Recurrent Scalp Erosion in an Elderly Woman

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The 89-year-old has used topical mupirocin twice daily for several weeks without improvement. Examine the images. What's your diagnosis?

An 89-year-old woman is seen in follow-up for a new erosion on the right frontal scalp area (Figure 1). She has a history of biopsy-proven actinic keratosis (AK) on her scalp that was treated with topical 5-fluorouracil cream. She uses a washcloth to scrub the area.

On examination, she is very fair skinned with extensive photo damage. The skin of the scalp is very thin. She had used topical mupirocin twice a day for several weeks without improvement and now there is crusting and purulent exudate overlying the area (Figure 2). Skin cultures taken show normal flora. No other pathology or adenopathy are noted.

What is your diagnosis?

A. Dissecting cellulitis of the scalp

B. Eosinophilic pustular folliculitis

C. Erosive pustular dermatosis of the scalp

D. Chronic bacterial folliculitis

E. Chronic actinic damage with secondary infection

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