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
Hematoxylin-eosin –stained sections of the ulcer edge demonstrated a mildly atrophic epidermis with basal vacuolization and dermal melanophages. There was basement membrane thickening, with superficial and deep perivascular lymphohistiocytic inflammation in the dermis. The subcutaneous fat had marked hyaline fat necrosis with septal fibrosis and dense lobular lymphocytic inflammation. These findings were consistent with the diagnosis of LEP.
This patient was treated with prednisone, hydroxychloroquine, mycophenolate mofetil, and intralesional triamcinolone injections. The ulcers healed with residual scarring after 3 months on this therapeutic regimen.
Nonhealing Ulcers on the Scalp —Diagnosis. Arch Dermatol. 2011;147(12):1443-1448. doi:10.1001/archderm.147.12.1443-h