Treatment of erosive pustular dermatosis of the scalp using aminolevulinic acid photodynamic therapy: A report of 2 cases

Erosive pustular dermatosis (EPD) of the scalp is an inflammatory condition that is characterized by skin atrophy, erosions, and keratotic crusts and primarily affects elderly patients. The lesions of EPD develop over time and can lead to scarring alopecia. There are no established clinical guidelines or consensus on treatment for EPD, but some authors report success with photodynamic therapy using aminolevulinic acid as the sensitizer (ALA-PDT). This report presents 2 cases of male patients, 91 and 86 years of age, with EPD that did not resolve despite prior treatment with topical steroids or retinoids but was successfully treated using ALA-PDT. In both patients, ALA-PDT resulted in improvement of EPD of the scalp after 2 sessions, with visible progress by 6 weeks after the second ALA-PDT session. The ALA-PDT treatments were well tolerated. The cases presented here demonstrate that ALA-PDT can be a potential therapeutic option for EPD of the scalp.