Erosive Pustular Dermatosis of the Scalp Induced by Imiquimod

An 84-year-old Caucasian man developed erosive pustular dermatosis of the scalp (EPDS), a rare condition characterized by sterile pustules, erosions, and crusted lesions, after using imiquimod cream to treat actinic keratoses. His condition, which did not improve with topical antibiotics and steroids, was diagnosed as EPDS based on clinical features and medical history. Systemic steroid treatment led to significant improvement within ten days and complete resolution after two months, without any relapses. This case highlights the importance of considering EPDS in the differential diagnosis for persistent erosive pustular dermatosis of the scalp, especially in patients treated with imiquimod, as it can lead to scarring alopecia if not adequately treated.