Erosive pustular dermatosis of the scalp

Erosive pustular dermatosis of the scalp is a rare condition characterized by sterile pustules, erosions and crusted lesions on the scalp of elderly patients. It can be misdiagnosed with tinea capitis or even skin cancer, so it is important to be aware of this entity for a correct diagnosis. An 80-year-old Caucasian man presented with a 3 month history of painful erythematous erosions and crusts on his scalp. The lesions appeared after treatment with cryotherapy of actinic keratoses. The patient underwent treatment with topical mupirocine and topical antifungals without success. Physical examination revealed the presence of extensive erosions and crusts along the scalp, with tiny pustules on the sides. The clinical and histopathological findings lead us to the diagnosis of erosive pustular dermatosis of the scalp. Treatment with potent topical corticosteroids twice daily was started with improvement after ten days. A maintenance therapy with topical tacrolimus was initiated without clinical relapse after 3 months.