Erosive pustular dermatosis of the scalp following herpes zoster: successful treatment with topical tacrolimus

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.

Keywords: Erosive pustular dermatosis of the scalp; Herpes zoster; Tacrolimus.

Fig. 1

(A) Erosions and crusted pustular lesions on the left occipital scalp. One week (B) and, 2 months (C) following treatment with topical tacrolimus.

Fig. 2

Ulceration, parakeratosis and serum-crust in the epidermis, and a mixed dermal infiltrate of lymphocytes, neutrophils and plasma cells (H&E stain, ×100).