What is the best unifying diagnosis and treatment approach for recalcitrant facial erosions following ablative resurfacing procedures?
In this case series of 3 women presenting with persistent facial erosions after resurfacing procedures for actinic damage, all were diagnosed with facial erosive pustular dermatosis. Treatment was challenging and improvement occurred slowly over months to years.
Facial erosive pustular dermatosis should be considered in the differential diagnosis of nonhealing erosions following resurfacing procedures; anti-inflammatory therapies and tincture of time are central to improvement.
Erosive pustular dermatosis (EPD) is a rare condition that typically affects actinically damaged skin of the scalp. Characterized by sterile pustules, erosions, and crusts, EPD is difficult to treat and heals slowly. The exact cause of EPD is unknown, although trauma is an inciting factor.
To describe 3 women who presented with prolonged facial erosions after cosmetic resurfacing procedures, specifically fully ablative carbon dioxide laser or medium-depth chemical peel.
Design, Setting, and Participants
This case series describes the clinical features, histopathological findings, laboratory results, and treatment of 3 patients with an ultimate diagnosis most consistent with facial EPD. Patients were evaluated between September 10, 2010, and May 6, 2016, in a dermatology clinic in an academic medical center. The patients were 3 women seeking diagnostic evaluation and therapeutic options for nonhealing facial erosions occurring after ablative procedures (carbon dioxide laser resurfacing or Jessner solution/trichloroacetic acid chemical peel).
Main Outcomes and Measures
Histologic examination and wound culture from initial presentation as well as clinical follow-up documenting improvement with therapeutic interventions.
All 3 patients were women in their 50s or 60s for whom EPD was deemed to be the best diagnosis, after infection, immunobullous disorders, and other pustular dermatoses were considered. Histologic features were nonspecific. Treatment included a combination of topical and systemic therapies, such as corticosteroids, dapsone, isotretinoin, and/or antibiotics. Watchful waiting (tincture of time) appeared to be central to the healing process.
Conclusions and Relevance
After cosmetic resurfacing, patients may develop EPD isolated to the face. As a diagnosis of exclusion that should be considered in patients who have nonhealing wounds following ablative procedures, EPD is challenging to treat and may require the use of anti-inflammatory agents. Recognizing this condition is important, especially as cosmetic procedures become more widespread.
Mervak JE, Gan SD, Smith EH, Wang F. Facial Erosive Pustular Dermatosis After Cosmetic Resurfacing. JAMA Dermatol. 2017;153(10):1021–1025. doi:10.1001/jamadermatol.2017.2880
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