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.

• Contact dermatitis
• Dissecting cellulitis of the scalp
• Discoid lupus
• Kerion
• Psoriasis
• Scalp folliculitis
• Seborrheic dermatitis
• Tinea capitis

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

• Ketoconazole
• Tar
• Salicylic acid shampoos
• Zinc pyrithione

Tinea capitis

• Antifungal therapy

Kerion

• Anti-fungal 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 retinoids
• Antibiotic therapy