Supplementary Material for: Erosive Pustulosis of the Scalp with Subsequent Bone Erosion Treated with Skin Graft: A Case Report

Introduction: Erosive pustular dermatosis of the scalp (EPS) is a rare, chronic inflammatory skin disease that can be refractory to treatment and is typically confined to the epidermis and superficial dermis. We report an unusual case of EPS with extensive scalp destruction and underlying bone erosion

Case Presentation: A woman in her late seventies presented with an 11-year history of painful, non-healing scalp ulcers, eventually leading to bone exposure. Multiple treatments failed, including topical corticosteroids, systemic immunosuppressants, and antibiotics. Imaging revealed skull erosion without intracranial involvement. Surgical debridement and split-thickness skin grafting led to complete healing and pain resolution.

Conclusion: In rare, refractory cases of EPS with deep structural involvement, surgical intervention with skin grafting may offer a successful therapeutic strategy.

引言：头皮糜烂脓疱性皮肤病（Erosive pustular dermatosis of the scalp, EPS）是一种罕见的慢性炎症性皮肤病，治疗常具难治性，病变通常局限于表皮及浅真皮层。本文报告1例罕见的EPS病例，该患者出现了广泛的头皮破坏及下方骨质侵蚀。

病例报告：1名年近八旬的女性患者，有11年头皮疼痛性难治性溃疡病史，最终出现骨质外露。患者曾接受多种治疗均告失败，包括外用糖皮质激素、系统性免疫抑制剂及抗生素。影像学检查提示颅骨侵蚀，但未累及颅内。行外科清创术及分层皮片移植术后，患者溃疡完全愈合，疼痛症状消失。

结论：对于罕见的伴深部结构受累的难治性EPS病例，皮肤移植外科干预或可成为有效的治疗策略。