Therapeutic options for erosive pustular dermatosis of the scalp: a systematic review

Summary Background Erosive pustular dermatosis of the scalp (EPDS) is a chronic condition characterized by erosive plaques and subsequent scarring alopecia as a result of local trauma or inflammation. A number of therapeutic approaches have been described in the literature but there is no consensus of opinion on optimal treatment of the disease. Objectives To provide evidence‐based recommendations for topical and systemic treatment of adult patients with EPDS by performing a systematic review. Methods The MEDLINE, MEDLINE In‐Process, Embase and Cochrane databases were searched from inception to 26 June 2019 in accordance with the PRISMA guidelines for studies involving adult patients treated for EPDS with at least one reported response to treatment. The study was registered on PROSPERO. Texts were reviewed independently by two authors. The risk of bias and quality of the studies were assessed using the Quality Appraisal Checklist for Case Series Studies. Results In total 75 studies were included, involving 168 patients. Many treatments have been reported in the literature, with varying degrees of therapeutic success. The results were highly heterogeneous and methodological quality was very low. We were unable to perform a meta‐analysis on the data. Conclusions The limited available evidence supports use of topical corticosteroids, with or without oral zinc, followed by maintenance therapy with topical calcineurin inhibitors as being effective in managing this condition. Topical photodynamic therapy is also potentially beneficial in the management of EPDS. Prospective, comparative, randomized controlled trials are required in order to provide further evidence to guide treatment. What is already known about this topic? Erosive pustular dermatosis of the scalp (EPDS) is a chronic skin condition affecting elderly patients with actinic damage, and may lead to significant morbidity. EPDS is frequently caused by iatrogenic injury from medical treatments and is increasingly recognized in the literature. No guidelines on optimal treatment of patients with EPDS exist. What does this study add? There is little evidence to support decisions on treatment of EPDS in the literature. Clinicians might use topical corticosteroids followed by topical calcineurin inhibitors, and consider topical photodynamic therapy. Further studies are needed to improve the evidence base underpinning treatment decisions. Plain language summary available online