Erosive pustular dermatosis of the scalp (EPDS) is an uncommon chronic inflammatory condition first described by Burton and Pye in 1977. Predominantly affecting females aged 60-70 years, the condition manifests as superficial erosions or keratotic lesions, either solidary or multiple, triggered by a preceding event such as trauma or surgery. Diagnostic challenges arise from nonspecific histological findings and a clinical presentation which may mimic skin malignancy or infection. Primary treatment involves topical corticosteroids and retinoids with the avoidance of surgery due to potential for exacerbation. We present a case of an 80-year-old woman with EPDS, initially considered to be recurrent malignancy following previous excision of a well-differentiated squamous cell carcinoma of the scalp. Multiple reconstructive procedures were unsuccessful and resulted in a non-healing wound with calvarial exposure. This case highlights the difficulty of diagnosis in EPDS and the pitfalls of failing to recognise this condition. EPDS should be considered in the differential of all non-healing wounds of the scalp and early dermatological opinion should be sought.