CONTACT DERMATITIS OF THE SCALP
SEBORRHOEIC DERMATITIS OF THE SCALP
FUNGAL INFECTIONS OF THE SCALP(RINGWORM)
BACTERIAL AND VIRAL INFECTIONS OF THE SCALP
HEAD LICE
PSORIASIS
DISCOID LUPUS ERYTHEMATOSIS
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DISEASES OF THE SCALP
N Raboobee FFDerm(SA)
 
CONTACT DERMATITIS OF THE SCALP
 
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.
 
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SEBORRHOEIC DERMATITIS OF THE SCALP
 
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
 
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FUNGAL INFECTIONS OF THE SCALP (RINGWORM)
 
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
 
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BACTERIAL AND VIRAL INFECTIONS OF THE SCALP
 
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.

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HEAD LICE
 
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
 
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PSORIASIS
 
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
 
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DISCOID LUPUS ERYTHEMATOSIS
 
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.
 
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