Erosive pustular dermatosis of the lower legs (EPDL): A rarely diagnosed neutrophilic dermatosis of the elderly.

Erosive pustular dermatosis of the lower legs (EPDL) is a rarely diagnosed, chronic inflammatory skin disease that occurs predominantly in elderly people. Predisposing factors include skin atrophy, chronic venous insufficiency, and trauma. Although the pathogenesis of EPDL has not yet been conclusively clarified, there are ongoing discussions on its nature as a neutrophilic dermatosis in which exogenous triggers lead to immunological dysregulation with local skin damage. Clinically, EPDL manifests with superficial, sterile pustules from which sharply defined erosions develop. The predilection sites are the middle third of the lower leg extensor sides. It is a diagnosis of exclusion, which makes diagnostic differentiation more difficult. Potent topical glucocorticoids with a high therapeutic index (TIX) and calcineurin inhibitors are used therapeutically. Systemic immunomodulating therapies are reserved for refractory courses. Optimization of wound care is also important. In the long term, education and skin care are at the forefront of the complex and often long-term treatment. Due to the chronic recurrent course and the risk of secondary ulcerations and superinfections, early diagnosis and individual treatment planning is important. Interdisciplinary and interprofessional collaboration can make a decisive contribution to improve quality of life of affected patients and reduce the risk of complications.