Erosive Pustular Dermatosis of the Scalp and Foul Odor
Erosive pustular dermatosis of the scalp (EPDS) does not typically present with a foul odor as a characteristic feature of the condition itself.
Clinical Presentation of EPDS
The classic presentation of EPDS includes specific features that do not include malodorous discharge:
- Sterile pustules, erosions, and crusting are the hallmark findings, typically occurring on sun-damaged scalp skin in elderly individuals 1, 2
- The pustules and lakes of pus are sterile by definition, meaning bacterial cultures are typically negative 3
- Clinical examination reveals erythema, erosions, crusts, follicular pustules, and in advanced stages, scarring alopecia 2
- The condition is characterized by chronic inflammation with a mixed inflammatory infiltrate consisting of neutrophils, lymphocytes, and plasma cells on histopathology 2
Important Clinical Caveat: Secondary Bacterial Infection
While EPDS itself does not produce foul odor, secondary bacterial superinfection can occur and would be the primary cause of any malodorous presentation:
- The erosive nature of the lesions creates a disrupted epithelial barrier that can permit bacterial invasion 4
- If a foul odor is present, this suggests secondary bacterial colonization or superinfection of the erosive lesions, which would require additional antimicrobial treatment beyond the standard EPDS management 4
- Bacterial cultures should be obtained if foul odor is present to guide appropriate antibiotic therapy, even though routine cultures in uncomplicated EPDS are typically negative 2, 3
Diagnostic Approach When Odor is Present
When evaluating EPDS with associated foul odor:
- Obtain bacterial cultures to identify specific pathogens causing superinfection
- Consider that the presence of odor indicates a complication rather than a typical presentation of EPDS 2
- Bacterial superinfection may require systemic antibiotics in addition to the standard anti-inflammatory treatments used for EPDS 5, 3
The presence of foul odor should prompt investigation for secondary infection rather than being considered a characteristic feature of erosive pustular dermatosis itself.