Erosive Pustular Dermatosis of the Scalp (EPDS): Every Patient Deserves Surveillance !!!

Erosive pustular dermatosis is an inflammatory condition that often affects the scalp (EPDS) of older individuals. It has the potential to cause scarring hair loss. Many individuals with EPDS have history of a variety of “triggers” that are thought to be relevant to initiating the condition including a history of UV radiation exposure (among others).
Several authors through the years have noted skin cancers arising in patients with EPDS.

Shamloul et al, 2023

Authors of a new study set out to retrospectively evaluate the incidence and time to development of malignancies arising on the scalp of patients with EPDS. The authors’ study included a total of 80 patients evaluated over the period 2000 to 2021. There were 53 males and 27 females. Overall, 55% of patients (44 total patients) developed a scalp skin cancer after diagnosis of EPDS. Most patients who went on to develop a skin cancer were males  (72.7%, 32 of the 44 patients). Interestingly, about one half of the patients with a skin cancer after diagnosis of EPDS also had another skin cancer before they received their diagnosis of EPDS. The cancers developing after EPDS were squamous cell carcinoma, SCC in 77.2% of patients (34 patients), basal cell carcinoma, BCC in 15.9 % of patients (7 patients), atypical fibroxanthoma in 4.6% (2 patients) and pleomorphic dermal sarcoma in 2.3 % (1 patient). 23 patients (28.8%) had more than one malignancy. 50% of cancers that develop in EPDS develop within 3 years.

EPDS: Every Patient Deserves Surveillance !!!

Close surveillance is clearly needed in our patients with EPDS. EPDS scalp lesions that have not responded fully to treatment (ie topical clobetasol or tacrolimus) might need a biopsy to rule out cancer.  50 % of patients with EPDS are likely to go on to develop a skin cancer and many of these patient’s cancers will arise within the first 5 years after EPDS is diagnosed. I remember the four letter acronym EPDS as meaning both erosive pustular dermatosis of the scalp as well as “every patient deserves surveillance”

For me, this is a helpful reminder that I really need to be watching and monitoring for skin cancer in our patients with erosive pustular dermatosis of the scalp.

Every patient deserves surveillance!

Reference

Shamloul N  et al. Incidence and time to development of malignancies arising on the scalp of patients with erosive pustular dermatosis based on sex: A retrospective analysis. J Am Acad Dermatol. 2023 Jun 13;S0190-9622(23)01111-8.

Negbenebor NA et al. Nonmelanoma skin cancer in the setting of erosive pustular dermatosis of the scalp: A case series and comment on management implications. Dermatol Ther. 2022 Jul;35(7):e15584. doi: 10.1111/dth.15584. Epub 2022 May 28.