engleski

Recurrent ulceration of the scalp in an elderly female

Introduction Erosive pustular dermatosis of the scalp (EPDS) is a chronic inflammatory skin disease typically affecting elderly patients following a history of extensive sun exposure or after local trauma. Most commonly it presents on the scalp and progresses slowly over the years. We hereby present a case of a 68-year old women with EPDS. Results The first symptoms of the disease started with itching and burning sensation in the parietal region of the scalp followed by development of multiple superficial erosions and a deeper ulceration with peripheral yellow-brown keratotic crusts. Over a period of three years, multiple skin biopsies were undertaken for histopathological and immunofluorescent studies, which excluded a diagnosis of skin neoplasm and bullous dermatoses. Skin swabs showed the presence of multi-sensitive Staphylococcus aureus or Staphylococcus epidermidis, while mycological investigations remained negative. The patient was treated with topical and systemic antibiotics, topical corticosteroids and different wound dressings resulting in only partial improvement and development of scarring alopecia over the entire vortex area. However, she experienced multiple recurrences characterized by intense itching and burning sensation. Due to unsatisfactory therapeutic results, the patient was admitted to hospital and treated with topical corticosteroid and antibiotic ointments in adjunction to the application of hydrocolloid non- adherent wound dressing leading to almost complete closure of eroded areas within only 10 days. Successful maintenance over the 6-month follow up period was achieved with once a day application of tacrolimus ointment. Discussion Erosive pustular dermatosis of the scalp is excruciating chronic disease leading to cicatricial alopecia. The pathogenesis is unknown, but multiple triggering factors have been recognized, such as local trauma, surgery, cryotherapy, radiotherapy, imiquimod, and exposure to ultraviolet light. EPDS has no pathognomonic histopathological findings ; it is a clinical diagnosis of exclusion and should be suspected in an elderly patient presenting with scalp erosions, ulcerations or scarring alopecia. Multiple treatment options have been reported, with various success. In the presented case, we have achieved a very good response to potent topical corticosteroids in combination with topical tacrolimus as maintenance therapy.

Erosive pustular dermatosis of the scalp ; Wound ; Cicatricial alopecia ; topical corticosteroids ; topical tacrolimus

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