A large scalp ulceration

Abstract

A 57-year-old Caucasian man presented with a 3-month history of an expanding irregularly shaped superficial ulcer on the vertex of the scalp with associated hair loss. The patient reported blisters and pustules prior to the onset of the ulcer and alopecia. He denied other skin or oral lesions and specifically denied picking at the scalp. At the time of presentation, physical examination revealed a superficial ulcer, measuring roughly 15 × 8 cm (Fig 1), on the vertex of the scalp. A shave biopsy (Fig 2) was initially performed, followed by 2 punch biopsies; one for hematoxylin and eosin staining, and one for direct immunofluorescence (Fig 3).