Erosive pustular dermatosis of the scalp
Erosive pustular dermatosis of the scalp is a condition in which tiny pustules form on the scalp, forehead or temples of the elderly. A similar condition may arise on the legs. Erosive pustular dermatosis of the scalp affects severely sun damaged skin usually in areas of scarring such as after injury, skin cancer surgery or shingles.
The pustules evolve into yellow brown crusts. If these are removed, the skin underneath is red and moist. Extensive disease can itself result in scarring and extensive balding. The pustules are often colonised by bacteria such as Staphylococcus aureus (impetigo).
What is the cause of erosive pustular dermatosis of the scalp?
The cause of erosive pustular dermatosis of the scalp is unknown. However, it appears to relate to sun damage and is possibly triggered by a minor injury to the affected skin (including a surgical procedure). Infection is not thought to be the primary cause, as the lesions do not clear with antibiotics alone.
The crusting should be removed by gentle soaking, perhaps using potassium permanganate (Condy's crystals) or acetic acid solution (dilute vinegar) as antiseptic astringent.
Secondary infection should be treated with oral anti-Staphylococcal antibiotics such as flucloxacillin or erythromycin.
Erosive pustular dermatosis of the scalp improves with potent or ultrapotent topical steroids applied once or twice daily to the affected areas for a couple of weeks, then repeated as necessary if and when the skin disorder recurs.
Other helpful treatments include:
- Anti-inflammatory antibiotics for six weeks or more (e.g. minocycline)
- Calcipotriol cream
Patients with erosive pustular dermatosis of the scalp should see their medical practitioner or dermatologist regularly. New solar keratoses and skin cancers may arise in the affected areas and should be treated promptly. They may be difficult to distinguish from erosive pustular dermatosis of the scalp so biopsies may be necessary.