Pathophysiology and Treatment Considerations for Erosive Pustular Dermatosis

In this issue of JAMA Dermatology, Mervak et al describe the rare condition of erosive pustular dermatosis (EPD) that presented in a series of patients after undergoing fully ablative carbon dioxide laser resurfacing or deep chemical peel. Several weeks to months after the procedure, the patients exhibited facial nonhealing erythematous plaques with overlying pustules, erosions, and yellow crust. Results of histologic and microbial work-up were nondiagnostic, which was consistent with EPD. Each patient experienced an arduous and lengthy healing regimen, as is expected with this difficult diagnosis. The authors conclude that tincture of time and reassurance in addition to antibiotics, anti-inflammatories, and immunomodulators are warranted in the treatment of EPD. In the wake of increasing demand for elective surgical treatments, this case series highlights an important and fortunately rare adverse effect of ablative procedures. This phenomenon begs the questions, Are these cases underreported? What is the pathophysiology of EPD? What other options exist for treatment?