Abstract
INTRODUCTION: Erosive pustular dermatosis of the scalp (EPS) is a rare, chronic inflammatory skin disease that can be refractory to treatment and is typically confined to the epidermis and superficial dermis. We report an unusual case of EPS with extensive scalp destruction and underlying bone erosion. CASE PRESENTATION: A woman in her late seventies presented with an 11-year history of painful, nonhealing scalp ulcers, eventually leading to bone exposure. Multiple treatments failed, including topical corticosteroids, systemic immunosuppressants, and antibiotics. Imaging revealed skull erosion without intracranial involvement. Surgical debridement and split-thickness skin grafting led to complete healing and pain resolution. CONCLUSION: In rare, refractory cases of EPS with deep structural involvement, surgical intervention, and skin grafting may offer a successful therapeutic strategy.