A 62-year-old female with no significant medical history presented with a 2-year history of erosive pustulosis of the scalp after an outbreak of HZ (positive Tzanck smear) involving her right forehead and scalp in V1 distribution (trigeminal nerve). Initially, for HZ, she was treated with famciclovir 1 g three times daily (TID) with resolution. However, she continued to have itch and persistent crusting of the scalp in a linear distribution corresponding to the previous HZ eruption. The clinical features and histopathology were consistent with EPDS. The patient was accordingly started on clobetasol 0.05% cream once a day. She had improvement of pain and crusting, as well as partial hair regrowth of the alopecic patches. Treatment was tapered. After a few months, she experienced a flare and clobetasol 0.05% QD was restarted. After 5 months of on-and-off therapy, she was transitioned to tacrolimus 0.1% daily. After an additional 3 months, she presented with an acute vesicular eruption in the same area of previous HZ and was diagnosed with recurrent HZ (+positive Tzanck) [Figures 1 and 2]. Notably, there was no ocular involvement. She completed a course of famciclovir 1 g TID with resolution. She was seen in follow-up and continues to do well on a maintenance regimen of topical tocopherol spray [Figures 3 and 4]. Topical immunosuppression was not restarted as it was thought to contribute to the HZ recurrence.