Erosive Pustular Dermatosis of the Scalp Treated with Serial Debridement: Case Report

Abstract

An 82-year-old man with a past medical history of numerous non-melanoma skin cancers (NMSCs), including unresectable squamous cell carcinoma of the right temple treated with radiation therapy and cemiplimab, presented with worsening erosive pustular dermatosis of the scalp (EPDS). This had initially onset four years prior in the setting of 5-fluorouracil and photodynamic therapy for actinic keratoses. He had failed topical ultra-potent steroids, tacrolimus, and dapsone as well as oral dapsone, doxycycline, and acitretin. The condition’s chronicity and radiation to the area likely exacerbated his EPDS. We pursued serial debridement, followed by clobetasol propionate 0.05% ointment twice daily. The patient reported marked improvement with stable condition between treatments. Upon better control of his EPDS, a suspicious ulcerative lesion under a previously affected area was identified and biopsied, revealing atypical fibroxanthoma. EPDS is an inflammatory dermatosis characterized by pustules, erosions, and crusting, often caused by sun damage, local trauma, and topical medications. First-line treatment is topical corticosteroids. We show that serial debridement is effective for treating recalcitrant EPDS. We emphasize the importance of maintaining adequate control of EPDS to avoid masking suspicious lesions, as the patient demographic affected by EPDS is at high risk for NMSCs.