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June 1, 2008

Extensive Erosions and Pustular Lesions of the Scalp—Diagnosis

Author Affiliations

Carrie Ann R.CusackMDSenait W.DysonMDJacqueline M.Junkins-HopkinsMDVincentLiuMDKarla S.RosenmanMD

Arch Dermatol. 2008;144(6):795-800. doi:10.1001/archderm.144.6.795-g

Findings from repeated skin cultures were negative for viruses and microorganisms. Histopathologic analysis of a skin biopsy specimen taken from the left side of the scalp 1 month before presentation revealed an incidental actinic keratosis with granulation tissue within the dermis (Figure 3).

The patient was treated with clobetasol ointment twice daily and frequent moisturization to prevent recurrent crust formation. Chlorhexidine topical antiseptic cleanser was used to clean the scalp daily. Four weeks later, the scalp showed complete clearing, and the topical corticosteroid treatment was discontinued. Two weeks later, the crusted lesions recurred, and treatment with tacrolimus, 0.1%, ointment was initiated for maintenance therapy. During the next 2 years, the patient continued to have occasional erosions, which resolved under treatment with clobetasol. The scarring alopecia persisted.

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