May 9,2016: Cryotherapy 4 keratoses on vertex of scalp
August 11, 2016: Crusted lesions at site of cryotherapy. Clinical diagnosos of erosive pustular dermatosis of scalp made. Treated with mupirocin oint and clobeyasol ointment Initially improved.
Sept 9 2016: Resolved
10/24/2016: Continued to do well
April 4, 2017: Recurrent lesions on vertex of scalp. Thick crusted lesions (see photo) The crusts were brownish and dirty looking, but unfortunately I removed them before taking the photo of April, 2017.
O/E: What was initially hypertrophic keratosit papules were transformed into ~ 1 cm crusted erosive lesions.
|4.4.17 (after crusts removed)|
|s/p 1 week Chlorhexidine, 4 days tacrolimus 0.1%|
Lab: August 11, 2016: + Staph aureus from lesion Vx scalp - usual sensitivities
This is either erosive pustular dermatosis of the scalp or squamous cell ca. The rapid worsening since cryotherapy suggests the former. It appears that biopsy may be necessary. Not all cases of EPD respond to clobetasol ointment.
Questions: Is this EPD or are these lesions squamous cell carcinomas. Patient is reluctant to have a biopsy done. This process appears to have been gtriggered by the trauma of liquid nitrogen and did respond initially to clobetasol. 10 - 20% of EPD cases appear to be non-responders ro clobetasol.
Follow-up. Marked improvement following chlorhexidine wash daily and topical tacrolimus 0.1% ointment at the suggestion of a colleague. He recurred after clobetasol ointment.