Crusted Plaques of the Scalp After Deep Brain Stimulation Surgery

A 77-year-old man with Parkinson’s disease and androgenic alopecia developed crusted plaques on his scalp after undergoing deep brain stimulation (DBS) surgery. The plaques, located on the vertex and surrounded by an erythematous patch, were initially suspected to involve hardware infection. However, cultures identified Streptococcus pyogenes and methicillin-sensitive Staphylococcus aureus, leading to a diagnosis of impetigo. The patient responded well to a 14-day course of oral cefalexin, resulting in complete resolution of the plaques. This case highlights the importance of distinguishing between impetigo and other conditions like erosive pustular dermatosis of the scalp (EPDS), which does not respond to antibiotics.