Erosive Pustular Dermatosis

Presented by Hamish Dunwoodie, MBBS
The Pas,  Manitoba Canada

Abstract:  98 yo woman with exophitic tumor of the forehead

HPI:  The patient is a light complected Caucasian with a 4 month history of a keratotic lersion on the forehead.  She has a history of nonmelanoma skin cancer.  She is a poor historian.

O/E:  4 cm in diameter crusted tumor forehead.

Photos:

After crust removed

Procedure:  The lesion was compressed with a warm wet gauze pad for 10 minutes and the crust was easily removed.  A deep shave biopsy wes performed and the lesion was electrodessicated and curretted.

Histopathology:
The specimen shows cocally confluent ulceration with underlhying granulation tissue and a moderate to dense lymphoplasmacytic infiltrate.  This is consistent with erosive pustular dermatosis.

Diagnosis:  Erosive Pustular Dermatosis

Discussion:  Clinically, I thought this was a nonmelanoma skin cancer.  Most cases of EPD are on the scalp but they have been described in other sites.

Photo:  3 week post op:

Based on path report, she was treated with clobetasol ointment 0.05% b.i.d.  for two weeks; and after this pictures wwas taken she was switched to fluocinalone 0.025% ointment for two more weeks.

References:
1, emedicine.com Erosive Pustular Dermatosis

2. Erosive pustular dermatosis of the scalp and nonscalp.

Van Exel CE, English JC 3rd.
J Am Acad Dermatol. 2007 Aug;57(2 Suppl):S11-4.

University of Pittsburgh, Department of Dermatology, PA
Abstract; Erosive pustular dermatosis of the scalp is characterized by an idiopathic pustular eruption occurring in association with iatrogenic or incidental, antecedent trauma to actinically damaged skin. We present two cases of erosive pustular dermatosis, one of which occurred on the scalp, the other of which was primarily located on the face. (The editor can send a link to full text if you want.)