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SUMMARY
Pustular dermatoses of the scalp are several disorders characterized by the presence of folliculitis.
It is an inflammatory process that affects the hair follicle, represented by pustular elements centered by a hair.
There are numerous types of pustular dermatoses, based on etiology: infectious, inflammatory and neoplastic disorders.
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TIPS FOR DIAGNOSIS
Clinical evaluation is crucial for diagnosis.
Trichoscopy helps the clinician to confirm the diagnosis.
Scalp biopsy is requested in rare cases, especially in scarring alopecia.
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TIPS FOR TREATMENT
Local therapy is the first approach in mild cases.
Combined therapy with topical and oral therapy may increase the cure rate in severe cases.
Possible secondary infection can be found.
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DON’T FORGET
Pustular dermatoses of the scalp can determine scarring and non-scarring alopecia. Deep folliculitis represents a typical form of scarring alopecia instead of superficial folliculitis that represents a typical form of non-scarring alopecia.
They can manifest as single or multiple lesions.
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PITFALLS AND CAUTIONS
Pustular dermatosis of the scalp typically affected children, while erosive pustular dermatosis is typical of elderly patients.
Trichoscopy can be useful but together with the clinical history.
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EXPERT PEARLS
Most lesions are located at the head and neck, but they can also be seen at trunk and extremities.
In erosive pustular dermatosis of the scalp, ask always about a trigger traumatic event.
Treatment should be started as early as possible to minimize permanent hair loss.
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BACTERIAL FOLLICULITIS (IMPETIGO)
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Bacterial folliculitis (also known as impetigo) is an infectious disorder of the scalp frequently caused by Staphylococcus aureus or Streptococcus pyogenes.1–6
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It is a rare condition, mostly shown in childhood.1–6
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Possible risk factors are trauma, bite, or use of immunosuppressive drugs.
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Tufted hair can emerge together from a yellow-white pustule with an erythematous border (Fig. 43.1). Itching with possible bleeding or pus leaking from injuries are frequently seen determining a secondary yellow-brown crust.5,6
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Dermoscopy is a fundamental tool, showing (Fig. 43.2):
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Pustular lesions centered by hair grouped all together, with erythematous border.
Color crusts varying from intense red in the acute phases, to yellowish-brown in the chronic phase.
Transitory alopecia after the disappearance of the crust.
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