Management of erosive pustular dermatosis of the scalp

* We typically avoid high-potency topical corticosteroids for patients who present with significant skin atrophy on the scalp. For these patients, we proceed directly to topical tacrolimus therapy.
¶ A sample regimen is application of topical tacrolimus 5 days per week and application of the topical corticosteroid 2 days per week. Alternatively, patients may be transitioned to tacrolimus monotherapy.
Δ A 4- to 8-week prednisone taper is a common initial treatment for refractory disease. Additional options for refractory disease include photodynamic therapy and a variety of topical and oral therapies. Efficacy data for all of these therapies are limited. Refer to additional UpToDate content on erosive pustular dermatosis of the scalp for details.