 |
| |
 |
| N Raboobee FFDerm(SA) |
| |
 |
| |
| Contact dermatitis represents an allergic reaction
to chemical substances which come into contact with the scalp.
The most common substances incriminated are hair dyes (paraphenylamine
diamine/ PPD) and fragrances in hair care products, shampoos
and conditioners. Patients may present with itching of the scalp,
redness, scaling, weeping and crusting. Often but not always,
there is a history of contact shortly preceding the dermatitis.
PPD may produce severe swelling of the eyes and the dermatitis
may not be limited to the scalp. Contact dermatitis is investigated
by means of a patch test, where several chemicals are applied
to the back and left on for 48hours, after which the chemicals
are removed and the test read. A further reading is taken 96
hours after application. Treatment includes withdrawal of the
offending agent if identified. Topical steroids are most commonly
used. However, should the dermatitis be severe, a short course
of systemic corticosteroids is indicated. |
| |
 |
| |
| Allergic reaction to hair dye affecting
the scalp and forehead. |
| |
BACK TO TOP  |
 |
| |
| Seborrhoeic dermatitis is classified as an eczema
of unknown origin. However in recent times, a role for Pitryrosporum
organisms has been advocated. The condition involved the scalp,
eyebrows, ears, nasolabial folds, neck, axillae and groins. Typically,
greasy yellow crusting is seen in the involved areas. Scaling
of the eyelid margins is not uncommon. Infantile seborrhoeic
dermatitis is a similar condition occuring in children. Treatment
is with creams containing salicylic acid, sulphur and tar. Shampoos
containing tar, selinium sulphide or antifungal agents may be
used. |
| |
 |
| |
| Yellow, greasy scales are characteristic
of
seborrhoeic dermatitis |
| |
| BACK TO TOP |
 |
| |
| For practical purposes, fungal infection of the
scalp occurs in children only. The condition presents with scaling,
a dull lustreless surface and short broken off hairs. The condition
needs to be differentiated from alopecia areata where there is
smooth and total hair loss in affected patches. Exclamation mark
hairs may be seen the edges of the lesions. The diagnosis of
fungal infection is established by means of microscopic examination
of the hairs in the affected area or by culture for fungal organisms.
Treatment is usually with oral antifungal agents and any of the
following may be used: Griseofulvin, Itraconazole, Fluconazole
and Terbinafine. Dosage depends on the age and weight of the
child. |
| |
 |
| |
A dull lustreless surface is typical
of tinea capitis.
The hairs are
short and broken off |
| |
| BACK TO TOP |
 |
| |
| Folliculitis may occur on the scalp and may resemble
follicultitis elsewhere. Small red bumps occur around the hair
follicles in the scalp, often surmounted by a pustule. Staphylococcal
organisms are commonly found but may include streptococcus. Acne
of the scalp mirrors acne of facial skin and is caused by Propionebacterium
acnes. Treatment of acne of the scalp does not differ from acne
treatment elsewhere and includes the use of antibiotics, hormonal
therapy (in females) and occasionally oral isotretinoin.
The scalp is an extension of the skin on the face and neck.
Consequently, many infections that involve the face may involve
the scalp. Viral warts may occur on the scalp and these are
most commonly treated with liquid nitrogen or electrocautery.
|
| BACK TO TOP |
 |
| |
| Lice infestation (Pediculus humanus capitis) is
common in children and in environments where there is close contact
or overcrowding. It is highly contagious and spreads through
personal contact and sharing of combs, brushes, hats and other
personal items. The organism responsible is visible to the naked
eye. Occasionally, only the nits are seen attached to the hair.
Treatment includes using a fine toothed comb and one of the commercially
available anti lice shampoos. Care must be exercised with lindane
because of neurological side effects. |
 |
| |
| Head lice |
| |
| BACK TO TOP |
 |
| |
| Usually manifesting as distinctive thick white
scales either in isolated patches or confluent and affecting
large areas of the scalp. The condition may mimic seborrhoeic
dermatitis and other inflammatory conditions of the scalp, especially
where scaling is not a prominent feature. The clinical diagnosis
is strengthened when other areas of the body are involved with
Psoriasis eg the elbows, knees, nails and joints. Treatment includes
salicylic acid, tar, Calcipotriol, topical cortico-steroids and
ultraviolet light. The treatment needs to be individualised depending
on the extent of the psoriasis. Psoriasis may affect the scalp
without affecting other parts of the body. |
| |
 |
| |
| Psoriasis of the scalp. Thick white
scales on
an erythematous background |
| |
| BACK TO TOP |
 |
| |
| DLE is a cutaneous form of Lupus Erythematosis.
Its main features are scaling, erythema, follicular plugging,
atrophy and telangiectasia. It differs from psoriasis in that
scarring is a prominent feature of the former but is absent in
the latter. Treatment is with potent topical steroids or intralesional
corticosteroids. If extensive, oral immunosuppressive agents
are used. |
| |
 |
| |
| Scaling, scarring, telangiectasia
and erythema are
clearly visible in this patient with DLE. |
| |
| BACK TO TOP |
 |
| |
|
