The commonest scaly scalp conditions include: -

• Seborrhoeic dermatitis
• Psoriasis
• Pityriasis Amiantacea
• Ringworm

Also see under hair loss, fungal infections, eczema and psoriasis.

Seborrhoeic Dermatitis and Psoriasis

The scaling tends to be diffused throughout the scalp in seborrhoeic dermatitis whereas in psoriasis it tends to be in well defined heaped up plaques. Look for evidence of seborrhoeic dermatitis on the face and the front of the chest and look for evidence of psoriasis on the elbows and knees and elsewhere, and in the nails. Sometimes it is not possible to distinguish between seborrhoeic dermatitis and psoriasis and we sometimes refer to this as sebopsoriasis. The response of seborrhoeic dermatitis to Ketoconazole Shampoo and/or Cream is usually impressive.

Pityriasis Amiantacea

Mostly occurs in children. It is usually a manifestation of seborrhoeic eczema but occasionally of psoriasis. An area of scaling occurs, which may be localised or more generalised. The hairs in that area become loose and can easily be pulled out. The scale tends to be clumped and adherent to the hair shafts, giving an “asbestos-like” appearance. The use of Cocois (or Ung Cocois Co) and a tar shampoo such as Capasal is usually very effective. The hair almost always regrows.

Ringworm

The association of inflammation in the scalp with loss of hair and broken hairs should make one suspicious of scalp ringworm. Pluck hairs for mycology and do not rely on scraping alone. Remember that topical treatments for scalp ringworm are not effective. Do not rely on Wood’s Light to make the diagnosis. Many fungi that cause scalp ringworm are Wood’s Light negative. Treatment - Oral griseofulvin 10mg /kg/day or Lamisil for 6 to 8 weeks.