Erosive Pustular Dermatosis of the Scalp: Challenges and Solutions

Erosive pustular dermatosis of the scalp (EPDS) is a rare chronic inflammatory disorder that typically affects elderly people, leading to pustular lesions, erosions, and crusts on the scalp, and in advanced stages, scarring alopecia. The cause of EPDS is not fully understood, but skin trauma and autoimmune mechanisms are known predisposing factors. Associated diseases include autoimmune disorders such as rheumatoid arthritis and Hashimoto thyroiditis. Diagnosis is based on a combination of predisposing factors, clinical manifestations, non-specific histology, and negative laboratory investigations for other diseases. Treatments include topical high-potency corticosteroids, retinoids, and photodynamic therapy, although relapses after discontinuation of treatment are common. The study suggests that early treatment can lead to a greater response with minimal risk of recurrence, and long-term follow-up is advisable to monitor for possible relapses or the development of cutaneous malignancy.