Erosive pustular dermatosis of the scalp. A chronic recalcitrant dermatosis developed upon CO2 laser treatment

Abstract

Erosive pustular dermatosis of the scalp (EPDS) is a rare, chronic inflammatory dermatosis that mostly affects elderly patients, who develop erosions, pustulation, crusting and scarring on the scalp. Its aetiology remains elusive, although the role of local trauma is being emphasized. Treatment is difficult, with several topical and systemic agents being reported to induce improvement. A 63-year-old Caucasian male had been suffering from persistent painful pustules, erosions and crusts on his scalp for 2 years. The onset of the lesions followed a CO2 laser vaporization procedure to treat multiple actinic keratoses. Different topical and systemic treatments had unsuccessfully been tried. A 4-month course of bid 0.1% tacrolimus ointment, along with strict external photoprotection, resulted in dramatic improvement, sustained after careful tapering of tacrolimus. This case is interesting in that the scalp eruption followed CO2 laser treatment. Other cases have been associated with cryosurgery, radiotherapy, surgery, and 5-FU. In fact, to our knowledge, ours is the fourth reported case of EPDS following CO2 laser treatment. Our case also strengthens previous observations as to the efficacy and safety of topical calcineurin inhibitors in this dermatosis. This is noteworthy bearing in mind the atrophic character of the skin in EPDS, which limits the usefulness of chronically administered topical steroids.