Erosive pustular dermatosis of the leg associated with compression bandaging and fungal infection

BACKGROUND: Erosive pustular dermatosis of the leg (EPDL) has been described in association with venous insufficiency and atrophy of the skin of the lower leg. Like erosive pustular dermatosis of the scalp, this disease has also been reported to be a non-infective condition. OBJECTIVES: To investigate the clinicopathological features and, where possible, the aetiology of clinical EPDL. METHODS: We identified a group of patients undergoing continuous compression bandaging for venous dermatitis of the legs and/or predominantly venous leg ulceration with clinical features described in patients with EPDL. They were investigated by skin biopsy, patch testing and microbiological tests for the presence of bacteria and fungi. RESULTS: Twenty-four of 400 (6%) patients were noted to have pustules on the leg(s). There was laboratory evidence of fungal infection in 13 of 24 patients (54%), with complete and sustained resolution of pustules after antifungal treatment. Pustulation in the other 11 patients (46%) was unresponsive to antibiotics for confirmed bacterial infection; some improvement was seen with potent topical corticosteroids but full clearance was achieved only after a switch from continuous four-layer compression bandaging to the use of intermittent long stretch compression. CONCLUSIONS: EPDL is a fairly common clinical picture seen in patients undergoing continuous compression bandaging. It may be produced by opportunistic, particularly fungal, infection. In almost half an infective aetiology cannot be demonstrated and a pyoderma gangrenosum-like process may be implicated.     

Erosive pustular dermatosis of the leg: report of three cases

Erosive pustular dermatosis of the leg is a distinct form of spongiform amicrobial pustulosis. The disorder typically affects the lower limbs of elderly patients presenting with chronic venous insufficiency and stasis dermatitis, and has a chronic course. Three elderly patients with chronic venous ulcers are described, who developed pustules and moist eroded lesions on the leg. The clinical and histological features were typical for erosive pustular dermatosis. The lesions rapidly responded to topical treatment with either tacrolimus or corticosteroids. Of note, this condition was associated with a diverticular disease in two patients, while in another patient an epidermoid carcinoma of the tongue was present. Erosive pustular dermatosis of the leg is an uncommon but distinct skin disorder typically associated with trophic changes of the lower limbs. Our observations raise the question of the relation of erosive pustular dermatosis of the leg with the group of neutrophilic dermatoses. Topical immunotherapy with tacrolimus may constitute a novel therapeutic option for this frequently recalcitrant condition.     

Erosive pustular dermatosis of the scalp in an adolescent with near‐total hair regrowth: Case report and review of the literature

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon chronic inflammatory response to scalp trauma that usually resolves with cicatricial alopecia. It most commonly affects elderly patients with a history of actinic damage. Herein, we describe a 16‐year‐old girl with acrofacial dysostosis type 1 presenting after surgery with crusting purulent scalp lesions, whose clinical presentation and histopathologic findings were consistent with EPDS. A review of the literature on EPDS in children is also detailed.     

头皮糜烂性脓疱性皮病一例

患者,女,50岁.头皮红斑、脓疱伴疼痛6个月.皮肤科查体:头皮弥漫性分布紫红色浸润性斑片,其上见脓疱,局部见斑片状脱发区.实验室检查:取脓疱疱液多次行细菌及真菌培养均阴性.组织病理:表皮角化过度伴角化不全;真皮浅中层弥漫性淋巴细胞、浆细胞、中性粒细胞浸润.抗生素治疗效果不佳,口服糖皮质激素及外用他克莫司治疗后有效.诊断...     

Erosive pustular dermatosis of the scalp: a successful treatment with photodynamic therapy

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease of unknown aetiology that usually occurs in the elderly. It is characterized by sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. The histopathology is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a case of EPDS in a 75-year-old female in whom there was a marked response to photodynamic therapy with methyl 5-aminolaevulinic acid.     

角层下脓疱性皮病2例临床分析

报道2例角层下脓疱性皮病,男女各1例,男63岁,女34岁,皮损表现为红斑、丘疹、水疱、脓疱,病程均为2年,无明显伴发疾病.组织病理学特征为角层下脓疱,直接免疫荧光检查及脓疱疱液细菌培养均阴性.2例患者分别给予糖皮质激素和甲砜霉素治疗,疗效好.     

Erosive pustular dermatosis of the leg

Two women with a distinctive rash on the legs are reported. The clinical features of erythema, erosions, crusting and pustular lakes, and the failure to respond to any treatment except very potent topical corticosteroids (Dermovate®). are very similar to those of erosive pustular dermatosis of the scalp.     

角层下脓疱性皮病合并结缔组织病二例

报道2例角层下脓疱性皮病，皮损均表现为红斑基础上的水疱、脓疱，组织病理学特征为角层下脓疱，直接免疫荧光阴性；脓疱疱液细菌培养阴性。患者1，女，53岁，合并类风湿关节炎。口服阿维A，糖皮质激素和羟氯喹治疗。患者2，女，69岁，合并干燥综合症及自身免疫性肝炎，予糖皮质激素及米诺环素治疗。2例患者均好转。     

米诺环素治疗角层下脓疱病一例并文献复习

报道米诺环素治疗角层下脓疱病1例并对相关文献进行复习。患者，女,14岁，臀部、腹股沟、双下肢屈侧反复出现红斑、脓疱6年，加重半月。组织病理学表现为角质层下脓疱，疱内有中性粒细胞浸润，免疫荧光示表皮细胞间及基底膜IgG、IgA、IgM、C3阴性。结合临床表现及病理学检查，确诊为角层下脓疱病。给予口服米诺环素，外用地奈德乳膏治疗，1个月后皮损消退,维持治疗2个月，随访6个月，未复发。     

A Case of Pustular Ulcerative Dermatosis of the Scalp Associated with Ulcerative Skin Lesions on the Scrotum

A 79-year-old man developed pustules, erosions, and ulcer with severe pain on the parietal regions of the scalp and the scrotum. In another hospital, mycobacterium was detected from the pustules of the scalp at Gaffky scale 1, and this patient was referred to our clinic. In our hospital, repeated cultures of the pus from the skin lesions of the scalp were negative for mycobacterium. Biopsy specimens obtained from the skin lesions on the scalp disclosed ulcerative granulation with infiltration of inflammatory cells. Antibiotics and antituberculotic agents were ineffective. In contrast, the ulcerative skin lesions on the scalp and scrotum responded well to topical and systemic glucocorticosteroids. Although this patient developed pustular ulcerative skin lesions not only on the scalp but also on the scrotum, we considered this case to be pustular ulcerative dermatosis of the scalp developing ulcerative skin lesions on the scrotum.     

Erosive pustular dermatosis of leg:a case report

报告1例腿部糜烂性脓疱性皮病.患者女,17岁.因左足内踝反复红斑、丘疹、脓疱伴瘙痒3年就诊,实验室检查、皮损分泌物细菌和真菌学检查及皮损组织病理检查均无特异发现.抗真菌治疗无效,对外用糖皮质激素和他克莫司治疗抵抗,短期系统应用阿奇霉素静脉滴注皮损有好转,但随访中该药无后续疗效.临床表现和组织病理改变符合腿部糜烂性脓疱性皮病的诊断.     

Erosive pustular dermatosis of the scalp successfully treated with oral prednisone and topical tacrolimus

Erosive pustular dermatosis of the scalp is a rare inflammatory disorder of the scalp, affecting elderly patients after local trauma and leading to scarring or cicatricial alopecia. Case Report: An elderly female patient complained of painful pustules on the parietal region bilaterally with progressive enlargement and ulceration. A biopsy suggested erosive pustular dermatosis of the scalp and the patient was treated with prednisone 40 mg/day and 0.1% topical tacrolimus. After 10 weeks complete closure of the eroded areas was observed and a stable scarring alopecia developed.     

Pustular dermatosis of the scalp associated with autoimmune diseases

A 36-year-old woman visited our hospital with a five month history of persistent pustulation, crusting, and alopecia on the vertex of the scalp. No pathological organisms were isolated from the lesions. Histological examination revealed non-specific changes of chronic inflammation with destroyed follicles. Antibiotic therapy produced no response, but steroid therapy was effective. From these observations, a diagnosis of erosive pustular dermatosis of the scalp (EPDS), as described by Pye et al., was made. The patient also had Hashimoto's thyroiditis, autoimmune hepatitis, and Takayasu's aortitis. The laboratory studies revealed an increased erythrocyte sedimentation rate, C-reactive protein 3+, hypergammaglobulinemia, and various auto-antibodies, suggesting the possibility of a pathogenesis common to both this dermatosis and the autoimmune diseases.