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?

Scalp Psoriasis Case

Scalp Psoriasis Case

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:

Post treatment

Post 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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