tacrolimus and Scalp-Dermatoses

Erosive pustular dermatosis of the scalp is a rare condition which primarily affects older women after local trauma and has historically been treated with topical steroids. As it is a rare entity and resembles other dermatologic conditions, it may easily be misdiagnosed. Identifying the causes and evaluating the efficacy of treatments of erosive pustular dermatosis of the scalp (EPDS) is of great importance to both avoid misdiagnosis and ensure optimal treatment of this rare condition. There are numerous causes. In addition to surgeries and physical injuries, topical and procedural treatments for actinic keratoses and androgenetic alopecia can trigger the development of lesions. There are also documented associations with several autoimmune and systemic conditions. Besides corticosteroids, topical tacrolimus and photodynamic therapy were the most commonly used treatments for EPDS. They were effective with few recurrences and adverse effects. Other successful treatment options were topical dapsone, silicone gels, calcipotriol, acitretin, and isotretinoin. Oral dapsone can be used in cases of disseminated disease. Zinc sulfate should be considered with low-serum zinc levels. While cyclosporine was effective, there were adverse effects that may limit its use. It is important for dermatologists to be aware of the wide array of potential causes of erosive pustular dermatosis and include it on their differential. Additionally, although high-potency topical steroids have been historically used as the first-line treatment, there are many other effective treatments that may avoid recurrence and skin atrophy, particularly in the elderly population.

Topics: Acitretin; Adrenal Cortex Hormones; Aminolevulinic Acid; Anti-Infective Agents; Calcitriol; Dapsone; Dermatologic Agents; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Photochemotherapy; Scalp Dermatoses; Tacrolimus

Erosive pustular dermatosis (EPD) is a rare chronic inflammatory condition of the scalp and legs that is often difficult to manage. Currently, there are no treatment guidelines.. To systematically assess the existing literature on various treatment modalities and their efficacies when used in the management of EPD.. We searched PubMed, Cochrane Libraries, Scopus, and clicnialtrial.gov databases for articles in the English language with no limited time frame. Emphasis was placed on articles that reported on treatment for EPD.. Of the 168 articles identified by the literature search, 92 met eligibility criteria and were included for qualitative analysis. Efficacious topical treatments included clobetasol, betamethasone, and tacrolimus. Ninety-three and 88% of cases utilizing clobetasol and betamethasone respectively demonstrated improvement or resolution. All 32 cases utilizing tacrolimus reported improvement. Efficacious systemic treatments included oral steroids such as prednisone, methylprednisolone, and dexamethasone. Topical dapsone, photodynamic therapy, systemic steroids, cyclosporine, and oral zinc derivatives were also described with some success.. According to available data, limited solely to case reports and case series, potent topical steroids are an effective treatment option for EPD. Topical tacrolimus may also be considered in cases that require long-term use or maintenance. Other treatment modalities shown to be successful based on high reported efficacy and low rates of recurrence after treatment include topical dapsone, systemic steroids, zinc derivatives, and cyclosporine. Further studies are needed to compare treatment modalities and to establish treatment protocols.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Infective Agents; Betamethasone; Calcineurin Inhibitors; Clobetasol; Dapsone; Dexamethasone; Glucocorticoids; Humans; Leg Dermatoses; Methylprednisolone; Photochemotherapy; Scalp Dermatoses; Tacrolimus

Erosive pustular dermatosis of the scalp has particular relevance in Australia, due to its association with actinic damage. Despite its rarity, the recalcitrant nature of erosive pustular dermatosis of the scalp dictates a protracted recovery fraught with relapse and recurrence, posing inherent challenges to successful treatment and complete recovery. In Australia, erosive pustular dermatosis of the scalp is prevalent in the elderly, who are negatively affected due to the condition. We propose a management outline to aid clinical practice, to improve the quality of life in the elderly, whilst providing insight into the current understanding and treatment of erosive pustular dermatosis of the scalp.

Topics: Algorithms; Anti-Inflammatory Agents; Australia; Betamethasone; Calcineurin Inhibitors; Curettage; Dermoscopy; Diagnosis, Differential; Glucocorticoids; Humans; Incidence; Mometasone Furoate; Recurrence; Scalp Dermatoses; Skin Diseases, Vesiculobullous; Tacrolimus

To evaluate the efficacy of two topically applied immunomodulative agents through the detection of lymphocyte subsets using monoclonal antibodies against CD4, CD8 and MHC II.. Fifty patients from the Departments of Medical Biochemistry, Dermatology and Pathology at Cairo University with different degrees of alopecia areata (AA) were included in this study. They were classified into two groups each of 25 patients. Each patient was treated with the immunomodulative agent on one side of the scalp and the other side was left as a control. Biopsies were taken from all patients at the beginning of treatment and at the end of the study. Tissue specimens were prepared for histologic and immunophenotypic analysis. The main outcome measures were the uses of diphencyprone (DPCP) and topical tacrolimus as two topical immunotherapeutic modalities in the treatment of AA.. A clinical response of 68% was achieved in group A (treated with DPCP) while group B (treated with 0.1% tacrolimus) showed an insignificant clinical response. Decreased expression of CD4 and increased expression of CD8 and MHC II was detected in the post-treated areas compared with pretreated areas in cases treated with DCPC. In tacrolimus-treated cases, there was a decrease in CD4 and MHC II, with no change in CD8 between the pre- and post-treated areas.. DCPC is one of the most accepted therapeutic modalities in the treatment of AA, with a favourable prognosis among patchy hair loss. MHC II expression was the one correlating with clinical response. Tacrolimus, though beneficial in other dermatoses, could not be considered effective in the treatment of AA.

Topics: Administration, Topical; Adolescent; Adult; Alopecia Areata; Antibodies, Monoclonal; Biomarkers; CD4 Antigens; CD8 Antigens; Child; Cyclopropanes; Egypt; Female; Histocompatibility Antigens Class II; Humans; Immunohistochemistry; Immunosuppressive Agents; Male; Scalp Dermatoses; T-Lymphocyte Subsets; Tacrolimus; Treatment Outcome; Young Adult

Previous studies have shown that topical steroid and shampoo containing zinc pyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. But the clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor on seborrheic dermatitis, is not well investigated yet. We wanted to compare the clinical efficacy of topical tacrolimus with that of conventional treatment (zinc pyrithione shampoo and topical betamethasone) for treatment of seborrheic dermatitis of the scalp. Patients with seborrheic dermatitis of the scalp were randomly allocated to receive topical betamethasone, topical tacrolimus or zinc pyrithione shampoo. Some patients were instructed to continue the treatments for 8 weeks and the others to discontinue the treatments at week 4. We evaluated the efficacy using a clinical severity score, dandruff score and sebum secretion at baseline, week 4 and week 8. All treatment groups showed significant improvements in clinical assessment after 4 weeks. While the patients treated by zinc pyrithione improved continuously even after cessation of the treatment, the patients treated by betamethasone lotion or tacrolimus ointment were aggravated clinically. Topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone. To treat seborrheic dermatitis of the scalp, we think that the combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione is recommended.

Topics: Administration, Topical; Adult; Antifungal Agents; Betamethasone Valerate; Calcineurin Inhibitors; Dermatitis, Seborrheic; Female; Glucocorticoids; Humans; Male; Middle Aged; Organometallic Compounds; Pyridines; Recurrence; Scalp Dermatoses; Tacrolimus; Time Factors; Young Adult

Topics: Adrenal Cortex Hormones; Alopecia; Child; Doxycycline; Humans; Indomethacin; Male; Scalp; Scalp Dermatoses; Tacrolimus

Topics: Administration, Cutaneous; Aged, 80 and over; Aminolevulinic Acid; Clobetasol; Female; Humans; Keratosis, Actinic; Light; Ointments; Photochemotherapy; Photosensitizing Agents; Scalp Dermatoses; Tacrolimus; Treatment Outcome

Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia.. We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease.. Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus.. The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.

Topics: Alopecia; Female; Humans; Male; Middle Aged; Retrospective Studies; Scalp; Scalp Dermatoses; Tacrolimus

Topics: Acne Keloid; Adult; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Scalp Dermatoses; Sirolimus; Tacrolimus

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Betamethasone; Calcitriol; Dermatologic Agents; Drug Combinations; Female; Humans; Immunosuppressive Agents; Ointments; Scalp Dermatoses; Tacrolimus

Folliculitis decalvans is an embarrassing and challenging disease with no established treatment guidelines. In this paper, we described four patients with this disease treated successfully with Tacrolimus ointment. All of them showed significant control of the condition, stopping inflammatory lesions and progression of the disease, although weak transitory outbreaks of inflammatory lesions were observed in some cases. Alopecia and tufted hairs remained unchanged. The discontinuation of the therapy produced rapid relapses in all cases. Close monitoring of these patients is recommended due to the potential risk of malignant transformation of the disease.

Topics: Adult; Female; Folliculitis; Humans; Immunosuppressive Agents; Male; Ointments; Scalp Dermatoses; Tacrolimus; Treatment Outcome; Young Adult

Erosive pustular dermatosis of the scalp is a rare condition characterized by sterile pustules, erosions and crusted lesions on the scalp of elderly patients. It can be misdiagnosed with tinea capitis or even skin cancer, so it is important to be aware of this entity for a correct diagnosis. An 80-year-old Caucasian man presented with a 3 month history of painful erythematous erosions and crusts on his scalp. The lesions appeared after treatment with cryotherapy of actinic keratoses. The patient underwent treatment with topical mupirocine and topical antifungals without success. Physical examination revealed the presence of extensive erosions and crusts along the scalp, with tiny pustules on the sides. The clinical and histopathological findings lead us to the diagnosis of erosive pustular dermatosis of the scalp. Treatment with potent topical corticosteroids twice daily was started with improvement after ten days. A maintenance therapy with topical tacrolimus was initiated without clinical relapse after 3 months.

Topics: Administration, Topical; Adrenal Cortex Hormones; Aged, 80 and over; Biopsy; Cryotherapy; Humans; Immunosuppressive Agents; Keratosis, Actinic; Male; Scalp Dermatoses; Tacrolimus

Erosive pustular dermatosis of the scalp is a rare condition that tends to occur mainly in elderly patients. Clinically it is characterized by the presence of pustules, chronic crusted erosions with progressive scarring alopecia, and skin atrophy. Although etiology remains unclear, it seems to be triggered by local trauma such as surgical procedures, skin graft, ultraviolet light exposure, cryotherapy, craniotomy, or radiotherapy. To our knowledge, erosive pustular dermatosis of the scalp after photodynamic therapy has been seldom reported. We described a 81-year-old woman presenting with erosive pustular dermatosis of the scalp after photodynamic therapy for actinic keratosis.

Topics: Aged, 80 and over; Female; Humans; Keratosis, Actinic; Mometasone Furoate; Photochemotherapy; Pregnadienediols; Scalp Dermatoses; Skin Diseases, Vesiculobullous; Tacrolimus; Treatment Outcome

Topics: Acitretin; Aged, 80 and over; Anti-Inflammatory Agents; Drug Therapy, Combination; Female; Folliculitis; Humans; Immunosuppressive Agents; Keratolytic Agents; Prednisolone; Scalp Dermatoses; Tacrolimus; Trace Elements; Treatment Outcome; Zinc

Topics: Administration, Topical; Aged; Alopecia; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Scalp Dermatoses; Tacrolimus

Erosive pustular dermatosis of the scalp (EPDS) is a rare form of nonmicrobial pustulosis mainly occurring in elderly patients with long-term sun damage to the skin. Clinically, it is characterized by pustular lesions that progressively merge into erosive and crusted areas over the scalp. The histology of EPDS is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a 24-year-old woman who developed EPDS after cochlear implant surgery for profound sensorineural hearing loss. We speculate that either the cutaneous surgery during cochlear implantation or the skin inflammation that commonly occurs near the magnet might have triggered the disorder. It is of note that the patient's skin lesions healed completely after treatment with topical tacrolimus, a relatively novel immunosuppressive molecule. Thus, topical tacrolimus may be indicated as a therapeutic alternative to the widely used steroids for this disease, mainly to avoid steroid-related cutaneous atrophy.

Topics: Biopsy; Cochlear Implantation; Female; Humans; Immunosuppressive Agents; Scalp; Scalp Dermatoses; Tacrolimus; Young Adult

Erosive pustular dermatosis (EPD) is a rarely reported condition that primarily involves the actinically damaged scalp of elderly women. Although the condition is well recognized in the United Kingdom and Europe, no US cases have heretofore been reported.. We sought to document the presence, and determine the clinical characteristics, of EPD in the US population.. Patients were recruited from the dermatology clinic at a university in California and from the private practices of dermatologists in the Northern California region.. Eleven patients with EPD were identified. Eight were women and 3 were men. The scalp was involved in 9 patients and the extremities in two patients. The involved skin was actinically damaged in 9 patients. The patients were elderly (66-90 years) but one patient was a 15-year-old boy. All lesions resolved or greatly improved with the application of high-potency steroids or tacrolimus.. Not all patients were examined personally by the authors of this article. The length of follow-up was relatively short.. EPD is a fairly common disease and is the most likely diagnosis in instances where chronic, nonhealing, shallow erosions occur on actinically damaged, or otherwise atrophic, skin. In spite of the name, intact pustules are rarely present. The histology is that of moderate to marked, nonspecific chronic inflammation. EPD responds well to high-potency topical steroids.

Topics: Administration, Topical; Adolescent; Aged; Aged, 80 and over; Atrophy; Calcineurin Inhibitors; Clobetasol; Extremities; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Photosensitivity Disorders; Scalp Dermatoses; Skin Diseases; Skin Diseases, Vesiculobullous; Steroids; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Aged; Humans; Immunosuppressive Agents; Male; Scalp Dermatoses; Skin Diseases, Vesiculobullous; Tacrolimus

Topics: Administration, Cutaneous; Diagnosis, Differential; Female; Graft vs Host Disease; Humans; Immunosuppressive Agents; Lymphoma; Middle Aged; Scalp Dermatoses; Severity of Illness Index; Stem Cell Transplantation; Tacrolimus

Topics: Administration, Topical; Aged; Humans; Immunosuppressive Agents; Male; Middle Aged; Scalp Dermatoses; Tacrolimus

Topics: Administration, Topical; Chronic Disease; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Middle Aged; Scalp Dermatoses; Tacrolimus