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Dissecting cellulitis of scalp (DCS) is an uncommon inflammatory dermatosis, which can be difficult to diagnose in the absence of concomitant cutaneous markers. We present an interesting case of DCS in a 60-year-old male, with an onset after blunt trauma to head. The progression was fast and diagnosis could be achieved on multiple biopsies only. The response to therapy with a combination of oral isotretinoin and intralesional triamcinolone acetonide injections is highlighted in this difficult to treat dermatoses. [ABSTRACT FROM AUTHOR]

Dissecting cellulitis of scalp (DCS) is an uncommon inflammatory dermatosis, which can be difficult to diagnose in the absence of concomitant cutaneous markers. We present an interesting case of DCS in a 60-year-old male, with an onset after blunt trauma to head. The progression was fast and diagnosis could be achieved on multiple biopsies only. The response to therapy with a combination of oral isotretinoin and intralesional triamcinolone acetonide injections is highlighted in this difficult to treat dermatoses.

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory condition commonly associated with antecedent iatrogenic insult. EPDS may be diagnostically challenging owing to a lack of pathognomonic histologic findings and cutaneous manifestations that overlap with alternative dermatologic conditions. Therefore, EPDS may be more common than previously recognized. We present a 60-year-old woman with a four-year history of non-healing scalp erosions, progressive skin atrophy, and scarring alopecia despite intravenous antibiotics and intraoperative debridement who improved with systemic glucocorticoids. Our report emphasizes the importance of early recognition of EPDS when delayed wound healing and erosive disease occur in the setting of iatrogenic injury to the scalp. Timely treatment with systemic anti-inflammatory agents is paramount to prevent cicatricial alopecia and mitigate further scalp insult in EPDS.

Epidermal growth factor receptor inhibitors are anti-tumour agents that are frequently used for the treatment of neoplastic disorders. In addition to their cutaneous adverse effects, these drugs can rarely lead to erosive pustular dermatosis of the scalp. We report a case of a 67-year-old female who developed erosive pustular dermatosis of the scalp after being started on erlotinib from a trichoscopic perspective, which has been described in literature only once till now. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Erosive pustular dermatosis is a rare and chronic inflammatory condition of the scalp which can be mistaken for cutaneous malignancy, precancerous lesions, dermatitis or pyoderma gangrenosum. The recurrent and resistant characteristics of erosive pustular dermatosis of the scalp pose a challenge to successful management and remission of the condition. The purpose of this case report is to provide management options and treatment recommendations for refractory cases of erosive pustular dermatosis of the scalp. We report a case of erosive pustular dermatosis of the scalp that proved resistant to treatment, with various therapeutic modalities explored to address the persistent condition. In our patient, multiple treatment modalities included topical and oral corticosteroids, topical and oral antibiotics, topical vitamin D analogue, topical calcineurin inhibitor and oral isotretinoin. Based on our findings, refractory disease progression of erosive pustular dermatosis of the scalp may be more responsive to combination therapy rather than monotherapy., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2025.)

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder.

Background: Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory cutaneous disorder typically affecting sun‐damaged skin of mature individuals. Clinical features of EPDS include sterile pustules and chronic crusted erosions that can be hyperkeratotic and lead to scarring alopecia, atrophy, and telangiectasia. While the condition occurs on sun‐damaged skin, a relationship with non‐melanoma skin cancer (NMSC) has not been investigated. Objectives: Here we attempted to identify cases of NMSC developing in the setting of EPDS. Methods: Retrospective review of EPDS cases in a dermatology practice. Results: Six patients with mean (range) age 82 (65–92) years that developed NMSC in the setting of EPDS are reported. Five patients had skin phototype I or II associated with substantial solar elastosis. Four patients had history of NMSC. Four patients developed squamous cell carcinoma and two patients basal cell carcinoma on the scalp in the setting of EPDS. A morphologic change in an EPDS lesion, such as a crusted plaque becoming nodular and/or growing significantly within a relatively short period of time, prompted a biopsy that revealed NMSC. Conclusions: NMSC may develop in the setting of EPDS. Possible mechanisms underlying this association include the chronic inflammation associated with EPDS and ultraviolet light exposure. It is crucial to promptly obtain a biopsy in EPDS cases showing signs suspicious for NMSC. Further studies are required to confirm whether NMSC shows a higher prevalence in the setting of EPDS. [ABSTRACT FROM AUTHOR]

Competing Interests: None disclosed.

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. [ABSTRACT FROM AUTHOR]

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder. [ABSTRACT FROM AUTHOR]

Introduction: Erosive pustular dermatosis of the scalp (EPDS) is a rare and recalcitrant condition in which chronic scalp pustules and erosive patches are diagnosed by nondiagnostic laboratory tests and histopathological tests. Although various precipitating factors including trauma have been reported, erosive pustular dermatosis arising on the long-standing burn scars is rare., Case Presentation: We report three cases of EPDS arising on long-standing burn scars. Based on clinical and histological findings, erosive pustular dermatosis was diagnosed and successfully treated with topical steroid ointment., Conclusion: We propose that chronic burn scar is another precipitating factors for EPDS and clinicians should consider EPDS in differential diagnoses of erosive pustular dermatosis in long-standing burn scars on the scalp., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Background: It is general opinion that histopathology is nonspecific and of little value in diagnosing erosive pustular dermatosis of the scalp (EPDS).Objectives: Clinicopathologic correlation of erosive pustular dermatosis of the scalp.Methods: We reviewed the clinical and pathologic records of patients with a clinicopathologic diagnosis of EPDS between 2011 and 2016 at the Dermatopathology Unit of Turin University.Results: Thirty elderly patients with EPDS were identified (22 men and 8 women). Androgenetic alopecia was present in 19 of 30 patients. Triggering factors included mechanical trauma in 10 of 30 cases, surgical procedures in 4 of 30 cases, and herpes zoster in 1 of 30 cases. Three patients were affected by autoimmune disorders. The vertex was the most common location. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum. The pathologic changes differed according to lesion type and disease duration. Interestingly, a spongiotic and suppurative infundibulo-folliculitis was observed in 8 of 30 cases.Limitations: This was a retrospective study.Conclusions: We believe that the primary lesion of erosive pustular dermatosis of the scalp is a spongiotic, pustular superficial folliculitis. The clinicopathologic similarities with other neutrophilic dermatoses, such as pustular pyoderma gangrenosum, suggest this condition should be included in this spectrum, where pathergy plays a pathogenetic role. [ABSTRACT FROM AUTHOR]

We present a unique patient with erosive pustular dermatosis of the scalp (EPDS) with several unique features: (1) a rare case of EPDS occurring after herpes zoster (HZ) infection and (2) the first reported case of recurrence of HZ induced by topical immunosuppressive therapy (clobetasol 0.05% cream and tacrolimus 0.01% cream) in a patient with underlying EPDS. Based on our patient, we recommend to exercise caution with the prolonged use of potent topical steroids in areas previously affected by herpes zoster. [ABSTRACT FROM AUTHOR]

Erosive pustular dermatosis (EPD) of the legs and the scalp have been described as two separate entities occurring in a different context. We report the original case of a patient with an EPD of both the scalp and legs.

Abstract: Introduction: Erosive pustular dermatosis (EPD) is a cutaneous condition, characterised by sterile pustular lesions, erosions and crusting. Extensive or infected disease may result in scarring. EPD has never been reported following burn. The aim of this study was to describe the presentation and management of EPD complicating burns wounds. Methods: A consecutive series of EPD cases secondary to burn. Results: Six cases were identified. In each case, erosive lesions and crusts were located at the site of burn or at the site of split skin grafting after tangential burn excision. All cases presented as failure to heal or repeated wound breakdown, despite standard burn wound management. Pain was a significant feature in all cases. Microbiological cultures demonstrated either benign colonising bacteria or no pathogens. Time to EPD diagnosis by the interdisciplinary team was 126±27 days (mean±SEM). Topical therapy with short course, potent corticosteroids resulted in clinical remission in 15±2 days (mean±SEM) without clinical relapses after 15±4 months (mean±SEM). Conclusion: EPD may occur following burns. EPD should be considered in the differential diagnosis of a non-healing burn wound and resolves readily with topical potent corticosteroid therapy. [Copyright &y& Elsevier]

Erosive pustular dermatosis is a rare noninfectious disease of the scalp or legs. Clinical findings are nonspecific, with crusts, atrophy, and pustules. A later complication of erosive pustular dermatosis is secondary cicatrical alopecia. The list of possible differential diagnoses is long, and includes infectious, inflammatory, and neoplastic dermatoses. Treatment is challenging. Topical drug therapy may improve the condition, but rarely results in a complete resolution. Surgery has been linked to exacerbation in some patients. In our hands, it achieved complete remission in male patients. [ABSTRACT FROM AUTHOR]

Background: Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory disorder of unknown origin characterized by pustules, erosions, and crusting in areas of alopecia that tend to be atrophic, actinically damaged, or both. The most common treatments reported include antibiotics and topical anti-inflammatories, which can be ineffective. In the search for effective treatment for EPDS, we share our experience with topical dapsone 5% gel. Observations: We present 4 patients with EPDS, all with classic clinical presentations and histologic findings of EPDS, who had failed a variety of treatments including oral, intralesional, or topical steroids, tacrolimus, and antibiotics. All patients demonstrated rapid improvement or resolution with topical dapsone 5% gel. Limitations: Our experience and success with topical dapsone for EPDS is observational and not the result of a randomized controlled trial. Conclusion: Our observations demonstrate topical dapsone 5% gel to be a novel, safe, and efficacious therapeutic alternative for mild to moderate EPDS. [ABSTRACT FROM AUTHOR]

Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp as well as co-existence of auto-immune diseases. Laboratory data, bacteriological and mycological investigations and histopathology are generally not diagnostic. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete resolution in few months. No relapse after 1 year of follow-up was seen. EPDS represents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially resolutive choice. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]