Pustulosis aguda erosiva del cuero cabelludo / Erosive pustular dermatosis of the scalp

La Pustulosis Erosiva del cuero cabelludo fue descrita por primera vez por Pye, Peachy y Burton en 1979, en mujeres mayores¹. De etiología y patogenia no del todo clara, se relaciona con exposición a trauma local. Se presenta como lesiones erosivas, costrosas y pustulosas de carácter estéril. Su cuadro histológico no es específico, por lo que el diagnóstico es de exclusión. Se han reportado múltiples tratamientos, pero los que han demostrado mejor resultado se basan en el uso de corticoides tópicos de alta potencia y retinoides orales. Presentamos un caso de pustulosis erosiva del cuero cabelludo en un paciente varón y una revisión de los principales aspectos clínicos e histopatológicos de esta enfermedad.

In 1979 Pye, Peachy and Burton described the Erosive Pustular Dermatosis of the scalp in elder women. The etiology and pathogenesis is still unknown; nonetheless, it is most commonly associated with the exposure to local trauma. The disease is manifested as sterile erosive, crusty and pustular lesions on the scalp. Its histological profile is unspecific; therefore, it is a diagnosis of exclusion. Multiple treatments have been reported, high-potency topical corticosteroids and oral retinoids have shown favorable response. Herein we present a case of an erosive pustular dermatosis of the scalp on a male patient and a review of the clinical and histological characteristics of this disease.

Arterite de Takayasu e ulceração no couro cabeludo em mulher com 24 anos etários / Takayasu?s arteritis and ulceration of the scalp in a 24-year-old woman

O objetivo é descrever dados clínicos e de imagem em mulher de 24 anos com arterite de Takayasu, que apresentou extensa ulceração de difícil controle no couro cabeludo. Houve acometimento da pele, do tecido subcutâneo, de músculos e ossos parietais subjacentes. A paciente relatou fraqueza nos membros superiores, mais intensa à esquerda, e isquemia intermitente nas quatro extremidades. Ao exame, havia ausência bilateral de pulsos braquiais, radiais e ulnares. Os pulsos tibiais posteriores e pediosos tinham suas amplitudes diminuídas. Constatou-se pressão arterial de 86 por 54 mmHg no braço esquerdo e 100 por 62 mmHg no direito. A associação de arterite de Takayasu com ulceração cutânea é incomum, em especial no couro cabeludo, e deve ser considerada a dermatose pustulosa erosiva como diagnóstico diferencial dessa condição.

The aim is to describe clinical and imaging data of a 24-year-old woman with Takayasu?s arteritis and presenting an extensive ulceration of difficult control in the scalp. There was involvement of the skin and subcutaneouslayer, in addition to the subjacent muscles and parietal bones. The patient claimed of weakness on the upper limbs more intense at the left, and intermitent ischemia in all the extremities. Physical examination showed bilateral absence of brachial, radial, and ulnar pulses, and posterior tibial and dorsalis pedis pulses had reduced amplitudes. Blood pressure levels were 86/54 mmHg on the left arm and 100/62 mmHg on the right arm. Association between Takayasu?s arteritis and skin ulcers is uncommon, in special on the scalp, and erosive pustular dermatosis must be considered as a differential diagnosis of this condition.

Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus

Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of the elderly characterized by multiple pustular lesions with erosions and crusting that result in scarring alopecia. EPDS typically develops in aged or sun-damaged skin with a history of trauma. Histopathologically, EPDS is nonspecific, showing atrophic epidermis and chronic inflammation. Bacteriological and mycological investigations of EPDS are generally negative. Although herpes zoster is a common disorder in elderly people, previously reported cases of EPDS were rarely associated with herpes zoster. We present a rare case of EPDS following herpes zoster treated successfully with topical tacrolimus.

A Case of Erosive Pustular Dermatosis of the Scalp / 대한피부과학회지

Erosive pustular dermatosis of the scalp is a rare disorder of the elderly and it is characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The predisposing factors have been reported to be trauma, including mechanical trauma, skin grafting, surgery and prolonged exposure of a bald scalp to UV light. Yet the laboratory data, the bacteriological and mycological investigations and the histopathologic findings of the previously reported cases were generally negative and not diagnostic. We herein present a case of erosive pustular dermatosis of the scalp that occurred after mechanical trauma on the previous skin graft site. This type of case has not been previously reported in the Korean dermatologic literature.