Erosive Pustular Dermatosis: An important differential diagnosis for the non-healing burn wound

Erosive Pustular Dermatosis (EPD) presents a diagnostic challenge due to its non-specific biopsy findings and clinical features which overlap with other dermatological conditions but should be suspected in non-healing burns wounds. We present our experience with the condition and an investigation and treatment algorithm.

Three cases of EPD complicating burn wound healing are presented; two males and one female, aged 32, 40 and 56 respectively, with an average total body surface area of 33% (range 24-46%).

The average time post-burn before EPD was suspected was 18.9 months (range 3.6-34.2 months). All three patients began treatment with potent topical steroids, following dermatological advice. Their wounds fully healed within an average of 32 days (range 27-37 days) and they remain healed after a weaning protocol.

We propose a diagnostic and therapeutic algorithm for the investigation and management of suspected EPD in the non-healing burn wound to promote early detection and treatment, thus reducing the ongoing burden of injury for burn survivors. Moving forward, it is essential for burn care providers to be aware of and maintain a high index of suspicion for EPD in patients with non-healing burn wounds, especially those resistant to conventional treatments.