Erosive pustular dermatosis of the scalp: a pathogenetic mystery and therapeutic challenge

Abstract

Erosive pustular dermatosis of the scalp (EPD) is a rare condition that affects predominantly the adult population and occurs on a previously photo-damaged bald scalp. The physical examination is presented with large erythematous, erosive and crusted patches with granulation on an atrophic skin. The problem in patients with erosive pustular dermatosis of the scalp arises from the non-specific clinical and histopathological findings, which can be misleading. Biopsy followed by careful histopathological verification is mandatory, although the finding is nonspecific. The histopathology findings are characterized by superficial erosions with mild neutrophil infiltrate, mainly intravascular and focally with neutrophil exocytosis; focal parakeratosis, smoothed rete ridges without pronounced interface changes; pronounced lymphoplasmacytic infiltrate with focal distribution in the dermis and giant cell reaction with the formation of a "foreign body" granuloma.. We report a 58-year-old male patient with a 1-year-old lesion, suspected for skin cancer, later diagnosed with EPDS, which was successfully treated with topical clobetasol proprionate after 3-5weeks.

Keywords: Clobetasol propionate; Erosive pustular dermatosis; Foreign body granuloma; Neutrophil exocytosis; Topical treatment.

Figure 1.

A,B) Clinical picture of a histopathologically proven form of erosive pustular dermatosis of the scalp with large erythematous, erosive and crusted patches with granulation on an atrophic skin with androgenetic alopecia.

Figure 2.

A,B) Improvement of the patient after starting therapy with topical clobetasol proprionate 0.5mg/g after 3-5 weeks. Residual erythema, with slight scarring can be seen.