054 DOI: 10.4103/2277-9175.139412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/23/2012] [Indexed: 11/05/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease with unknown etiology that usually occurs in the elderly. It is characterized by multiple sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. It typically develops in aged or sun-damaged skin and is most often accompanied by a history of local trauma. Histopathologically, non-specialized change manifests as atrophic epidermis and chronic inflammation. Although this disease mainly occurs in elderly white women, we here report a case of EPDS in a 35-year-old man, following hair transplantation as a local trauma, that was successfully treated with topical steroid.
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Affiliation(s)
| | | | - Mohsen Pourazizi
- Student Research Committee (SRC), Semnan University of Medical Sciences, Semnan, Iran
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13
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Jourdan M, Chaby G, Meziane L, Arnault JP, Chatelain D, Lok C. A case associating an erosive pustular dermatosis of the legs and scalp. Case Rep Dermatol 2012; 4:186-91. [PMID: 23271992 PMCID: PMC3529573 DOI: 10.1159/000342809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Erosive pustular dermatosis (EPD) of the legs and the scalp have been described as two separate entities occurring in a different context. We report the original case of a patient with an EPD of both the scalp and legs.
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Affiliation(s)
- Marie Jourdan
- Departments of Dermatology, Anatomopathology, University Hospital of Amiens, Amiens, France
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14
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Kim KR, Lee JY, Kim MK, Yoon TY. Erosive pustular dermatosis of the scalp following herpes zoster: successful treatment with topical tacrolimus. Ann Dermatol 2010; 22:232-4. [PMID: 20548924 DOI: 10.5021/ad.2010.22.2.232] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 11/08/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of the elderly characterized by multiple pustular lesions with erosions and crusting that result in scarring alopecia. EPDS typically develops in aged or sun-damaged skin with a history of trauma. Histopathologically, EPDS is nonspecific, showing atrophic epidermis and chronic inflammation. Bacteriological and mycological investigations of EPDS are generally negative. Although herpes zoster is a common disorder in elderly people, previously reported cases of EPDS were rarely associated with herpes zoster. We present a rare case of EPDS following herpes zoster treated successfully with topical tacrolimus.
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Affiliation(s)
- Kyu Ri Kim
- Department of Dermatology, School of Medicine and the Medical Research Institute, Chungbuk National University, Cheongju, Korea
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15
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Marzano AV, Ghislanzoni M, Zaghis A, Spinelli D, Crosti C. Localized erosive pustular dermatosis of the scalp at the site of a cochlear implant: successful treatment with topical tacrolimus. Clin Exp Dermatol 2009; 34:e157-9. [DOI: 10.1111/j.1365-2230.2008.03054.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths CEM, Paus R. Management of primary cicatricial alopecias: options for treatment. Br J Dermatol 2008; 159:1-22. [PMID: 18489608 DOI: 10.1111/j.1365-2133.2008.08591.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary cicatricial alopecias (PCAs) are a poorly understood group of disorders that result in permanent hair loss. Clinically, they are characterized not only by permanent loss of hair shafts but also of visible follicular ostia along with other visible changes in skin surface morphology, while their histopathological hallmark usually (although not always) is the replacement of follicular structures with scar-like fibrous tissue. As hair follicle neogenesis in adult human scalp skin is not yet a readily available treatment option for patients with cicatricial alopecias, the aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. However, inconsistent terminology, poorly defined clinical end-points and a lack of good quality clinical trials have long made management of these conditions very challenging. As one important step towards improving the management of this under-investigated and under-serviced group of dermatoses, the current review presents evidence-based guidance for treatment, with identification of the strength of evidence, and a brief overview of clinical features of each condition. Wherever only insufficient evidence-based advice on PCA management can be given at present, this is indicated so as to highlight important gaps in our clinical knowledge that call for concerted efforts to close these in the near future.
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Affiliation(s)
- M J Harries
- The Dermatology Centre, The University of Manchester, Hope Hospital, Manchester M6 8HD, UK.
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19
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Van Exel CE, English JC. Erosive pustular dermatosis of the scalp and nonscalp. J Am Acad Dermatol 2007; 57:S11-4. [PMID: 17637361 DOI: 10.1016/j.jaad.2006.07.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 06/08/2006] [Accepted: 07/05/2006] [Indexed: 11/26/2022]
Abstract
Erosive pustular dermatosis of the scalp is characterized by an idiopathic pustular eruption occurring in association with iatrogenic or incidental, antecedent trauma to actinically damaged skin. We present two cases of erosive pustular dermatosis, one of which occurred on the scalp, the other of which was primarily located on the face.
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Mastroianni A, Cota C, Ardigò M, Minutilli E, Berardesca E. Erosive Pustular Dermatosis of the Scalp: A Case Report and Review of the Literature. Dermatology 2005; 211:273-6. [PMID: 16205074 DOI: 10.1159/000087023] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Accepted: 12/03/2004] [Indexed: 11/19/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp as well as co-existence of auto-immune diseases. Laboratory data, bacteriological and mycological investigations and histopathology are generally not diagnostic. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete resolution in few months. No relapse after 1 year of follow-up was seen. EPDS represents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially resolutive choice.
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Affiliation(s)
- A Mastroianni
- Dermatologic Institute S. Gallicano, IRCCS, Rome, Italy
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Abstract
UNLABELLED The cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of the hair follicle and irreversible hair loss. Destruction of the hair follicle can result from primary, folliculocentric disease or as a secondary result. This article focuses on the former, or primary cicatricial alopecias. The cause and pathogenesis of many of these disorders are largely unknown. Although unique clinicopathologic features allow for accurate diagnosis in some cases, diagnostic certainty is often elusive and reflects the limits of present understanding. Classification of the primary cicatricial alopecias on the basis of pathology provides a diagnostic and investigational framework and, it is hoped, will facilitate future enlightenment. Details of classification, etiopathogenesis, clinicopathologic features, differential diagnosis, and practical management of the primary cicatricial alopecias will be discussed. LEARNING OBJECTIVES Upon completion of this learning activity, participants should be familiar with the following aspects of the primary cicatricial alopecias: (1) the new, consensus-issued classification scheme, (2) current understanding about etiopathogenesis, (3) salient clinicopathologic features, (4) differential diagnosis, and (5) therapeutic management.
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Affiliation(s)
- Elizabeth K Ross
- Department of Medicine, University of British Columbia, Vancouver Coastal Health Research Insitute, Vancouver, British Columbia, Canada
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Bielsa Marsol I, Paradelo García C, Ribera Pibernat M, Ferrándiz Foraster C. Dermatosis erosivopustulosa del cuero cabelludo. Descripción de siete casos. ACTAS DERMO-SIFILIOGRAFICAS 2001. [DOI: 10.1016/s0001-7310(01)76523-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pustular Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Sadayama T, Muramatsu T, Shirai T. A case of pustular ulcerative dermatosis of the scalp associated with ulcerative skin lesions on the scrotum. J Dermatol 1998; 25:657-61. [PMID: 9830265 DOI: 10.1111/j.1346-8138.1998.tb02476.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 79-year-old man developed pustules, erosions, and ulcer with severe pain on the parietal regions of the scalp and the scrotum. In another hospital, mycobacterium was detected from the pustules of the scalp at Gaffky scale 1, and this patient was referred to our clinic. In our hospital, repeated cultures of the pus from the skin lesions of the scalp were negative for mycobacterium. Biopsy specimens obtained from the skin lesions on the scalp disclosed ulcerative granulation with infiltration of inflammatory cells. Antibiotics and antituberculotic agents were ineffective. In contrast, the ulcerative skin lesions on the scalp and scrotum responded well to topical and systemic glucocorticosteroids. Although this patient developed pustular ulcerative skin lesions not only on the scalp but also on the scrotum, we considered this case to be pustular ulcerative dermatosis of the scalp developing ulcerative skin lesions on the scrotum.
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Affiliation(s)
- T Sadayama
- Department of Dermatology, Nara Medical University, Japan
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