An 80-Year-Old Man with Erosions on the Scalp

Abstract

Erosive pustular dermatosis of the scalp is a rare inflammatory condition of the scalp The etiopathology of the disease is not fully described. The possible trigger factors are prior trauma, radiation, herpes zoster, treatment with topical fluorouracil or imiquimod, cryotherapy, and photodynamic therapy. The lesions typically occurs 6 months after the triggering event. The disease mainly affects elderly with aging of onset at 60–70 years. Clinically, it is characterized by recurrent pustules, inflamed erosions and grey, yellow or yellow-brown crusts that lead to the scarring alopecia. Affected areas undergo a continuous cycle of healing and recurrences with a fluctuating course. The vertex is the most common location for erosive pustular dermatosis of the scalp, followed by the frontal and the parietal areas. Diagnosis of the disease is based on a combination of history, physical examination, trichoscopy, and histopathology. Potent or ultrapotent topical corticosteroids and topical calcineurin inhibitors are usually first line treatment. Moreover, the improvement after topical calcipotriene (calcipotriol), systemic prednisone, doxycycline, isotretinoin or acitretin, dapsone and zinc has been described.