December 2009



History: A 79-year-old white female presents with a painful, oozing rash on the scalp for 1.5 years, which has been treated with short courses of multiple topical agents including antimicrobials and topical steroids without significant improvement.

Past Medical History: breast cancer (> 20 years ago), hypertension, CVA, no history of skin cancer

Medications: ASA, spironolactone, diltiazem

Family History: non-contributory

Physical Exam: On the scalp, there is an erythematous plaque with associated serum crust and pustules (Fig.1).


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