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September 2009

Acute Onset of Erythematous Scalp Nodules in a Child—Quiz Case

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Arch Dermatol. 2009;145(9):1053-1058. doi:10.1001/archdermatol.2009.184-a

A 10-year-old healthy boy presented to a pediatric dermatology clinic with a 2-week history of 2 rapidly enlarging, bleeding, reddish lesions on the scalp. Previously, a primary care pediatrician had treated the lesions with oral cephalexin and topical mupirocin without improvement. The patient denied subjective fever or other symptoms.

Physical examination revealed a 0.9-cm erythematous, dome-shaped nodule on the right occipital scalp and a 2.5-cm ulcerated erythematous nodule with crusted drainage and foul odor on the left occipital scalp (Figure 1). Shave biopsy specimens were taken from the right scalp lesion (Figure 2 and Figure 3), and the base was curettaged and electrodessicated. Culture results from the lesions showed no fungus and only mixed bacterial flora. Five days after the office visit, the parent reported that the biopsied lesion had recurred along with an adjacent new lesion.

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