Photodynamic Therapy in Treatment of Patients with Severe Erosive Pustular Dermatosis of Scalp

Erosive pustular dermatosis (EPD) is a rare inflammatory condition characterized by sterile pustules, crusting, and cicatricial alopecia. A 99-year-old Caucasian male with extensive sun damage and a history of multiple skin cancers presented with recurrent hyperkeratotic plaques on the scalp refractory to standard treatments, including high-potency topical corticosteroids, topical calcineurin inhibitors, topical and oral antibiotics, and intralesional corticosteroid injections. Photodynamic therapy (PDT) using aminolevulinic acid and blue light was initiated as an alternative approach. After four sessions, clinical improvement was demonstrated by a significant reduction in serous crusting and plaque burden. This case highlights the role of PDT as an effective treatment for refractory EPD and underscores the need for further research into its long-term efficacy.