DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20201575

An overview of scalp dermatoses in a tertiary care institute

Ramesh Aravamuthan, Sampath Vadivelu, Shabari Arumugam, Mukesh Mithran J.

Abstract


Background: The scalp is unique among skin areas in humans, with high follicular density and high rate of sebum production which though providing thermal insulation also creates an environment conducive to superficial mycotic infections and parasitic infestations. As there is a paucity of studies on scalp dermatoses in the Indian and Western literature, a clinical study of these scalp dermatoses can unravel the common clinico-epidemiological manifestations in our population.

Methods: This is a prospective observational study conducted for a period of 6 months. All the patients reporting to our department were evaluated for entry into the study and patients having scalp lesions were enrolled. A detailed clinical history and a thorough scalp examination were performed.

Results: The incidence of scalp dermatoses is more among adolescents and early adulthood with a male to female ratio 1.8:1. 57% of patients had lesions exclusive to scalp. Scalp was the initial site of presentation in 54.6% of cases who had generalized lesions. Itching (n=107; 53.5%) is the commonest presenting complaint. Among the scalp sites, parietal area was involved the most (73%). The most common dermatoses were psoriasis (21.5%) followed by alopecia areata (11.5%).

Conclusions: The scalp dermatoses have significant psychological impact affecting the social profile of the patients. To the best of our knowledge, this is the first Indian study on scalp dermatoses involving all age groups which gives a precise clinical insight into scalp dermatoses.


Keywords


Scalp dermatoses, Scalp psoriasis, Alopecia, Scalp dysaesthesia

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References


Allen HB, Honig PJ. Scaling scalp diseases in children. Clin Pediatr (Phila). 1983;22(5):374-7.

Grimalt R. A practical guide to scalp disorders. J Investig Dermatol Symp Proc. 2007;12(2):10-4.

Suchankova D. Diseases affecting the scalp. Cas Lek Cesk. 2017;156(3):137-40.

Osment LS. Dermatoses of the scalp. J Fam Pract. 1979;8(6):1217-33.

Elewski BE. Clinical diagnosis of common scalp disorders. J Investig Dermatol Symp Proc. 2005;10(3):190-3.

Pillai J, Okade R. A clinical spectrum of scalp dermatoses in adults presenting to a tertiary referral care centre. Int J Biol Med Res. 2014;5(4):4434-9.

Langley RGB, Krueger GG, Griffiths CEM. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(2):18-25.

Henseler T, Christophers E. Psoriasis of early and late onset: Characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450-6.

Finlay AY, Kelly SE. Psoriasis-an index of disability. Clin Exp Dermatol. 1987;12(1):8-11.

Merola JF, Li T, Li WQ, Cho E, Qureshi AA. Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol. 2016;41(5):486-9.

Kerkhof PCM, Steegers-Theunissen RPM, Kuipers MV. Evaluation of Topical Drug Treatment in Psoriasis. Dermatology. 1998;197(1):31-6.

Frez MLF, Asawanonda P, Gunasekara C, Koh C, Loo S, Oon HH, et al. Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group. J Dermatol Treat. 2014;25(1):38-45.

Aldredge LM, Higham RC. Manifestations and Management of Difficult-to-Treat Psoriasis. J Dermatol Nurses’ Assoc. 2018;10(4):189-97.

Dopytalska K, Sobolewski P, Błaszczak A, Szymańska E, Walecka I. Psoriasis in special localizations. Reumatologia. 2018;56(6):392-8.

Fricke VAC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015;8:397-403.

Liu LY, Craiglow BG, Dai F, King BA. Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients. J Am Acad Dermatol. 2017;76(1):22-8.

Rhodes T, Girman CJ, Savin RC, Kaufman KD, Guo S, Lilly FR, et al. Prevalence of male pattern hair loss in 18-49 years old men. Dermatol Surg off Publ Am Soc Dermatol Surg Al. 1998;24(12):1330-2.

Hagenaars SP, Hill WD, Harris SE, Ritchie SJ, Davies G, Liewald DC, et al. Genetic prediction of male pattern baldness. PLoS Genet. 2017;13(2):1006594.

Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(1):136-41.

Grant JE, Chamberlain SR. Trichotillomania. Am J Psychiatry. 2016;173(9):868-74.

Filbrandt R, Rufaut N, Jones L, Sinclair R. Primary cicatricial alopecia: diagnosis and treatment. CMAJ Can Med Assoc J. 2013;185(18):1579-85.

Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015;3(2).

Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185-90.

Kamalam A, Thambiah AS. Tinea capitis an endemic disease in Madras. Mycopathologia. 1980;71(1):45-51.

Duran C, Tamayo L, Orozco LM, Maldonado RR. Scabies of the scalp mimicking seborrheic dermatitis in immunocompromised patients. Pediatr Dermatol. 1993;10(2):136-8.

Madke B, Khopkar U. Pediculosis capitis: an update. Indian J Dermatol Venereol Leprol. 2012;78(4):429-38.

Mihic LL, Barisic F, Bulat V, Buljan M, Situm M, Bradic L, et al. Differential diagnosis of the scalp hair folliculitis. Acta Clin Croat. 2011;50(3):395-402.

Pomian SM, Konop M, Gala K, Rudnicka L, Olszewska M. Scalp involvement in pemphigus: a prognostic marker. Adv Dermatol Allergol Dermatol Alergol. 2018;35(3):293-8.

Wilson CL, Burge SM, Dean D, Dawber RP. Scarring alopecia in discoid lupus erythematosus. Br J Dermatol. 1992;126(4):307-14.

Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2016;9:483-9.

Hoss D, Segal S. Scalp Dysesthesia. Arch Dermatol. 1998;134(3):327-30.

Thornsberry LA, English JC. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013;149(2):200-3.

Sarifakioglu E, Onur O. Women with scalp dysesthesia treated with pregabalin. Int J Dermatol. 2013;52(11):1417-8.

Frieden IJ. Aplasia cutis congenita: a clinical review and proposal for classification. J Am Acad Dermatol. 1986;14(4):646-60.

Amaral TN, Marques Neto JF, Lapa AT, Peres FA, Guirau CR, Appenzeller S. Neurologic involvement in scleroderma en coup de sabre. Autoimmune Dis. 2012;2012:719685.

Hesari KK, Seirafi H, Jahan S, Aghazadeh N, Hejazi P, Azizpour A, et al. Nevus sebaceus: a clinicopathological study of 168 cases and review of the literature. Int J Dermatol. 2016;55(2):193-200.

Kang S, editor. Fitzpatrick’s dermatology. Ninth edition. New York: McGraw-Hill Education; 2019: 2053-2063.

Ramaswamy AS, Manjunatha HK, Sunilkumar B, Arunkumar SP. Morphological Spectrum of Pilar Cysts. North Am J Med Sci. 2013;5(2):124-8.

Fong PH, Lee ST, Lim Tan SK. Primary scalp cancer in Singapore. Ann Acad Med Singapore. 1986;15(1):67-70.

Mellenberg DE, Schoeppel SL. Total scalp treatment of mycosis fungoides: the 4 x 4 technique. Int J Radiat Oncol Biol Phys. 1993;27(4):953-8.