Scalp rash
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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.
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; can aid in determining seborrheic dermatitis
Treatment
Acute Pharmacotherapies
Suborrheic dermatitis
- Ketoconazole
- Tar
- Salicylic acid shampoos
- Zinc pyrithione
Tinea capitis
- Antifungal therapy
Kerion
- Antifungal therapy
- Steroids
Scalp folliculitis
- 1st generation cephalosporin or tetracycline derivative for 2-4 weeks
Injections
Discoid lupus
- Intralesional injection of steroids
Dissecting cellulitis
- Intralesional steroids
- systemic retnoids
- antibiotic therapy