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Dec 2011

Nonhealing Ulcers on the Scalp —Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(12):1443-1448. doi:10.1001/archderm.147.12.1443-d

A 53-year-old African American woman presented with a 6-month history of painful, progressively enlarging ulcers on the scalp. There was no clear trigger, and she denied creating or manipulating the lesions. She had been applying mupirocin ointment without improvement. The ulcers were limited to the scalp. She had a remote history of discoid lupus that resulted in scarring of the face. Findings from a complete review of systems were negative for systemic symptoms.

Physical examination revealed large, atrophic, erythematous plaques with central punched-out ulcers over the temporal and parietal scalp bilaterally (Figure 1). Regional lymphadenopathy was not present. Findings of bacterial cultures of the ulcer base were negative. Laboratory studies revealed a mild lymphopenia; however, antinuclear antibody, C3, and C4 findings were within normal limits. A 4-mm punch biopsy specimen was obtained from the ulcer edge of the left parietal scalp (Figure 2 and Figure 3).

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