Topical tacrolimus in the treatment of erosive pustular dermatosis of the scalp.
BACKGROUND
Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation.


METHODS
A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth.


CONCLUSIONS
This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.
Cenkowski
Marta J
MJ
Faculty of Medicine and the Division of Dermatology, University of Manitoba, Winnipeg, MB, Canada.
Silver
Shane
S
D000368:Aged; D000505:Alopecia / Q000188:drug therapy / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D012536:Scalp Dermatoses / Q000188:drug therapy* / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000188:drug therapy* / Q000473:pathology; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016559:Tacrolimus