Scalp rash

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Though diagnosis of scalp dermatitis / infection is easy, treatment can be more difficult. Topical therapy alone, or topical therapy in coordination with systemic therapy for long periods may be essential to maintain complete control of these problems.

Differentiating a Scalp Rash from other Diseases

In alphabetical order. [1][2]

Diagnosis

History and Symptoms

Seborrheic dermatitis

  • Diffuse
  • White
  • Non-adherent

Bacterial folliculitis

  • Use intact scalp pustule to determine diagnosis.

Laboratory Findings

  • KOH prep can be done in the office to check for spores within the hair shaft.
  • Fungal cultures can be taken at the site of a kerion or scalp scale to rule out tinea capitis.
  • Ensure root is intact.
  • A shave biopsy should not be done liberally, and it can aid in the determination of seborrheic dermatitis.

Treatment

Medical Therapy

Acute Pharmacotherapies

Suborrheic dermatitis
Tinea capitis
  • Antifungal therapy
Kerion
  • Anti-fungal therapy
  • Steroids
Scalp folliculitis

Injections

Discoid lupus
  • Intralesional injection of steroids
Dissecting cellulitis
  • Intralesional steroids
  • Systemic retinoids
  • Antibiotic therapy

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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