Erosive pustular dermatosis of the scalp from topical minoxidil 5% solution

A 77-year-old woman with type II diabetes and chronic obstructive pulmonary disease developed erosive pustular dermatosis of the scalp (EPDS) after using a 5% minoxidil solution for female-type androgenetic alopecia. The condition, which began as itchy, scaly skin changes and progressed to pustules and erosions, did not respond to oral and topical antibiotics or antifungals. No bacterial or fungal growth was found in cultures, and patch testing for minoxidil did not show any reactions. Histologic examination supported the diagnosis of EPDS. The patient's condition improved markedly after an eight-week treatment with topical 0.05% clobetasol propionate foam, although she was left with residual scarring alopecia. This case is notable as EPDS from topical minoxidil has not been previously reported in the literature, and the alcoholic solution of minoxidil may have been the triggering factor.