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Brief Report |

Aminolevulinic Acid Photodynamic Therapy in the Treatment of Erosive Pustular Dermatosis of the Scalp A Case Series

Catherine S. Yang, MD1; Helena Kuhn, MD1; Lisa M. Cohen, MD2; George Kroumpouzos, MD, PhD1,3
[+] Author Affiliations
1Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
2StrataDx, Lexington, Massachusetts
3GK Dermatology, PC, South Weymouth, Massachusetts
JAMA Dermatol. 2016;152(6):694-697. doi:10.1001/jamadermatol.2015.6300.
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Importance  Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory skin condition that develops on sun-damaged skin in older individuals. Patients with EPDS present a therapeutic challenge because medical treatments and surgical modalities have met with limited success. Methyl aminolevulinate photodynamic therapy has been effective in 1 case but induced the disease in others.

Observations  Eight patients with EPDS with mean (range) age 84 (67-93) years underwent gentle curettage of the hyperkeratotic lesions followed by aminolevulinic acid photodynamic therapy (PDT) 1 to 2 weeks later. Lesions resolved in 6 patients, whereas 2 patients had residual lesions at 6-week follow-up and underwent a second cycle of curettage and aminolevulinic acid PDT with resolution. One patient experienced a partial recurrence 5 months after the procedure and was successfully retreated with curettage + aminolevulinic acid PDT. No adverse effects were noted, and patients were satisfied with the treatment.

Conclusions and Relevance  This series of patients demonstrated EPDS successfully treated with PDT. Lesions resolved in all patients with a protocol that included curettage followed by aminolevulinic acid PDT. Therefore, this protocol represents an efficacious modality for EPDS.

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Photographs of the Treated Area of Erosive Pustular Dermatosis of the Scalp in Patient 1

A, A hyperkeratotic, crusted, yellow to brown plaque prior to aminolevulinic acid photodynamic therapy. B, Lesion immediately after removal of the hyperkeratotic crust with superficial curettage. C, Complete resolution of the lesion 6 months after aminolevulinic acid photodynamic therapy.

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