Erosive pustular dermatosis—a common development in atrophic skin

Abstract

Erosive pustular dermatosis (EPD), an ulcerated eruption with loosely attached scale overlying macerated tissue with pustulation, has been described on the scalp, mainly in women, and responds to topical steroids.1 However, many patients with long-standing damaged skin show identical changes, particularly well seen around stasis ulcers. Thirty consecutive patients with venous ulceration were examined for the changes of erosive pustular dermatosis using a 9-point check list which included pustulation, loose scale, maceration etc. Twenty-eight patients gave a history of varicose veins and five of deep venous thrombosis. Seventeen patients showed definite clinical changes of erosive pustular dermatosis, four showed some evidence and nine showed no changes. Patient details are shown in the Table. Table 1. Patient details Age (years) Ulcer duration (years) No. M F Mean (Range) Mean (Range) EPD +ve 17 6 II 62·8(27–79) 11·8(1–30) EPD -v e 9 6 3 61·5(40–84) 7·0(1–15) EPD equivocal 4 1 3 71·3(61–80) 10·0(4–15) Total 30 13 17 63·8 (27–84) 9·7 (1–30) It can be seen that patients with longer duration of ulceration showed a trend towards erosive pustular dermatosis, and this was most commonly seen in patients with dermatoliposclerosis. These latter changes were seen histologically in skin biopsies from two positive cases. Immunochemical analysis of the loosely adherent scale overlying macerated tissue in three patients confirmed this to be keratin rather than necrotic debris. All patients in the positive group responded to potent topical steroids. We feel that the changes of erosive pustular dermatosis are a common accompaniment to long-standing atrophic skin damage, particularly around stasis ulcers, and may proceed to frank ulceration, and these changes respond well to potent topical corticosteroids.