Erosive Pustular Dermatosis of the Scalp Mimicking Squamous Cell Carcinoma: Can Dermoscopy Be Helpful?

Camila Scharf; Aleksandra Stefaniak; Mario Vaccaro; Francesco Borgia; Federico Vaccaro; Fabrizio Chirico; Andrea Battisti; Valentino Valentini; Giuseppe Argenziano

doi:10.5826/dpc.1502a4796

Erosive Pustular Dermatosis of the Scalp Mimicking Squamous Cell Carcinoma: Can Dermoscopy Be Helpful?

Authors

Camila Scharf Dematology Unit, University of Campania L.Vanvitelli, Naples, Italy https://orcid.org/0000-0003-3705-7310
Aleksandra Stefaniak Department of Dermatology, Venerology and Allergology, Wroclaw Medical Univeristy, Poland
Mario Vaccaro Department of Clinical and Experimental Medicine - Section of Dermatology - University of Messina
Francesco Borgia Department of Clinical and Experimental Medicine - Section of Dermatology - University of Messina
Federico Vaccaro
Fabrizio Chirico Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli," Naples, Italy.
Andrea Battisti Maxillofacial Surgery Unit, Odontostomatological Science and Maxillo-facial Surgery Dept., “Sapienza” University of Rome, Policlinico Umberto I, Italy.
Valentino Valentini Maxillofacial Surgery Unit, Odontostomatological Science and Maxillo-facial Surgery Dept., “Sapienza” University of Rome, Policlinico Umberto I, Italy.
Giuseppe Argenziano Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy

Keywords:

erosive pustulosis, dermoscopy, cutaneous squamous cell carcinoma

Abstract

Introduction: Erosive pustular dermatosis of the scalp (EPDS) presents as a rare and challenging skin disorder marked by erosions, pustules, and crusted lesions on the scalp. Diagnosing EPDS is complex, often mimicking other dermatological conditions like actinic keratosis (AK), basal cell carcinoma (BCC), or squamous cell carcinoma (SCC). Therapeutic challenges arise from its chronic and relapsing nature, requiring long-term management.

Objective: In this study, we aimed to assess the frequency of misdiagnosis of EPDS as SCC.

Methods: A retrospective cohort study was conducted in two Italian dermatological centers from 2017 to 2023 including patients initially diagnosed with SCC of the scalp that was afterwards confirmed as EPDS through histology. Clinical and dermoscopic criteria were evaluated.

Results: A total of 43 patients were included, predominantly male (42:1). Androgenetic alopecia was present in 65% of cases, predominantly in the parietal area (44%). Upon dermoscopy, SCC-like features were present in the majority of cases, with 46% displaying targetoid structures and 49% polymorphic vessels.

Conclusions: EPDS poses diagnostic and therapeutic challenges due to its unique features and elusive etiology. Distinguishing SCC from EPDS is crucial to avoid unnecessary treatments and the biopsy has proven to be of great importance as clinical and dermoscopical criteria might not be specific.

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