Erosive Pustular Dermatosis of the Arm Following Burn Injury

Abstract

® ), sulphadiazine silver cream, bucladesine sodium, hydro-fibre, and hydrocolloid, but all were negative. A biopsy on her left arm showed subcorneal and intraepidermal pustules filled with neutrophils, spongiosis at the epidermis, and diffuse dermal inflammatory infiltrate consisting of neutrophils, lym- phocytes and erythrocytes. No signs of granuloma or vasculitis were observed (Fig. 2). The area taken for biopsy ulcerated. Considering the distinctive characteristic clinical course and histologically non-specific inflammatory findings, we concluded that the patient had EPD. Al though we initially chose topical betamethasone dipropionate cream, the condi - tion did not improve; therefore, we started oral prednisolone, 20 mg daily. The lesion resolved gradually and the dosage of prednisolone was tapered by 5 mg every week. When tapered to 10 mg daily, the condition did not improve further, there- fore the dose was increased again to 15 mg daily and tapered carefully while monitoring her condition. If the lesion flared up, the dose of prednisolone was increased again. During the first year, 10-20 mg oral prednisolone was administered daily. It was tapered gradually to 5 mg daily over the following years. In addition, the topical steroid was changed to betamethasone valerate cream. The patient still takes oral prednisolone, 5 mg daily. The lesion on her upper arm resolved completely after approximately one year, while the lesion on her forearm has continued as erosions covered by pustules and crusted plaques until now, 3.5 years later.