Specific conditions involving the Scalp
Abscess Kerion, Dissecting cellulitis scalp, Acne keloidalis nuchae, Infected epidermoid cyst,Perifolliculitis capitis abscedens et suffodiens
Annular Elastolytic granuloma,Neonatal lupus
Blisters Brunsting-Perry pemphigoid
Congenital abscence Aplasia cutis congenita
Crusts Bullous impetigo,Pemphigus vegetans,Tinea capitis
Folds Cutis verticis gyrata
Nodules Sebaceous or Pilar cysts,Nevus,Dermoid cyst(Infancy),Encephalocoele,Proliferating trichelemal cyst,Cylindroma,Meningioma,Metastases,Angiosarcoma
Pigmented Nevus en cocarde,Sun damage(lentigo maligna)
Plaque Nevus sebaceous
Pruritus Nits,seborrhoeic dermatitis,psoriasis,contact dermatitis
Pustules Bacterial folliculitis,Acne necrotica miliaris(Tycoon scalp),Eosinophilic pustular folliculitis(Ofugi's disease),Erosive pustular dermatosis of the scalp, Tinea capitis
Receding frontal scalp Frontal fibrosing alopecia
Red scaly Seborrhoeic dermatitis,Atopic dermatitis,Psoriasis,Discoid lupus, Tinea capitis,Contact dermatitis,Darier's disease,rarely Langerhans cell histiocytosis,T cell lymphoma
Scaly Cradle cap,Psoriasis,Seborrhoeic dermatitis,Pityriasis amianticea ,Tinea capitis
Swelling (boggy) Kerion,Dissecting cellulitis of the scalp
Scalp Hair Loss
Generalised Androgenetic alopecia,Telogen effluvium,Anagen effluvium(chemotherapy),Hair shaft defect especially in children,Drug induced hair loss(Isotretinoin,etretinate,lithium,anticoagulants,anticonvulsants,beta blockers),Endocrine abnormalities particularly hypothyroidism,polycystic ovaries,adrenal tumours,secondary syphilis.
Localised Bacterial folliculitis,Tinea capitis,alopecia areata,alopecia neoplastica,Discoid lupus erythematosus,Lichen planopilaris,frontal fibrosing alopecia,folliculitis decalvans,Dissecting cellulitis of the scalp,Tufted folliculitis,Morphea (En coup de sabre linear),Aplasia cutis congenita,Trichotillomania,Traction alopecia
Localised hair loss has three common possibilities,alopecia areata,tinea capitis and trichotillomania.In alopecia areata the area of hair loss is complete,the involved area is smoothe and the hairs may be broken at the edges.The bald area is not inflammed.In tinea capitis the area is never completely bare,the hairs are broken,there may be scale on the surface and signs of scalp inflammation.In trichotillomania the hairs may be broken and the pattern of loss is unusual.The scalp may show inflammation around recently traumatically removed hairs.
Management-Take scrapings if scaly for fungal culture and include a few hairs.Do a hairpull test to see if the hairs around the bare area come out from the base with a telogen bulb on the end,a feature typical of alopecia areata.
Rare causes-Incontinentia pigmenti,nevus sebaceous,post tick bite,follicular mucinosis,Ofugi' disease,localised morphea,aplasia cutis,post herpes zoster,meningocoele,