Chronic atrophic erosive dermatosis of the scalp and extremities: A recharacterization of erosive pustular dermatosis

Background Erosive pustular dermatosis (EPD) is a rarely reported condition that primarily involves the actinically damaged scalp of elderly women. Although the condition is well recognized in the United Kingdom and Europe, no US cases have heretofore been reported. Objectives We sought to document the presence, and determine the clinical characteristics, of EPD in the US population. Methods Patients were recruited from the dermatology clinic at a university in California and from the private practices of dermatologists in the Northern California region. Results Eleven patients with EPD were identified. Eight were women and 3 were men. The scalp was involved in 9 patients and the extremities in two patients. The involved skin was actinically damaged in 9 patients. The patients were elderly (66-90 years) but one patient was a 15-year-old boy. All lesions resolved or greatly improved with the application of high-potency steroids or tacrolimus. Limitations Not all patients were examined personally by the authors of this article. The length of follow-up was relatively short. Conclusions EPD is a fairly common disease and is the most likely diagnosis in instances where chronic, nonhealing, shallow erosions occur on actinically damaged, or otherwise atrophic, skin. In spite of the name, intact pustules are rarely present. The histology is that of moderate to marked, nonspecific chronic inflammation. EPD responds well to high-potency topical steroids.