Pustolosi erosiva del cuoio capelluto

Erosive pustular dermatosis of the scalp is an unusual inflammatory skin disorder of unknown aetiology, which affects mostly elderly Caucasian women, characterized by erythema, erosions, crusting and pustules localized on the scalp. The case of a 75 year-old female, without relevant clinical history, who was admitted because of a large erosion on the scalp is reported. The lesion appeared three years before and had been treated with topical antibiotics and antiseptics without benefits. Clinical examination showed an extensive erosion, grossly triangular in form, which extended over the left side of her scalp, with irregular, non infiltrated borders. A purulent exudate was present at the perifery of the lesion. Extensive alopecia was present over all the area and the surrounding scalp. History excluded previous significant predisposing factors. Microbiologic investigations for bacteria and fungi were negative. Histologic examination showed a dermo- epidermal detachment for dermal edema. In the papillary and reticulary dermis there was a compact inflammatory infiltrate consisting mostly of lymphocytes and plasma cells; neutrophils and giant cells were also noted. In addition there was a complete absence of hair follicles, with persistence of erector pili muscles. Direct immunofluorescence was negative. A diagnosis of erosive pustular dermatosis of the scalp was made. A rapid improvement with complete disappearance of pustular and erosive lesions was observed after a 4-week treatment with a high potency topical steroid (Clobetasol propionate 0.05%) once daily. Over the next 8 weeks a complete healing was observed, with a residual extensive area of scarring alopecia. Three months later, the patient experienced a relapse, consisting of new erosions followed by scales and crusts. The patient revealed to have spontaneously stopped the treatment and had a contusive trauma on the scalp. A 3-week treatment with nimesulide (200 mg/day for 10 days, then 100 mg/day for 10 days) associated with clobetasol ointment was suggested. After 4 weeks a complete healing occurred. Actually the patient is disease-free and is using clobetasol 2 times weekly.