Erosive Pustular Dermatosis of the Scalp Treated with Serial Debridement: Case Report

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Brenna Douthitt
Lydia A. Luu
R. Hal Flowers


erosive pustular dermatosis, debridement, skin cancer, case report


An 82-year-old man with a past medical history of numerous non-melanoma skin cancers (NMSCs), including unresectable squamous cell carcinoma of the right temple treated with radiation therapy and cemiplimab, presented with worsening erosive pustular dermatosis of the scalp (EPDS). This had initially onset four years prior in the setting of 5-fluorouracil and photodynamic therapy for actinic keratoses. He had failed topical ultra-potent steroids, tacrolimus, and dapsone as well as oral dapsone, doxycycline, and acitretin. The condition’s chronicity and radiation to the area likely exacerbated his EPDS. We pursued serial debridement, followed by clobetasol propionate 0.05% ointment twice daily. The patient reported marked improvement with stable condition between treatments. Upon better control of his EPDS, a suspicious ulcerative lesion under a previously affected area was identified and biopsied, revealing atypical fibroxanthoma. EPDS is an inflammatory dermatosis characterized by pustules, erosions, and crusting, often caused by sun damage, local trauma, and topical medications. First-line treatment is topical corticosteroids. We show that serial debridement is effective for treating recalcitrant EPDS. We emphasize the importance of maintaining adequate control of EPDS to avoid masking suspicious lesions, as the patient demographic affected by EPDS is at high risk for NMSCs.


1. Pye RJ, Peachey RD, Burton JL. Erosive pustular dermatosis of the scalp. Br J Dermatol. 1979;100(5):559–66.

2. Karanfilian KM, Wassef C. Erosive pustular dermatosis of the scalp: causes and treatments. Int J Dermatol. 2021 Jan;60(1):25–32.

3. Lee KH, Carley SK, Kraus CN, Mesinkovska NA. Treatment of erosive pustular dermatosis: a systematic review of the literature. Int J Dermatol. 2020;59(7):770–86.

4. Shavit E, Alkallabi M, Alavi A. Scalp ulcers – differential diagnoses that should be sought! Int J Dermatol. 2019;58(11):1283–92.

5. 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.

6. Starace M, Loi C, Bruni F, Alessandrini A, Misciali C, Patrizi A, et al. Erosive pustular dermatosis of the scalp: Clinical, trichoscopic, and histopathologic features of 20 cases. J Am Acad Dermatol. 2017 Jun 1;76(6):1109-1114.e2.

7. Junejo MH, Kentley J, Rajpopat M, Tan XL, Mohd Mustapa MF, Harwood CA. Therapeutic options for erosive pustular dermatosis of the scalp: a systematic review. Br J Dermatol. 2021 Jan;184(1):25–33.

8. Trüeb RM, Krasovec M. Erosive pustular dermatosis of the scalp following radiation therapy for solar keratoses. Br J Dermatol. 1999 Oct;141(4):763–5.

9. Starace M, Iorizzo M, Trüeb RM, Piccolo V, Argenziano G, Camacho FM, et al. Erosive pustular dermatosis of the scalp: a multicentre study. J Eur Acad Dermatol Venereol JEADV. 2020 Jun;34(6):1348–54.

10. Leung N, Eldik H, Ramirez MR, Sodha P. Oral Tofacitinib Treatment of Erosive Pustular Dermatosis of the Scalp. JAMA Dermatol. 2019 Jun 1;155(6):752–4.

11. Deb PQ, Cai D, Bhate C. Erosive pustular dermatosis of the scalp may not be mutually exclusive with other dermatoses. Clin Dermatol. 2021 Jun;39(3):489–92.

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