scaly scalp

There are a number of conditions that cause scaly scalp in children. Most cases are fairly trivial in nature, but there are significant medical problems that can appear first as rash in the scalp area. This list is not exhaustive. To help you narrow down what might be going on, here is your Common Sense Encyclopedia Scaly Scalp Decoder. Be sure to confer with your child's physician if there is anything more than a mild, temporary problem that you can handle yourself.

tinea capitis
(fungal infection)
Four forms:
patchy hairloss with raised borders (classic "ringworm" of the scalp) diagnosis may require scrapings and culture; treatment is oral grifulvin V
boggy, tender, inflammed nodules (kerion)  
clusters of pustules arising from hair follicles with hair loss  
diffuse seborrhea-like scaling without hair loss  
newborns: thick, greasy scaling of scalp in first few months of life - cradle cap; may be associated with rash behind ears or on face, in eyebrows, in diaper area oil or Vaseline® applied and left for several hours before shampooing out; hydrocortisone cream
older children and adolescents more classic dandruff symptoms, scaly, flaky eyebrows, inflammation in hair of chest for pubertal boys dandruff shampoos such as Head and Shoulders®, Tegrin®, etc.; hydrocortisone cream
atopic dermatitis
newborns often associated with facial rashes and diaper area rash; confused with cradle cap but treated the same
older children associated with classic eczematous, dry, itchy rashes; classically in creases of elbows and knees; other rough, dry, red and itchy areas
thick silvery scale on the scalp which may bleed when scraped off; look for similar involvement around the umbilicus, behind the ears, and around the buttocks creases very mild scalp involvement treated similar to seborrheic dermatitis
classic itchy, itchy papules and burrows treatment: permethrin cream or lindane lotion/shampoo head to toe as directed by your physician
a rare connective tissue disease; muscle weakness and tenderness in large muscle groups with characteristic rash around the eyes ("heliotrope rash") and other eczematous skin findings referral to a rheumatologist for definitive diagnosis and treatment

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