History
In erosive pustulosis of the scalp patients, a history of trauma or long-term sun exposure to the affected area can usually be established. Erosive pustulosis of the scalp is generally chronic and may have associated pruritus and/or pain. Patients with extremity involvement may report a history of chronic leg ulcers or chronic venous insufficiency. [19]
Physical Examination
Patients present with varying degrees of scarring associated with yellow-brown crusts, erosions, purulent drainage, pustules, and lakes of pus. Pustules may not be visualized, and, when seen, they are usually flattened and contain little or no fluid. Skin surrounding the erosions is almost always atrophic. Purulence may suggest infection, but edema, warmth, and regional lymphadenopathy are typically absent. [6]
Complications
Malignancy may develop in areas involved by erosive pustulosis of the scalp. Additionally, recurrence of erosive pustulosis of the scalp has been reported with cessation of treatment, but it tends to respond well to restarting the initial treatment. [5] Secondary infection may also occur.
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Yellow-brown crusts with atrophy on the vertex scalp.
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Yellow-brown crusts on the vertex scalp.
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A dense perifollicular infiltrate is composed of lymphocytes, neutrophils, histiocytes, and multinucleated giant cells (hematoxylin and eosin, 200x).
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Closer examination shows a predominantly neutrophilic infiltrate with a background of admixed lymphocytes and histiocytes (hematoxylin and eosin, 400x).
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Erosive pustular dermatosis on the bilateral lower extremities in a woman with history of extensive UV exposure.
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Crusts with underlying purulence on the lower extremity.
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Erosive pustulosis of the scalp prior to curettage.
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Erosive pustulosis of the scalp 4 weeks following two treatments of curettage debridement with electrodesiccation performed at 3-week intervals.
