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Bhargava S, Yumeen S, Henebeng E, Kroumpouzos G. Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management. Life (Basel) 2022; 12. [PMID: 36556462 DOI: 10.3390/life12122097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Williams NM, Abrouk M, Kerdel FA, Kirsner RS. Erosive pustular dermatosis after CO 2 laser resurfacing in mother and daughter. Dermatol Ther 2020; 33:e14306. [PMID: 32930486 DOI: 10.1111/dth.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/28/2020] [Accepted: 09/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie M Williams
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Abrouk
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco A Kerdel
- Florida Academic Dermatology Centers Research and Education LLC, Coral Gables, Florida, USA
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Brianti P, Paolino G, Mercuri S. Fractional 1,927 nm Thulium laser plus photodynamic therapy for the treatment of erosive pustular dermatosis of the scalp. Dermatol Ther 2020; 33:e13246. [DOI: 10.1111/dth.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/25/2020] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Pina Brianti
- Unit of Dermatology IRCCS San Raffaele Scientific Institute Milan Italy
| | - Giovanni Paolino
- Unit of Dermatology IRCCS San Raffaele Scientific Institute Milan Italy
- Clinica Dermatologica Sapienza University of Rome Rome Italy
| | - Santo Mercuri
- Unit of Dermatology IRCCS San Raffaele Scientific Institute Milan Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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