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March 1991

An Old Lady With Scarring Alopecia and an Ulcerated Sole

Author Affiliations

University of Genoa (Italy)

Arch Dermatol. 1991;127(3):410. doi:10.1001/archderm.1991.01680030131022

REPORT OF A CASE  A 76-year-old woman reported that erythematous bullous lesions had occurred on both of her big toes in the periungual area 20 years earlier. The lesions caused the nail plates to detach progressively and fall off eventually. Simultaneously, she noticed a large area of alopecia on her scalp. Three years before presenting to the clinic, after removing a plaster cast that had been applied to treat a fracture of the internal right malleolus, an ulcer developed on her right sole. Over the ensuing 3 years, the size of the lesion increased continuously and bullae developed occasionally, accompanied by sensations of burning and itching.On examination of her scalp, there was a large area of scarring alopecia on the vertex, with neither erythema nor follicular hyperkeratosis (Fig 1). The nails of both of her big toes were absent, and atrophy of the nail bed and matrix was noted

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