A Male with an Erythema, Pustules, and Crusts on the Scalp

Abstract

Erosive pustular dermatosis of the scalp (EPDS) is a rare chronic recurring dermatosis, characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The etiopathogenesis of EPDS remains uncertain. Local trauma, skin grafting and prolonged exposure to sunlight on the bald scalp and associations with auto-immune diseases have been reported as the predisposing factors. Histological pictures of EPDS present different patterns depending on the biopsy site and disease duration, but usually nonspecific. Necessary examinations are crucial for confirming/ruling out any other scalp diseases that might be mimicking EPDS. We report the case of a 22-year-old Asian man presented with 8-year history of repeated attacks of pustules, erosions and crusts on his scalp. Physical exam revealed small pustules and crusted lesions in the parietal regions. The front hairline moved back slightly. Biopsy results acanthosis in the epidermis; absence of hair follicles and sebaceous glands with a slight mix of inflammatory infiltrate in the dermis. Clinical and histologic findings were suggestive of EPDS. Lesions on the scalp were treated with topical tacrolimus and oral isotretinoin, which resulted in resolution at a 9-month follow-up. EPDS remains a diagnostic and therapeutic challenge due to its rarity. No standard of care has been established, though oral isotretinoin, nimesulide and zinc sulfate, as well as topical corticosteroids, calcipotriol, and tacrolimus have been reported as possible treatments in the literature.