“Scalp Pimples” – Folliculitis

This is a common problem. Patients often complain of itchy and mildly tender pimply bumps on their scalp. The number of “pimples” ranges from just a few to many. Bacteria infection is usually the cause and they respond well to oral antibiotic or topical medication.

Scalp folliculitis with pustules

Dandruff

Dandruff is the shedding of dead skin cells from the scalp at a faster than usual rate and it can be itchy at times. It could be due to fungal organisms, infrequent shampooing of hair or inadequate rinsing. Treatment includes scales softener and medicated prescriptive hair lotion or shampoo.

Pityriasis amiantacea

This scalp condition is characterised by thick silvery or yellowish scales encircling the hair shafts and binding down tufts of hair. Temporary or permanent hair loss may occur. It can be due to scalp psoriasis, seborrheic dermatitis, atopic dermatitis or scalp fungal infection. Treatment involves removing the adherent scales and treating the underlying disease.

Pityriasis Amiantacea

Itchy scalp rash ( Psoriasis, dermatitis)

Scalp psoriasis or dermatitis usually appears as an itchy rash with prominent scales or dandruff. Some severe cases can have hair loss as well. Dr Wong will treat with topical treatment or oral medication to manage the itch and the inflammation. In severe cases of psoriasis when a patient’s quality or way of life is affected badly, biologic injection is recommended due to its effectiveness.

Scalp dermatitis

Head Lice

Head lice are small, greyish wingless insects that are roughly the size of a sesame seed when fully grown. They feed off blood obtained by biting the scalp. When an infected person has developed sensitivity to their saliva, itch will occur. When Dr Wong suspects that there is lice, he will search for the live lice before prescribing anti-lice treatment. Medication will also be given to stop the itch and skin reaction.

Scalp growths

Common growths seen on the scalps are benign moles, seborrheic keratosis, epidermal cyst, pilar cyst, viral warts, birthmark (epidermal nevi), papilloma and many others. However, patients are more concerned if their scalp growth is cancerous? A consultation with an accredited dermatologist is prudent to allay one’s anxiety and fear. If needed, an excisional skin biopsy can be arranged to remove the growth and send for laboratory analysis.

Scarring alopecia

Scarring alopecia is where there is a localised bald patch with no visible hair follicle secondary to inflammation in the skin and damage to the hair follicles. Infections like shingles, boils and abscesses can lead to scarring alopecia. Skin diseases like lichen planus, discoid lupus erythematosus are common causes too.

Scarring alopecia

Nevus Sebaceous

A nevus sebaceous is usually a solitary birthmark on the scalp, appearing as a smooth, hairless yellow-orange patch at birth. Besides the scalp, it may also sometimes be found on the face or forehead. Nevus sebaceous is a benign growth / tumour that will become more bumpy, warty or scaly as one grows. Besides the cosmetic appearance, the lingering concern is the risk of cancerous growth arising from within the nevus. Hence, a nevus sebaceous should be monitored and full thickness excisional biopsy may need to be considered, usually at an older age.

Nevus sebaceous in a teenager

Nevus sebaceous in an adult