Erosive Pustular Dermatosis of the Scalp Following Topical Ingenol Mebutate for Actinic Keratoses
July 2017
in “
Dermatologic Therapy
”
erosive pustular dermatosis of the scalp EPDS ingenol mebutate actinic keratosis cryotherapy ALA photodynamic therapy erythema pustules crusts methylprednisolone clobetasol propionate scarring alopecia chronic inflammatory disease local trauma sun-damaged scalp skin Picato cryosurgery PDT steroid topical steroid hair loss inflammation skin damage
TLDR Two elderly men developed scalp inflammation after using a gel for skin lesions, which healed with treatment except for some permanent hair loss.
In the 2017 study, two elderly men, aged 74 and 85, developed erosive pustular dermatosis of the scalp (EPDS) after using ingenol mebutate gel to treat recurrent actinic keratosis. Both patients had a history of actinic keratosis treated with different methods (cryotherapy and ALA photodynamic therapy) and applied ingenol mebutate gel over a 25 cm² area of the scalp. They presented with symptoms 25 to 35 days after the last application, showing erythema, pustules, and crusts on the scalp. Bacterial and fungal infections were ruled out, and systemic diseases were excluded. The patients were treated with oral methylprednisolone and clobetasol propionate foam, leading to complete resolution of the lesions after eight weeks, except for some scarring alopecia areas. The study concluded that the clinical features and rapid resolution with treatment supported the diagnosis of EPDS, a chronic inflammatory disease that usually leads to scarring alopecia and is often triggered by local trauma on sun-damaged scalp skin. The paper suggests that further research is needed to understand the tissue changes that predispose to EPDS and the molecular targets of the immune response involved.
