Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management

Abstract

Erosive pustular dermatosis (EPD) is a chronic inflammatory skin disorder that usually affects mature individuals. It predominantly affects the scalp and can lead to scarring alopecia. Risk factors include actinic damage and androgenetic alopecia. A traumatic insult to the skin is considered a vital trigger of the condition. EPD is a diagnosis of exclusion; thus, several neoplastic, infectious, vesiculobullous, and inflammatory conditions should be ruled out. Biopsy and clinicopathologic correlation are required to differentiate between EPD and these entities. A dysregulated, chronic immune response is considered central to the etiopathogenesis of EPD. We performed an evidence-based systematic review of the management options. There were predominantly studies with level IV and V evidence and only two with level III. Despite the responsiveness of EPD to potent topical steroids, such as clobetasol propionate, recurrence occurs after treatment withdrawal. With the available data, tacrolimus 0.1%, curettage-assisted aminolevulinic acid-photodynamic therapy, and systemic retinoids can be considered second-line options for EPD with a role in maintenance regimens. However, controlled data and more powerful studies are needed to make solid recommendations.

Keywords: corticosteroids; differential diagnosis; erosive pustular dermatosis; etiopathogenesis; management; therapy; treatment.

Figure 1

Female patient in her 80s with EPD of the scalp. (A), crusted plaques can show massive hyperkeratosis. (B), a large superficial erosion partially covered by purulent exudate; such exudate is noted when uplifting the crusts with forceps. (C), an area of scarring alopecia developed at the later stages of EPD.

Figure 1

Female patient in her 80s with EPD of the scalp. (A), crusted plaques can show massive hyperkeratosis. (B), a large superficial erosion partially covered by purulent exudate; such exudate is noted when uplifting the crusts with forceps. (C), an area of scarring alopecia developed at the later stages of EPD.

Figure 2

Flow diagram of literature search and study selection.

Figure 3

Female patient in her 70s with skin atrophy of the right frontal scalp that resulted from prolonged use of clobetasol propionate cream for EPD. The atrophic area is thin, erythematous, and shows prominent telangiectasias.