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Erosive pustular dermatosis

What is it erosive pustular skin disease?

Erosive pustular dermatosis presents with located areas of pustuleseroded, lakes of pus, or crusts, that overlap plates or nodules and mainly affects the sun damaged bald scalp of elderly people.

Erosive pustular dermatosis is also known as erosive pustulosis and erosive pustular dermatosis of the scalp.

Who gets erosive pustular dermatosis?

Erosive pustular dermatosis occurs in men and women; The most affected people are over 80 years old and have actinic keratosis and a history of scaly cell carcinoma or (less frequently) basal cell carcinoma of the scalp. Usually affects areas of scars, as they arise after injury, skin Cancer surgery or shingles. As another neutrophilic skin disease, may be more common in association with immunosuppressionrheumatoid arthritis and myeloid hematological disorders

Erosive pustular dermatosis has been reported as an adverse effect of epidermal growth factor receiver inhibitors, such as gefitinib.

What is the cause of erosive pustular dermatosis of the scalp?

The cause of erosive pustular dermatosis of the scalp is unknown. However, it seems to be related to sun damage. It is often triggered by a minor injury to the affected skin (including a surgical procedure) (pathergy), and defective wound healing may be involved. Infection it is not believed to be the primary cause, since the lesions do not go away with antibiotics alone.

When it affects the lower legs, venous stasis and edema may be involved.

What are the clinical features of erosive pustular dermatosis?

Erosive pustular dermatosis usually begins with small pustules on the scalp, forehead, or temples. It has also been reported to affect the lower legs.

Pustules develop into yellow-brown or greenish lakes of pus or crusts. If they are removed, the skin underneath is red and wet. Extensive disease can lead to extensive scarring and baldness.

Erosive pustular dermatosis


Erosive pustular dermatosis


Erosive pustular dermatosis


Erosive pustular dermatosis

What are the complications of erosive pustular dermatosis?

The main complications of erosive pustular dermatosis are:

  • Located hair loss, which can be temporary or permanent
  • Secondary bacterial infection
  • Skin cancer.

How is erosive pustular dermatosis diagnosed?

Erosive pustular dermatosis is diagnosed by its characteristic clinical appearance. Culture of bacterial swabs can reveal Staphylococcus aureus. Scrapings for mycology can be done to rule out tinea capitis and kerion.

The underlying eroded skin frequently suffers biopsyas it is often difficult to determine clinically if there is an underlying skin cancer. Multiple and deep biopsies It can be useful. Histopathology shows subcorneal and notfollicular epidermal pustules hypertrophyor atrophy and erosions. There is a mix dermal inflammatory infiltrate. what includes plasma cells and neutrophils. Results are often nonspecific.

Which is the differential diagnosis for erosive pustular dermatosis?

Other conditions that should be considered in the differential diagnosis of erosive pustular dermatosis include:

  • Squamous cell carcinoma or other skin cancer

  • Brunsting-Perry kind of mucous membrane pemphigoid
  • Bacterial infection or fungal infection

  • Folliculitis decalvans.

What is the treatment for erosive pustular dermatosis?

the crust should be removed by gentle soaking, perhaps using potassium permanganate (Condy's crystals) or acetic acid solution (diluted vinegar) as an antiseptic astringent. A soft wound dressing is then applied.

Secondary bacterial infection should be treated with oral antistaphylococcal antibiotics such as flucloxacillin or erythromycin.

Erosive pustular dermatosis of the scalp improves with powerful or ultra-powerful current Steroids are applied once or twice a day to the affected areas for a couple of weeks, then repeated as needed if the skin disorder reappears. If long-term topical steroid is required, a calcineurin inhibitor such as tacrolimus ointment It may be more suitable.

Other treatments that are reported to be helpful include:

  • Anti-inflammatory antibiotics for six weeks or more (eg, minocycline)
  • Calcipotriol cream to reduce climbing

  • Cryotherapy of underlying actinic keratoses
  • Topical dapsone
  • Zinc sulfate
  • Photodynamic therapy
  • Oral retinoids, acetretin and isotretinoin.

Can erosive pustular dermatosis be prevented?

Patients diagnosed with erosive pustular dermatosis should protect themselves from the sun (wear a wide-brimmed hat when outdoors) and be vigilant for early signs of reappearance, which should be treated as above.

New actinic keratoses and skin cancers, especially squamous cell carcinoma, can develop in the affected areas and should be diagnosed and treated promptly. They can be difficult to distinguish from erosive pustular dermatosis of the scalp, so repeat biopsies may be necessary.

What is the prognosis for erosive pustular dermatosis?

Erosive pustular dermatosis usually goes away with treatment, but it can recur. The same treatment should be restarted, after careful re-examination of the skin to identify underlying skin cancers, if present.