Systematic Review of Erosive Pustular Dermatosis in Burns: An Underrecognized Cause of Delayed Wound Healing

Abstract Introduction Erosive pustular dermatosis (EPD) is a rare inflammatory disorder characterized by crusts, erosions, and pustules on atrophic skin. It typically arises in adults aged 60-70 and often involves the scalp. Lesions may be disfiguring and persist or relapse despite therapy. Long-term complications include alopecia, atrophy, and telangiectasia, particularly when diagnosis and treatment are delayed. Common risk factors include trauma or surgical procedures such as Mohs micrographic surgery. Methods This review focuses on EPD in burn patients and how its presentation compares to classical scalp-limited disease. Advanced search queries of “burn(s)” OR “burn patients” AND “EPD” were performed on Google Scholar, PubMed, Scopus, and JAAD. Results 11 studies comprising 20 patients (aged 2-66 years; mean: 40 years; 55% male) were included. Burn etiologies included flame, gas, scald, boiling water, chemical, sun, and self-inflicted injury. Among 10 cases with available data, mean total body surface area (TBSA) was 23% (range 2-60%). While the scalp is most involved in classical EPD, burn-associated cases can also present at other sites. Lesions were often initially characterized as “non-healing” burns and were sometimes complicated by Staphylococcus aureus superinfection. Clinically, patients developed erythematous plaques with hyperkeratotic crusts, erosions, and pustules, while biopsies demonstrated neutrophilic infiltration. Treatment generally included various combinations of high-potency topical corticosteroids (most often clobetasol), oral steroids, and dressing changes, which often led to stabilization, improvement, or resolution. Conclusions Burn-associated EPD differs from classical disease by affecting younger patients. It arises from diverse etiologies. Applicability of Research to Practice Early recognition of EPD in burn patients is essential to prevent misdiagnosis, avoid unnecessary antimicrobials, and improve outcomes. Funding for the study N/A.