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Chronic non-healing ulcers of the scalp after trauma
  1. Vyjayanti Kulkarni,
  2. Vedantam Rajshekhar
  1. Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India 632004
  1. Dr V Rajshekhar, CMC Hospital, Vellore, 632004, India (e-mail:v_rajshekhar{at}hotmail.com)

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A 11 year old boy presented with soft tissue swelling and multiple discharging sinuses over the forehead, which he had had for past eight months. There was no history of tuberculosis or any major illness. There had been no response to antibiotic treatment. He had sustained a forehead laceration in a road traffic accident, four years ago, which was primarily sutured and had healed well. Systemic and neurological examinations were normal. Local examination revealed a soft to firm, subcutaneous swelling over the forehead with multiple sinuses, discharging serosanguinous and granular material.

The biochemical tests were unremarkable except for a high erythrocyte sedimentation rate of 125 mm/hour. HIV testing was negative. Chest radiography showed no abnormality. The skullx ray film showed irregular patchy areas of radiolucencies in the right frontal and anterior parietal bones, with no surrounding sclerosis (figs 1 and 2). Cranial computed tomography revealed corresponding bone hypodensities, with a thin layer of epidural enhancement.    

Figure 1

Plain radiograph of the skull, lateral view, showing multiple irregular patchy radiolucencies involving the frontal and parietal bones.

Figure 2

Plain radiograph of the skull, anteroposterior view, showing multiple irregular patchy radiolucencies involving frontal and parietal bones.

Questions

(1)
What is the differential diagnosis of this clinical presentation and radiological picture?
(2)
How should this patient be managed?
(3)
What is the optimal treatment of this condition?

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