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Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122097. [PMID: 36556462 PMCID: PMC9784138 DOI: 10.3390/life12122097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
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.
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Aithal S, Shilpa K, Revathi TN. Erosive pustular dermatosis of the scalp: Report of three cases. Int J Trichology 2022; 14:178-180. [PMID: 36404881 PMCID: PMC9674056 DOI: 10.4103/ijt.ijt_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/05/2022] Open
Abstract
Erosive pustular dermatosis of the scalp is a chronic cutaneous condition presenting with areas of erosions and pustules, healing with scarring and alopecia. We report three such cases presenting with pus-filled lesions of the scalp with nonspecific pathological changes. This condition is often misdiagnosed and shows a poor response to antibiotics. Clinical suspicion is of primary importance for early diagnosis and proper treatment.
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3
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Gallo G, Ribero S, Conti L, Baglioni E, Fierro MT, Quaglino P. Erosive pustular dermatosis: not only scalp. J Eur Acad Dermatol Venereol 2020; 34:e399-e402. [PMID: 32107801 DOI: 10.1111/jdv.16314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Gallo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - L Conti
- Division of Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Baglioni
- Department of General and Specialized Surgery, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M T Fierro
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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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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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: 11] [Impact Index Per Article: 2.8] [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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Lee KH, Carley SK, Kraus CN, Mesinkovska NA. Treatment of erosive pustular dermatosis: a systematic review of the literature. Int J Dermatol 2020; 59:770-786. [PMID: 31904115 DOI: 10.1111/ijd.14744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Erosive pustular dermatosis (EPD) is a rare chronic inflammatory condition of the scalp and legs that is often difficult to manage. Currently, there are no treatment guidelines. OBJECTIVE To systematically assess the existing literature on various treatment modalities and their efficacies when used in the management of EPD. EVIDENCE REVIEW We searched PubMed, Cochrane Libraries, Scopus, and clicnialtrial.gov databases for articles in the English language with no limited time frame. Emphasis was placed on articles that reported on treatment for EPD. FINDINGS Of the 168 articles identified by the literature search, 92 met eligibility criteria and were included for qualitative analysis. Efficacious topical treatments included clobetasol, betamethasone, and tacrolimus. Ninety-three and 88% of cases utilizing clobetasol and betamethasone respectively demonstrated improvement or resolution. All 32 cases utilizing tacrolimus reported improvement. Efficacious systemic treatments included oral steroids such as prednisone, methylprednisolone, and dexamethasone. Topical dapsone, photodynamic therapy, systemic steroids, cyclosporine, and oral zinc derivatives were also described with some success. CONCLUSIONS AND RELEVANCE According to available data, limited solely to case reports and case series, potent topical steroids are an effective treatment option for EPD. Topical tacrolimus may also be considered in cases that require long-term use or maintenance. Other treatment modalities shown to be successful based on high reported efficacy and low rates of recurrence after treatment include topical dapsone, systemic steroids, zinc derivatives, and cyclosporine. Further studies are needed to compare treatment modalities and to establish treatment protocols.
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Affiliation(s)
- Katrina H Lee
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sama K Carley
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
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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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8
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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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9
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Giuffrida R, Borgia F, Cannavò SP. Two cases of erosive pustular dermatosis of the scalp occurring after topical 3.75% imiquimod for actinic keratoses. Dermatol Ther 2018; 32:e12770. [DOI: 10.1111/dth.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology; University of Messina; Messina Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology; University of Messina; Messina Italy
| | - Serafinella P. Cannavò
- Department of Clinical and Experimental Medicine, Dermatology; University of Messina; Messina Italy
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10
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Brito FF, Pereira GAAM, Kakizaki P, Ferrara FDS, Contin LA. Cicatricial Alopecia after a Surgical Procedure. Skin Appendage Disord 2018; 4:37-40. [PMID: 29457013 DOI: 10.1159/000477413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fernanda Freitas Brito
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Priscila Kakizaki
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Leticia Arsie Contin
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
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11
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Mervak JE, Gan SD, Smith EH, Wang F. Facial Erosive Pustular Dermatosis After Cosmetic Resurfacing. JAMA Dermatol 2017; 153:1021-1025. [PMID: 28813557 DOI: 10.1001/jamadermatol.2017.2880] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Erosive pustular dermatosis (EPD) is a rare condition that typically affects actinically damaged skin of the scalp. Characterized by sterile pustules, erosions, and crusts, EPD is difficult to treat and heals slowly. The exact cause of EPD is unknown, although trauma is an inciting factor. Objective To describe 3 women who presented with prolonged facial erosions after cosmetic resurfacing procedures, specifically fully ablative carbon dioxide laser or medium-depth chemical peel. Design, Setting, and Participants This case series describes the clinical features, histopathological findings, laboratory results, and treatment of 3 patients with an ultimate diagnosis most consistent with facial EPD. Patients were evaluated between September 10, 2010, and May 6, 2016, in a dermatology clinic in an academic medical center. The patients were 3 women seeking diagnostic evaluation and therapeutic options for nonhealing facial erosions occurring after ablative procedures (carbon dioxide laser resurfacing or Jessner solution/trichloroacetic acid chemical peel). Main Outcomes and Measures Histologic examination and wound culture from initial presentation as well as clinical follow-up documenting improvement with therapeutic interventions. Results All 3 patients were women in their 50s or 60s for whom EPD was deemed to be the best diagnosis, after infection, immunobullous disorders, and other pustular dermatoses were considered. Histologic features were nonspecific. Treatment included a combination of topical and systemic therapies, such as corticosteroids, dapsone, isotretinoin, and/or antibiotics. Watchful waiting (tincture of time) appeared to be central to the healing process. Conclusions and Relevance After cosmetic resurfacing, patients may develop EPD isolated to the face. As a diagnosis of exclusion that should be considered in patients who have nonhealing wounds following ablative procedures, EPD is challenging to treat and may require the use of anti-inflammatory agents. Recognizing this condition is important, especially as cosmetic procedures become more widespread.
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Affiliation(s)
- Julie E Mervak
- Department of Dermatology, University of Michigan Medical School, Ann Arbor
| | - Stephanie D Gan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor
| | - Emily H Smith
- Department of Dermatology, University of Michigan Medical School, Ann Arbor
| | - Frank Wang
- Department of Dermatology, University of Michigan Medical School, Ann Arbor
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12
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Atzori L, Lai M, Lappi A, Brundu M, Rongioletti F. Erosive pustular dermatosis of the scalp and Kindler syndrome: a new association. J Eur Acad Dermatol Venereol 2017; 32:e102-e104. [DOI: 10.1111/jdv.14577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L. Atzori
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; Cagliari Italy
| | - M. Lai
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; Cagliari Italy
| | - A. Lappi
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; Cagliari Italy
| | - M.A. Brundu
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; Cagliari Italy
| | - F. Rongioletti
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; Cagliari Italy
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13
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Brambilla L, Tourlaki A, Nazzaro G. Erosive pustular dermatosis of the scalp induced by ingenol mebutate. GIORN ITAL DERMAT V 2017; 153:743-745. [PMID: 28895376 DOI: 10.23736/s0392-0488.17.05691-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lucia Brambilla
- Department of Pathophysiology and Transplantation, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy
| | - Athanasia Tourlaki
- Department of Pathophysiology and Transplantation, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy
| | - Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy -
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Erosive pustular dermatosis of the scalp: Clinical, trichoscopic, and histopathologic features of 20 cases. J Am Acad Dermatol 2017; 76:1109-1114.e2. [DOI: 10.1016/j.jaad.2016.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
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15
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J Am Acad Dermatol 2017; 75:1081-1099. [PMID: 27846944 DOI: 10.1016/j.jaad.2014.09.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022]
Abstract
Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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16
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias. J Am Acad Dermatol 2017; 75:1101-1117. [PMID: 27846945 DOI: 10.1016/j.jaad.2015.01.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 01/30/2023]
Abstract
Primary cicatricial alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary cicatricial alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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17
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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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Zahdi MR, Seidel GB, Soares VC, Freitas CFNPD, Mulinari-Brenner FA. Erosive pustular dermatosis of the scalp successfully treated with oral prednisone and topical tacrolimus. An Bras Dermatol 2014; 88:796-8. [PMID: 24173187 PMCID: PMC3798358 DOI: 10.1590/abd1806-4841.20132109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
Abstract
Erosive pustular dermatosis of the scalp is a rare inflammatory disorder of the
scalp, affecting elderly patients after local trauma and leading to scarring or
cicatricial alopecia. Case Report: An elderly female patient complained of painful
pustules on the parietal region bilaterally with progressive enlargement and
ulceration. A biopsy suggested erosive pustular dermatosis of the scalp and the
patient was treated with prednisone 40 mg/day and 0.1% topical tacrolimus. After 10
weeks complete closure of the eroded areas was observed and a stable scarring
alopecia developed.
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Erosive pustular dermatosis of the scalp induced by imiquimod. Case Rep Dermatol Med 2012; 2012:828749. [PMID: 23259090 PMCID: PMC3521406 DOI: 10.1155/2012/828749] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/16/2012] [Indexed: 11/18/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by sterile pustules, erosions, and crusted lesions on the scalp of elderly patients. This inflammatory disorder has an unknown origin and it could develop into areas of alopecia that tend to be atrophic. An 84-year-old Caucasian man presented with a several months history of painful erythematous erosions and crusts on his scalp. The lesions appeared after treatment with imiquimod cream for actinic keratoses. Previous therapies included topical antibiotics and topical steroids. Physical examination revealed the presence of extensive erosions and crusts on the scalp, with minute pustules on the sides. The clinical features and the medical history led us to the diagnosis of EPDS. Treatment with systemic steroid was administered with improvement observed after ten days. The clinical manifestations of EPDS completely resolved after 2 months, without clinical relapses.
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Alopecias cicatriciales. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:376-87. [DOI: 10.1016/j.ad.2011.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/31/2011] [Accepted: 07/05/2011] [Indexed: 01/24/2023] Open
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Broussard KC, Berger TG, Rosenblum M, Murase JE. Erosive pustular dermatosis of the scalp: A review with a focus on dapsone therapy. J Am Acad Dermatol 2012; 66:680-6. [DOI: 10.1016/j.jaad.2011.10.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 10/05/2011] [Accepted: 10/09/2011] [Indexed: 11/17/2022]
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Erosive pustular dermatosis and associated alopecia successfully treated with topical tacrolimus. J Am Acad Dermatol 2011; 65:e93-e94. [DOI: 10.1016/j.jaad.2011.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/17/2011] [Accepted: 05/03/2011] [Indexed: 11/18/2022]
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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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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: 69] [Impact Index Per Article: 4.3] [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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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: 46] [Impact Index Per Article: 2.7] [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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Patton D, Lynch PJ, Fung MA, Fazel N. Chronic atrophic erosive dermatosis of the scalp and extremities: A recharacterization of erosive pustular dermatosis. J Am Acad Dermatol 2007; 57:421-7. [PMID: 17532096 DOI: 10.1016/j.jaad.2007.04.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 04/12/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Erosive pustular dermatosis (EPD) is a rarely reported condition that primarily involves the actinically damaged scalp of elderly women. Although the condition is well recognized in the United Kingdom and Europe, no US cases have heretofore been reported. OBJECTIVES We sought to document the presence, and determine the clinical characteristics, of EPD in the US population. METHODS Patients were recruited from the dermatology clinic at a university in California and from the private practices of dermatologists in the Northern California region. RESULTS Eleven patients with EPD were identified. Eight were women and 3 were men. The scalp was involved in 9 patients and the extremities in two patients. The involved skin was actinically damaged in 9 patients. The patients were elderly (66-90 years) but one patient was a 15-year-old boy. All lesions resolved or greatly improved with the application of high-potency steroids or tacrolimus. LIMITATIONS Not all patients were examined personally by the authors of this article. The length of follow-up was relatively short. CONCLUSIONS EPD is a fairly common disease and is the most likely diagnosis in instances where chronic, nonhealing, shallow erosions occur on actinically damaged, or otherwise atrophic, skin. In spite of the name, intact pustules are rarely present. The histology is that of moderate to marked, nonspecific chronic inflammation. EPD responds well to high-potency topical steroids.
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Affiliation(s)
- Douglas Patton
- Department of Dermatology, University of California, Davis, 3301 C St, Suite 1400, Sacramento, CA 95816, USA
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