SCALP

By Gary M. White, MD

Alopecia

See here.

Blue

Blue Nevus
Blue Nevus

Crusted Plaque

Tinea Capitis/Kerion

Erosive Pustular Dermatosis of the Scalp (EPDS). Crusted plaques, often with green pus underlying are typical of EPDS. It most commonly affects the bald areas of elderly men. Rarely, kerion can mimic this condition [Cutis 2013;91;73].
Erosive Pustular Dermatosis of the Scalp

Bacterial Folliculitis of the crown in a young male is not uncommon.
Bacterial Folliculitis of the Scalp

Erosion

Pemphigus Vulgaris

Gyrate Folds

Cutis Verticis Gyrata
Cutis Verticis Gyrata

Pachydermoperiostosis

Hyperkeratotic Papule

Picker's Nodule
Picker's Nodule

Itching

The most common cause of scalp itch is seborrheic dermatitis (SD). Any patient with scalp itch should have a careful examination looking for the redness and scale of SD. Examination behind the ear and ear canal may also show scale, etc., helping to confirm the diagnosis. Again, the vast majority of patients who present with itching of the scalp have something along the spectrum of dandruff/seborrheic dermatitis/psoriasis.

If redness and scale are not found, look for pustules anywhere (acne necrotica, dissecting cellulitis, etc.) or hyperkeratotic lesions in patients, usually men, with thinning hair (sun damage and actinic keratosis). Finally, inquire about any recent hair loss. In addition, the patient should be asked if s/he has noticed any recent hair loss as pruritus is often associated with hair loss of a variety of causes. If there is no hair loss and no primary lesion is found, then a potent topical steroid should be prescribed, e.g., clobetasol solution. If that does not help, then the diagnosis of scalp dysesthesia syndrome may be entertained. In that, diffuse itching, burning, numbness or tingling of the scalp without any primary lesion is seen.

Nodule(s), Acquired

Benign Nevus
Benign Nevus of the Scalp

Pilar Cyst
Pilar Cyst

Metastatic Disease. Here lung cancer.
Metastatic Lung Cancer

Epidermal Inclusion Cyst

Lipoma

Cylindromas
Cylindromas

Pigmented

Seborrheic Keratosis
Seborrheic Keratosis

Eclipse Nevus
Eclipse Nevus

Photodamage

Spreading Pigmented Actinic Keratosis
Spreading Pigmented Actinic Keratosis

Lentigo Maligna
Lentigo Maligna of the Scalp

Melanoma. If there is plenty of hair, melanoma is uncommon in the scalp. Once the hair thins and UV does its damage, melanoma may occur. See also melanoma scalp.
Melanoma of the Scalp

Plaque

Nevus Sebaceous
Nevus Sebaceous

Pustules

Acne Necrotica
Acne Necrotica

Dissecting Cellulitis of the Scalp

Tinea Capitis

Bacterial Folliculitis

Eosinophilic Pustular Folliculitis. This occurs in infants.
Eosinophilic Pustular Folliculitis

Erosive Pustular Dermatosis of the Scalp (see above).

Red, Scaly in an Adult

Seborrheic Dermatitis. The difference between seborrheic dermatitis (SD) and psoriasis is a matter of degree. SD is milder than psoriasis. Lesions on the body imply psoriasis. Still, overlap occurs and some patients fall in the middle.
Seborrheic Dermatitis of the Scalp

Psoriasis Psoriasis

Allergic Contact Dermatitis. Rarely, patients may be allergic to a component of their shampoo or to black hair dye, etc.
Allergic Contact Dermatitis on the Scalp

Ulcer

Temporal Arteritis

Vascular

Angiosarcoma of the Head and Neck
Angiosarcoma of the Head and Neck

Infants or Children

Annular

Neonatal Lupus Erythematosus
Neonatal Lupus Erythematosus

Scaly in a Child or Infant

Cradle Cap
Cradle Cap

Pityriasis Amiantacea. Most common in children.
Pityriasis Amiantacea

Tinea Capitis
Tinea Capitis

Langerhans Cell Histiocytosis
Langerhans Cell Histiocytosis

Congenital

General Workup of a Congenital Scalp Nodule

Several features should make the clinician consider that a scalp nodule may be more than just a pilar cyst or epidermal inclusion cyst. Those lesions arising in the midline or along suture lines, arising after trauma or cranial surgery, congenital lesions, pulsatile, nonmobile, and those with bruits deserve preoperative radiologic evaluation. Surgery on hemangiomas or temporal artery aneurysms which are thought to be cysts can lead to significant operative complications [JAAD 1993;29;260].

Cephalocele

Dermoid Cyst

Heterotopic Brain Tissue

Sinus Pericranii

Cranial Fasciitis

Hair Collar

Hair Collar Sign. Courtesy O. Dale Collins, MD
Hair Collar Sign

Lacerations

Scalp Electrode Laceration

Ulceration

AEC Syndrome. Denuded skin at birth and chronic scalp erosions, complicated by infection are characteristic of this syndrome.

Plaque, Yellow/Red

Nevus Sebaceous (see above).

RegionalDerm

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