Erosive pustular dermatosis of the scalp - Hair and Scalp
The etiology of EPD remains unknown. However, it is claimed that the major predisposing condition is cutaneous atrophy, which is primarily the result of actinic damage on the scalp and stretching of the skin secondary to the edema of venous insufficiency on the legs. Given this predisposing condition, EPD then develops from one or more triggering factors like physical, medical, or surgical trauma. The inflammation induced by this trauma probably plays an important role as well. Moreover, association of EPD with autoimmune disorders like rheumatoid arthritis, Hashimoto's thyroiditis, autoimmune hepatitis, and Takayasu's aortitis suggests that the physical trauma to the skin might trigger production of auto-antibodies against skin structures, resulting in a secondary inflammatory reaction.
Erosive pustular dermatosis is clinically characterized by sterile pustules and chronic crusted erosions. Crusts resolve leaving atrophic skin, and new areas of pustulation develop within a few days. Often, the presence of crusted erosions or ulcers predominates, and pustules are not seen.
EPD has a chronic, recurring, and slow but progressive course. Scarring alopecia and cutaneous malignancies such as basal cell carcinoma and squamous cell carcinoma may eventuate in the scar tissue.
L98.8 – Other specified disorders of the skin and subcutaneous tissue
238733003 – Erosive pustular dermatosis of the scalp
- Chronic bacterial or fungal infection – Response to antibacterial or antimycotic medications; bacterial or fungal cultures are positive for the etiologic organisms.
- Folliculitis decalvans – Staphylococcus aureus usually contributes to the pathology. Emergence of several hairs from a single hair follicle (so-called "tufting") is characteristic. Histopathologically, together with suppurative folliculitis, interstitial and perifollicular infiltrate with neutrophil predominance is noted.
- Dissecting cellulitis – Look for draining sinus tracts, scalp nodules, cysts, and abscesses. Also, it may be associated with other diseases characterized by follicular occlusion and secondary infection such as acne conglobata and hidradenitis suppurativa.
- Irritated actinic keratosis
- Squamous cell carcinoma
- Pyoderma gangrenosum
- Pustular psoriasis
- Subcorneal pustular dermatosis
- Darier's disease
- Histiocytosis X