CME INDIA Case Presentation by Dr Neel, DNB, Medicine, Jamshedpur.
CME INDIA Case Study:
21 yrs old with lesions like this for years, no itching, not on any specific medications. What is the Diagnosis?
CME INDIA Discussion
Dr S K Goenka, Begusarai: It is most probably, Scalp Psoriasis. The flakes of psoriasis resemble dandruff.
Dr Amit Kumar, Dermatologist, Ranchi: I agree. This is a case of Scalp Psoriasis. History of seasonal variation is important.
Differential diagnosis:
- Scalp psoriasis.
- Seborrheic dermatitis.
- Tinea capitis.
- Rarely: Can be seen in Allergic Contact Dermatitis.
Management:
- Lotion Propysalic NF or Topisal 3% twice daily over the lesions.
- Shampoo Ketakenazole alternate day to continue.
- Multivitamin.
- Tab Levocetrizine HS in case of itching.
- Review in 2 weeks.
- If recalcitrant can plan for Apremilast or Methotrexate.
Dr Molio Maregoan, Goa: Agree.
Differential:
- Tinea.
- Psoriasis.
- Xerotic eczema.
Dr Sakshi Santosh Malpani,Nanded: It looks like scalp psoriasis. It would be best to treat with combination of topical steroid and salicylic acid and a coal tar and ketoconazole combination shampoo.
Dr Rajesh Naik, Maregoan, Goa: Scalp Psoriasis.
After 3 days of treatment:
CME INDIA Learning Points
(By Dr Amit Kumar, Dermatologist, Ranchi)
- Scalp psoriasis is a variant of psoriasis where the scalp is involved only. It generally occurs along with lesions on other parts, however, can occur alone also but rare.
- It presents as erythematous plaques over the scalp with silvery flakes over the lesions which are generally loosely adherent.
- It can progress to involve the forehead as well as nape of neck also.
- The most important differential diagnosis is seborrheic dermatitis which is associated with similar types of lesions but generally do not cross the hairline
CME INDIA Tail Piece
- The scalp is a prime area for psoriasis because of the incidence of friction injury/trauma and the lack of UV exposure.
- In some cases, the scalp is the only involved area.
- There is a genetic predisposition to psoriasis and family history is therefore important.
- Psoriasis is characterized by discrete erythematous plaques covered by a silver-gray scale.
- These plaques may be seen at the hair margins as well as on hair-bearing areas.
- Pruritis may be present, but is usually not severe.
- Scalp psoriasis can be very difficult to treat.
- Most mild cases of scalp psoriasis are treated with tar shampoo.
- Salicylic acid may be used as well to break down scales;
- Topical corticosteroids may also be effective.
- Severe cases, or those associated with significant hair loss, may require systemic anti-psoriatic therapy such as methotrexate or cyclosporine.
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