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Erosive Pustulosis of the Scalp Medication

  • Author: Kristin L Eastman, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 05, 2014
 

Medication Summary

High-potency topical corticosteroids are the most commonly reported effective treatment for erosive pustulosis of the scalp. Topical tacrolimus is also reported to be useful and, when it works, may avoid the development of atrophy secondary to topical steroid therapy. For patients who do not respond to these medications, limited evidence supports trials of topical calcipotriol, topical and oral retinoids, and/or oral zinc sulfate.[3, 4, 18]

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Corticosteroids, topical (high potency)

Fluocinonide (Fluonex)

 

High-potency steroid that inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory. Also has antipruritic and vasoconstrictive properties.

Clobetasol (Clobex)

 

High-potency steroid that inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory. Also has antipruritic and vasoconstrictive properties.

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Immunosuppressant agents

Tacrolimus (Protopic)

 

Mechanism of action in atopic dermatitis is not known. Reduces itching and inflammation by suppressing release of cytokines from T cells. Also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in the early stages of T-cell activation. Additionally, may inhibit release of preformed mediators from skin mast cells and basophils, and may down-regulate expression of FCeRI on Langerhans cells. Can be used in patients as young as 2 y. Drugs of this class are more expensive than topical corticosteroids. Available as ointment in concentrations of 0.03 and 0.1%. Indicated only after other treatment options have failed.

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Topical skin products

Calcipotriene (Dovonex)

 

Synthetic vitamin D-3 analog that regulates skin cell production and development. Inhibits epidermal proliferation, promotes keratinocyte differentiation, and has immunosuppressive effects on lymphoid cells. Used in treatment of moderate plaque psoriasis. Use 0.005% cream, ointment, or solution.

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Antineoplastic agents, retinoid

Tretinoin topical (Retin-A)

 

Inhibits microcomedo formation and eliminates lesions present. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025, 0.05, and 0.1% creams. Available also as 0.01 and 0.025% gels.

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Antipsoriatic agents, systemic

Acitretin (Soriatane)

 

Metabolite of etretinate and related to both retinoic acid and retinol (vitamin A). Mechanism of action unknown; however, thought to exert therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.

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Minerals, parenteral

Zinc

 

Co-factor for >70 types of enzymes. Plays a role in many metabolic processes. Higher requirement may be indicated in pregnancy.

Use sulfate or gluconate zinc salts. Zinc sulfate 4.4 mg = 1 mg of elemental zinc. Zinc gluconate 7.1 mg = 1 mg of elemental zinc.

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Contributor Information and Disclosures
Author

Kristin L Eastman, MD Resident Physician, Department of Dermatology, University of Wisconsin School of Medicine and Public Health

Kristin L Eastman, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society, Chicago Dermatological Society, Wisconsin Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Bennett, MD Assistant Professor, Department of Dermatology, University of Wisconsin School of Medicine and Public Health

Daniel D Bennett, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Society for Investigative Dermatology, Dermatology Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kathryn Schwarzenberger, MD Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care

Kathryn Schwarzenberger, MD is a member of the following medical societies: Women's Dermatologic Society, American Contact Dermatitis Society, Medical Dermatology Society, Dermatology Foundation, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Cary Chisholm, MD Dermatopathology Fellow, Department of Dermatology, University of Texas Southwestern Medical Center

Cary Chisholm, MD is a member of the following medical societies: College of American Pathologists, Texas Medical Association, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Eiriny M Tadros, MD Resident Physician, Department of Internal Medicine, Baylor College of Medicine

Eiriny M Tadros, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

References
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  2. Semkova K, Tchernev G, Wollina U. Erosive pustular dermatosis (chronic atrophic dermatosis of the scalp and extremities). Clin Cosmet Investig Dermatol. 2013. 6:177-82. [Medline]. [Full Text].

  3. Van Exel CE, English JC 3rd. Erosive pustular dermatosis of the scalp and nonscalp. J Am Acad Dermatol. 2007 Aug. 57(2 Suppl):S11-4. [Medline].

  4. Patton D, Lynch PJ, Fung MA, Fazel N. Chronic atrophic erosive dermatosis of the scalp and extremities: A recharacterization of erosive pustular dermatosis. J Am Acad Dermatol. 2007 Sep. 57(3):421-7. [Medline].

  5. Aigner B, Legat FJ, Schuster C, El Shabrawi-Caelen L. Sun-induced Pustular Dermatosis of the Scalp - A New Variant of Erosive Pustular Dermatosis of the Scalp?. Acta Derm Venereol. 2013 Nov 21. [Medline].

  6. Al-Benna S, Johnson K, Perkins W, O'Boyle C. Erosive pustular dermatosis: new description of a possible cause of the non-healing burn wound. Burns. 2014 Jun. 40(4):636-40. [Medline].

  7. Guarneri C, Vaccaro M. Erosive pustular dermatosis of the scalp following topical methylaminolaevulinate photodynamic therapy. J Am Acad Dermatol. 2009 Mar. 60(3):521-2. [Medline].

  8. Tavares-Bello R. Erosive pustular dermatosis of the scalp. A chronic recalcitrant dermatosis developed upon CO2 laser treatment. Dermatology. 2009. 219(1):71-2. [Medline].

  9. Marzano AV, Ghislanzoni M, Zaghis A, Spinelli D, Crosti C. Localized erosive pustular dermatosis of the scalp at the site of a cochlear implant: successful treatment with topical tacrolimus. Clin Exp Dermatol. 2009 Jul. 34(5):e157-9. [Medline].

  10. Erdmann M, Kiesewetter F, Schuler G, Schultz E. Erosive pustular dermatosis of the leg in a patient with ankylosing spondylitis: neutrophilic dysfunction as a common etiological factor?. Int J Dermatol. 2009 May. 48(5):513-5. [Medline].

  11. Mehmi M, Abdullah A. Erosive pustular dermatosis of the scalp occurring after partial thickness skin graft for squamous cell carcinoma. Br J Plast Surg. 2004 Dec. 57(8):806-7. [Medline].

  12. Laffitte E, Kaya G, Piguet V, Saurat JH. Erosive pustular dermatosis of the scalp: treatment with topical tacrolimus. Arch Dermatol. 2003 Jun. 139(6):712-4. [Medline].

  13. Seez M, Rodriguez-Martín M, Sidro M, Carnerero A, Garcia-Bustínduy M, Noda A. Successful treatment of erosive pustular dermatosis of the scalp with topical tacrolimus. Clin Exp Dermatol. 2005 Sep. 30(5):599-600. [Medline].

  14. Zahdi MR, Seidel GB, Soares VC, Freitas CF, Mulinari-Brenner FA. Erosive pustular dermatosis of the scalp successfully treated with oral prednisone and topical tacrolimus. An Bras Dermatol. 2013 Sep-Oct. 88(5):796-8. [Medline]. [Full Text].

  15. Meyer T, Lopez-Navarro N, Herrera-Acosta E, Jose A, Herrera E. Erosive pustular dermatosis of the scalp: a successful treatment with photodynamic therapy. Photodermatol Photoimmunol Photomed. 2010 Feb. 26(1):44-5. [Medline].

  16. Levakov O, Gajic B. Erosive pustular dermatosis of the scalp-is it really a rare condition?. Vojnosanit Pregl. 2014 Mar. 71(3):307-10. [Medline].

  17. Allevato M, Clerc C, del Sel JM, Donatti L, Cabrera H, Juarez M. Erosive pustular dermatosis of the scalp. Int J Dermatol. 2009 Nov. 48(11):1213-6. [Medline].

  18. Ikeda M, Arata J, Isaka H. Erosive pustular dermatosis of the scalp successfully treated with oral zinc sulphate. Br J Dermatol. 1982 Jun. 106(6):742-3. [Medline].

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Yellow-brown crusts with atrophy on the vertex scalp.
Yellow-brown crusts on the vertex scalp.
A dense perifollicular infiltrate is composed of lymphocytes, neutrophils, histiocytes, and multinucleated giant cells (hematoxylin and eosin, 200x).
Closer examination shows a predominantly neutrophilic infiltrate with a background of admixed lymphocytes and histiocytes (hematoxylin and eosin, 400x).
 
 
 
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