Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management
Abstract
:1. Introduction
2. Epidemiology
3. Clinical Presentation
4. Laboratory Investigations
4.1. Histology
4.2. Trichoscopy
5. Differential Diagnosis
6. Etiopathogenesis
6.1. Predisposing Factors
6.2. Triggers
6.3. Mechanisms
6.3.1. Chronic Dysregulated Inflammatory Response
6.3.2. Autoimmune Mechanisms
6.3.3. Immunosenescence
6.3.4. Ultraviolet Light
6.3.5. EPD of the Leg and Venous Insufficiency
7. EPD Linked to NMSC
8. Management
8.1. Methods
8.1.1. Search Strategy
8.1.2. Study Selection
8.1.3. Extraction of Data
8.2. Results
Quality of Evidence Assessment
8.3. Topical Treatments
8.3.1. Corticosteroids
First Author, Year [Ref] | Type of Study | Level of Evidence | Patients (n), (M:F) | Affected Site | Therapy | Treatment Duration | Follow-Up | Primary Outcomes | Adverse Events |
---|---|---|---|---|---|---|---|---|---|
Topical Treatments | |||||||||
Bull et al., 1995 [56] | Case report | 4 | 2 (0:2) | Leg | Clobetasol | NR | NR | CR with solo clobetasol; R* after Rx switched from clobetasol to methotrexate or minocycline | None |
Patton et al., 2007 [6] | Case series | 4 | 8 (3:5) | Scalp | Clobetasol | 3–4 wks | NR | Immediate response | None |
Rongioletti et al., 2016 [25] | Case report | 5 | 2 (2:0) | Scalp | Clobetasol | 8 wks | NR | CR (n = 2); R* after Rx withdrawal | None |
Pileri A et al., 2017 [57] | Case series | 4 | 5 (2:3) | Legs | Clobetasol | 1–4 mos | 20–72 mos | CR (n = 5); R* after Rx withdrawal | None |
Starace et al., 2017 [12] | Case series | 4 | 17 (12:5) | Scalp | Clobetasol | 5 mos | NR | Inflammation improved (n = 14); R* 2–8 mos after Rx withdrawal in some pts but milder than the initial episode | Skin atrophy |
Borgia et al., 2018 [58] | Case series | 4 | 2 (1:1) | Scalp | Clobetasol | 6 wks | NR | CR (n = 2) | Skin atrophy |
Di Meo N et al., 2019 [59] | Case series | 5 | 3 (2:1) | Scalp | Clobetasol | 2–4 wks | NR | CR n = 2) | None |
Piccolo et al., 2019 [16] | Case Series | 4 | 8 (7:1) | Scalp | Clobetasol | 2 wks | 3 mos | CR (n = 7); R* (n = 1) | Atrophic scar after healing (n = 1) |
Giuffrida et al., 2019 [60] | Case series | 5 | 2 (2:0) | Scalp | Clobetasol | 6 wks | NR | CR | None |
Tomasini et al., 2019 [15] | Case series | 4 | 30 (22:8) | Scalp | Clobetasol | 4 mos (initial), 3 yrs (maintenance) | 3 yrs | Marked improvement (n = 27); R* after Rx withdrawal at 4 mos | None |
Lafitte et al., 2003 [61] | Case series | 5 | 2 (2:0) | Scalp | Tacrolimus 0.1% | 6 mos | 12 mos | CR (n = 2) | Skin atrophy due to previous TCS Rx resolved after 6 (case 1) and 8 mos (case 2) of tacrolimus Rx |
Starace et al., 2017 [12] | Case series | 4 | 3 (2:1) | Scalp | Tacrolimus 0.1% | 5 mos | NR | Inflammation improved (n = 3) | NR |
Broussard et al., 2012 [62] | Case series | 4 | 4 (2:2) | Scalp | Dapsone 5% | 4–17 wks | 7–24 mos | CR (n = 4); no R* | None |
Photodynamic Therapy | |||||||||
Yang et al., 2016 [7] | Case series | 4 | 8 (5:3) | Scalp | Curettage (1 wk before ALA-PDT) + ALA-PDT (n = 8) | 1 or 2 sessions | 3-9 mos | CR with 1 session (n = 6) or 2 sessions (n = 2); R* after 5 mos in 1 pt required another session; CR lasted up to 9 mos | Well tolerated |
Cunha et al., 2018 [8] | Case series | 4 | 5 (5:0) | Scalp | Preprocedure curettage + (ALA-PDT) + postprocedure silicone gel bid | 1 or 2 sessions | 4-12 mos | CR with 1 session (n = 4) or 2 sessions (n = 1); R* after 9 mos in 1 pt required another session; CR lasted up to 12 mos | None |
Misitzis et al., 2022 [63] | Comparative study | 3 | 9 (6:3) | Scalp | Protocol 1: curettage (1 wk before ALA-PDT) + ALA-PDT | 1 or 2 sessions | 3-13 mos | CR with 1 session (n = 7) or 2 sessions (n = 2); R* after 5 mos in 1 pt required another session; mean length of remission was 6.4 mos (CR lasted up to 13 mos) | None |
8 (6:2) | Scalp | Protocol 2: preprocedure curettage + (ALA-PDT) + postprocedure silicone gel bid | 1 session | 4-12 mos | CR with 1 session (n = 8); 1 pt had R*, which was managed at 9th mo with another session; mean length of remission was 7.5 mos (CR lasted up to 12 mos); protocol 2 was superior to protocol 1 regarding easiness of Rx and postoperative healing (p = 0.005 for both) | None | |||
Combination Treatments | |||||||||
Pye et al., 1979 [2] | Case report | 4 | 3 (0:2) | Scalp | Clobetasol, then hydrocortisone 1%, then betamethasone valerate 0.1%, neomycin 0.5%, (n = 1); betamethasone valerate 0.1%, neomycin 0.5% (n = 1); clobetasol, neomycin 0.5%, nystatin (n = 1) | NR (case 1), 4 mos (case 2), 2 yrs (case 3) | NR, 2 yrs (case 3) | CR to clobetasol and betamethasone valerate, neomycin but flare with hydrocortisone (case 1); CR (cases 2, 3) | None |
Caputo et al., 1993 [64] | Case report | 5 | 3 (2:1) | Scalp | Betamethasone 0.05%, salicylic acid 2% lotion (n = 1); ketoconazole 2% biw, oral nimesulide (200 mg/d tapered) (n = 1); Betamethasone 0.05%, oral nimesulide (n = 1) | 2 mos (cases 1,2), 1 mo (case 3) | NR | CR (case 1); PR (case 2); 50% improvement (case 3) | None |
Ena et al., 1997 [65] | Case report | 4 | 2 (1:1) | Scalp | Gentamycin-betamethasone, povidone-iodine, eosin 6% solution (with R*, dapsone 100 mg/d × 3 mos, then isotretinoin 40 mg/d × 3) (n = 1); isotretinoin 40 mg/d (n = 1) | 7 mos (case 1), 2 mos (case 2) | NR | CR with R* after Rx withdrawal in the 1st case; SD (2nd case) | None |
Brouard et al., 2002 [49] | Case report | 4 | 3 (1:2) | Leg | Betamethasone 0.05%, tacrolimus (n = 1); betamethasone 0.05% (n = 1); betamethasone 0.05%, tacrolimus, prednisone 15 mg/d, then tacrolimus, split-thickness skin graft, then prednisone 20 mg/d, tacrolimus, colchicine 0.5 mg/d (n = 1) | 3 mos | NR | CR (first 2 cases); PR (3rd case) | Skin atrophy (3rd patient) |
Allevato et al., 2009 [66] | Case series | 5 | 2 (1:1) | Scalp | Betamethasone 0.1%, prednisone 16 mg/d, zinc gluconate 50 mg tid, topical fusidic acid | 2 mos | 21 mos, 27 mos | CR (n = 2) | None |
Dall’Olio et al., 2011 [67] | Case report | 5 | 2 (0:2) | Leg (n = 1); scalp (n = 1) | Clobetasol, tacrolimus 0.1% (n = 1); betamethasone valerate 0.1%, oral dapsone 100 mg/d, tacrolimus 0.1% (n = 1) | 12 mos | 12 mos | CR (n = 2) | None |
Mervak et al., 2017 [68] | Case series | 5 | 2 (0:2) | Face | Tacrolimus 0.1%, prednisone 1 mg/kg/d, mupirocin, minocycline, then added dapsone 100 mg/d, isotretinoin 30 mg/d (n = 1); tacrolimus 0.1%, minocycline, dapsone 5%, triamcinolone acetonide 0.025% (n = 1) | 3.5–4 yrs | 3.5–4 yrs | PR with R* (n = 2); dapsone (2.5 yrs; maintenance dose 25–50 mg/d) and isotretinoin (3.5 yrs; maintenance dose 10–20 mg/d) provided further improvement in case 1 | None |
Sechi et al., 2019 [69] | Case series | 4 | 4 (4:0) | Scalp | Betamethasone 0.05%, fusidic acid 2%, hyaluronic acid dressing bid | 20–30 d | 6 mos | CR (n = 4) | None |
Siskou et al., 2021 [70] | Retrospective study | 3 | 23 (22:1) | Scalp | TCS (n = 22); TCs + TCi (n = 7); TCS + Acitretin 25 mg/d (n = 9); TCi + acitretin 25 mg/d (n = 2) | NR | TCS: CR (n = 14), PR (n = 7), SD (n = 1); TCS + TCi: CR (n = 3), PR (n = 4); TCS + acitretin: CR (7), PR (2); TCi + acitretin: PR (n = 2); R* in 78.3% of pts after Rx cessation at a median of 8 wks; new R* in 22.2% of pts that received acitretin vs. 71.4% that received TCi as maintenance | None |
8.3.2. Calcineurin Inhibitors
8.3.3. Other Topical Treatments
8.3.4. Wound Dressings/Allografts
8.3.5. Systemic Treatments
8.3.6. Photodynamic Therapy
8.3.7. Therapeutic Challenges and the Search for Treatment Algorithm
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Locally Applied Medications |
Diclofenac 5-Fluorouracil |
Imiquimod |
Ingenol mebutate |
Latanoprost |
Minoxidil |
Sirolimus Tretinoin |
Systemic Medications |
Afatinib Gefinitinib |
Nivolumab |
Panitumumab |
Surgery/Other Procedure |
PDT (aminolevulinic acid-PDT, methyl aminolevulinate PDT) |
Cryotherapy |
X-ray radiation therapy |
Electrodessication and curettage (ED & C) |
Wide excision |
Mohs micrographic surgery |
Neurosurgery (corrective surgery for ossification of the posterior longitudinal ligament and craniotomy) |
Cochlear implant |
Hair transplant Prosthetic hair piece |
CO2 laser resurfacing |
Surgical closures (secondary intent, primary closure, skin graft, local flap) |
Local Trauma |
Perinatal (e.g., caput secundum) |
Burns (sunburn, flame, scald, chemical) |
Physical injury |
Falls |
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Bhargava, S.; Yumeen, S.; Henebeng, E.; Kroumpouzos, G. Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management. Life 2022, 12, 2097. https://doi.org/10.3390/life12122097
Bhargava S, Yumeen S, Henebeng E, Kroumpouzos G. Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management. Life. 2022; 12(12):2097. https://doi.org/10.3390/life12122097
Chicago/Turabian StyleBhargava, Shashank, Sara Yumeen, Esther Henebeng, and George Kroumpouzos. 2022. "Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management" Life 12, no. 12: 2097. https://doi.org/10.3390/life12122097
APA StyleBhargava, S., Yumeen, S., Henebeng, E., & Kroumpouzos, G. (2022). Erosive Pustular Dermatosis: Delving into Etiopathogenesis and Management. Life, 12(12), 2097. https://doi.org/10.3390/life12122097