Trichotillomania as a Cause of Erosive Pustular Dermatosis of the Scalp

Erosive pustular dermatosis of the scalp (EPDS), a rare disorder of elderly individuals characterized by chronic, extensive, pustular, eroded, and crusted lesions of the scalp with progressive scarring alopecia, may result from severe uncontrolled trichotillomania, wrote authors of a letter to the editor published in the Journal of Cosmetic Dermatology.

The authors discussed the case of a 69-year-old woman with a history of anxiety and major depression, who presented with several eroded patches on her scalp that she described as painful and burning. The patches had been present for 3 weeks. Her psychiatrist noted psychotic symptoms and trichotillomania 6 months earlier.

Clinical exam revealed erosions with seropurulent exudate covered by yellow-brown crusts at the margins, and dermoscopy revealed features of trichotillomania.

The authors treated the patient with oral prednisone 25 mg/day with progressive reduction and 0.05% clobetasol propionate cream applied twice daily. Her lesions resolved rapidly after treatment.

Predisposing risk factors for EPDS include elderly age, androgenic alopecia, and sun-damaged skin, it was noted. Causes include local trauma, burns, topical medications, surgery, or dermatologic procedures.

“For this reason, dermatologists should consider EPDS in patients with erosions, pustules, and crusting of the scalp following one of these treatments,” the authors wrote.

Reference

Vaccaro M, Di Bartolomeo L, Guarneri F, Borfgia F. Erosive pustular dermatosis of the scalp as local complication of trichotillomania. J Cosmet Dermatol. 2022;00:1–2. doi:10.1111/jocd.14716