Dr. Ted Rosen discusses a simple, efficacious, and cost-effective solution for the treatment of erosive pustular dermatosis of the scalp.
By Ted Rosen, MD, FAAD
Editor-in-Chief
Zinc Oxide for Erosive Pustular Dermatosis of the Scalp
Erosive pustular dermatosis of the scalp (EPDS) is a rare neutrophilic disorder primarily seen In older individuals. The exact etiology remains unknown, although the most plausible possible hypotheses include impaired mechanism of wound healing plus local trauma, mostly in combination with predisposing actinic damage associated with immune dysregulation. EPDS presents initially as follicular pustules, but typically evolves into non-healing scalp erosions, often covered by thick, adherent scale-crust. There is progressive skin atrophy, and scarring alopecia can develop in those who still have scalp hair present. EPDS generally appears in individuals who have some degree of androgenetic alopecia and notable actinic damage. It is associated with and may be provoked by trauma, especially destructive treatment for actinic keratosis.
The most commonly employed therapeutic intervention consists of application of potent topical steroids. Other treatments employed have spanned quite a broad spectrum, and include: topical tacrolimus, photodynamic therapy, topical and systemic dapsone, and oral retinoids (acitretin, and isotretinoin). Despite ultimate clearing, EPDS is characterized by a protracted recovery which is fraught with relapses and recurrences.
Thus, this acute onset disease often transitions into a chronic disorder. The presence of pain, malodor and purulent drainage make EPDS particularly distasteful for the patients who suffer from this inflammatory condition.
Long-term use of most of the acute treatments enumerated above might be difficult or even dangerous among the geriatric population typically affected. Therefore, it would be advisable to perhaps develop a simple, safe and inexpensive preventative modality for EPDS. In fact, this can be achieved by ongoing application of zinc oxide ointment. The paper cited below is a striking example of the efficacy of this rather benign approach.
A one pound jar of 20% zinc oxide can be purchased, online and without a prescription, for about $10, making this also a very cost-effective strategy.
Reference:
Di Altobrando A, Tabanelli M. Topical zinc oxide: breaking the vicious cycle of erosive pustular dermatosis of the scalp. Int J Dermatol. 2022 Jun;61(6):e216-e217. doi: 10.1111/ijd.15867. Epub 2021 Aug 17. PMID: 34403492.