What are the other Names for this Condition? (Also known as/Synonyms)

• EPD (Erosive Pustular Dermatosis)
• Erosive Pustular Dermatosis of the Scalp
• Erosive Pustulosis

What is Erosive Pustular Dermatosis? (Definition/Background Information)

• Erosive Pustular Dermatosis (EPD) is an uncommon inflammatory condition of the scalp predominantly affecting elderly adults of unknown cause. In this skin condition, there is superficial pus-forming ulcerations on the sun-exposed (typically) bald parts of the head
• Erosive Pustular Dermatosis is generally observed in individuals with a medical history of skin cancers or autoimmune disorders. The condition is also strongly associated with trauma to the scalp region such as caused by surgical procedures or trauma

Who gets Erosive Pustular Dermatosis? (Age and Sex Distribution)

• Erosive Pustular Dermatosis are generally observed in elderly adults, typically over 80 years of age. However, it may be also observed less commonly in individuals of a wider age group including in infants and children
• Both males and females are affected; a greater number of cases are reported in women
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Erosive Pustular Dermatosis? (Predisposing Factors)

The risk factors for Erosive Pustular Dermatosis (EPD) may include individuals with a medical history of the following conditions:

• Actinic keratosis
• Squamous cell carcinoma (SCC) of the scalp
• Basal cell carcinoma (BCC) of the scalp, observed less commonly
• Shingles
• Rheumatoid arthritis
• Hematological disorders such as myeloid leukemia
• Hashimoto’s thyroiditis
• Autoimmune hepatitis

Other predisposing factors include:

• Sun damage
• Minor trauma to the scalp, including surgical wounds
• Site of surgery for skin cancer
• Iatrogenic factors including skin grafting, laser therapy, and cryotherapy
• Immunocompromised individuals
• Side effect of medications such as gefitinib (epidermal growth-factor receptor inhibitor)
• When EPD is observed on the lower limbs, it is believed to result from compression therapy for venous stasis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erosive Pustular Dermatosis? (Etiology)

The exact cause of formation of Erosive Pustular Dermatosis (EPD) is unknown. The cause is not associated with any infections.

• EPD is believed to be associated with sun damage and/or mechanical injury to the scalp, which may also be from medical (surgical) procedures to the region
• The condition is also associated with certain autoimmune conditions such as Hashimoto’s thyroiditis and rheumatoid arthritis

What are the Signs and Symptoms of Erosive Pustular Dermatosis?

The signs and symptoms of Erosive Pustular Dermatosis (EPD) may include:

• Appearance of small pustules (pus-filled blisters) mostly on the scalp; the other involved regions include the forehead and temples
• The blisters coalesce to form large pus-filled areas with yellow-brown-green crusts
• Pain, itching, and discomfort may be noted
• The skin beneath the crusts appear atrophied
• Scarring alopecia is often observed, which can result in severe balding
• EPD may rarely involve the lower legs

How is Erosive Pustular Dermatosis Diagnosed?

A diagnosis of Erosive Pustular Dermatosis may involve the following exams and procedures:

• Physical examination of the individual and detailed medical history evaluation
• Blood tests, analysis of pus, culture of the fluid being drained, as needed, to rule out infections
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis may be necessary to eliminate other conditions/infections that present similar signs and symptoms such as:

• Bacterial or fungal infection
• Cutaneous squamous cell carcinoma
• Folliculitis decalvans
• Mucous membrane pemphigoid, Brunsting-Perry type
• Other skin cancer types

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erosive Pustular Dermatosis?

The possible complications due to Erosive Pustular Dermatosis include:

• Emotional stress due to cosmetic issues
• Superimposed bacterial and fungal skin infections
• Permanent loss of hair, balding that may be extensive
• Malignant transformation of the condition to skin cancer
• Recurrence of the condition
• Treatment complications

How is Erosive Pustular Dermatosis Treated?

The treatment measures available for Erosive Pustular Dermatosis include scalp skin care and symptomatic therapy. These include:

• Use of potent topical steroidal creams or topical calcineurin inhibitors such as tacrolimus
• Administration of oral retinoids
• Antibiotic or antifungal therapy for secondary infections, if necessary
• Treating underlying/associated condition appropriately
• Photodynamic therapy
• Scalp skin care through:
  • Removal of crust formations using dilute vinegar or potassium permanganate solution
  • Dressing of the wound
  • Good personal and scalp hygiene
  • Use of moisturizing creams for dry skin and to prevent scale formation
  • Avoidance of sun exposure

Regular follow up visits with the healthcare provider is important and recommended, to early detect any malignant transformations (skin cancers).

How can Erosive Pustular Dermatosis be Prevented?

• Presently, it may be difficult to prevent Erosive Pustular Dermatosis in many cases
• Avoidance of sunlight exposure, use of wide-brimmed hats, and protective clothing is important
• Undertaking early diagnosis and prompt treatment of any skin cancer or autoimmune diseases

What is the Prognosis of Erosive Pustular Dermatosis? (Outcomes/Resolutions)

• The prognosis of Erosive Pustular Dermatosis may vary from one individual to another and is dependent on the severity of the condition and the underlying associated conditions
• With proper treatment, the scalp condition is known to improve and resolve, although recurrences have been noted

Additional and Relevant Useful Information for Erosive Pustular Dermatosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/