Junejo M H, Kentley J, Rajpopat M, Tan X L, Mohd Mustapa M Firouz, Harwood C A
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Department of Dermatology, Chelsea and Westminster Hospital, London, UK.
Br J Dermatol. 2021 Jan;184(1):25-33. doi: 10.1111/bjd.19026. Epub 2020 May 26.
Erosive pustular dermatosis of the scalp (EPDS) is a chronic condition characterized by erosive plaques and subsequent scarring alopecia as a result of local trauma or inflammation. A number of therapeutic approaches have been described in the literature but there is no consensus of opinion on optimal treatment of the disease.
To provide evidence-based recommendations for topical and systemic treatment of adult patients with EPDS by performing a systematic review.
The MEDLINE, MEDLINE In-Process, Embase and Cochrane databases were searched from inception to 26 June 2019 in accordance with the PRISMA guidelines for studies involving adult patients treated for EPDS with at least one reported response to treatment. The study was registered on PROSPERO. Texts were reviewed independently by two authors. The risk of bias and quality of the studies were assessed using the Quality Appraisal Checklist for Case Series Studies.
In total 75 studies were included, involving 168 patients. Many treatments have been reported in the literature, with varying degrees of therapeutic success. The results were highly heterogeneous and methodological quality was very low. We were unable to perform a meta-analysis on the data.
The limited available evidence supports use of topical corticosteroids, with or without oral zinc, followed by maintenance therapy with topical calcineurin inhibitors as being effective in managing this condition. Topical photodynamic therapy is also potentially beneficial in the management of EPDS. Prospective, comparative, randomized controlled trials are required in order to provide further evidence to guide treatment.
头皮糜烂性脓疱病（EPDS）是一种慢性疾病，其特征为糜烂性斑块以及因局部创伤或炎症导致的瘢痕性脱发。文献中已描述了多种治疗方法，但对于该疾病的最佳治疗尚无共识。
通过进行系统评价，为成年EPDS患者的局部和全身治疗提供循证推荐。
按照PRISMA指南，检索MEDLINE、MEDLINE在研数据库、Embase和Cochrane数据库，检索时间从建库至2019年6月26日，纳入涉及接受治疗的成年EPDS患者且至少有一项治疗反应报告的研究。该研究已在PROSPERO注册。由两名作者独立审查文献。使用病例系列研究质量评估清单评估研究的偏倚风险和质量。
共纳入75项研究，涉及168例患者。文献中报道了许多治疗方法，治疗成功率各不相同。结果高度异质性，方法学质量非常低。我们无法对数据进行荟萃分析。
有限的现有证据支持使用局部皮质类固醇，加或不加口服锌，随后用局部钙调神经磷酸酶抑制剂进行维持治疗，对控制该病有效。局部光动力疗法在EPDS的治疗中也可能有益。需要进行前瞻性、比较性、随机对照试验以提供进一步的证据来指导治疗。
