Chronic erosions and pustules on the scalp

Abstract

A 70-year-old man presented with a 20-year history of erosions and pustules on the vertex of his scalp. While the lesions had waxed and waned, they had never cleared completely. The physical examination revealed erythematous patches with erosion, crusting, pustules, and cutaneous atrophy resulting in scarring alopecia (Fig 1). The patient had suffered burns on the scalp 50 years ago but was otherwise healthy. The histopathologic examination revealed a nonspecific, atrophic epidermis and a mixed dense dermal infiltrate (Fig 2). 1.Based on the clinical and histopathologic findings, what is the most likely diagnosis? A.Squamous cell carcinoma B.Pemphigus foliaceus C.Erosive pustular dermatosis of the scalp D.Irritated actinic keratosis E.Dissecting cellulitis 2.What treatment is most appropriate for this persistent, pustular, erosive patch? A.Topical corticosteroids B.Topical antibiotics C.Systemic antibiotics D.Topical antifungal agents E.Systemic antifungal agents 3.Which topical agent is often used as an alternative therapy to avoid the development of further skin atrophy? A.Tacrolimus B.Retinoids C.Antifungal cream D.Antibacterial cream E.Steroids