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Skin Diseases and Disorders01:23

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Red Scalp Disease: An Underdiagnosed Entity.

Daniel Asz-Sigall1, Alejandra Segarra-Ponce2, Sofía Olvera-Lerma3

  • 1Trichology Clinic, Dermatology Department. Hospital General "Dr. Manuel Gea González", Mexico City, Mexico.

Skin Appendage Disorders
|June 6, 2025
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Summary

Scalp rosacea, an inflammatory scalp condition, is often misdiagnosed. Early diagnosis using specific trichoscopic findings and treatment with oral tetracyclines can significantly improve outcomes.

Keywords:
Inflammatory alopeciasNon-scarring alopeciaRed scalp diseaseScalp rosaceaScarring alopecia

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Area of Science:

  • Dermatology
  • Trichology

Background:

  • Scalp rosacea is an underrecognized inflammatory dermatosis.
  • It is frequently misdiagnosed as scarring alopecia due to nonspecific findings.
  • Facial rosacea is well-documented, but extrafacial involvement like the scalp is less recognized.

Purpose of the Study:

  • To highlight the diagnostic challenges of scalp rosacea.
  • To present a case of scalp rosacea with characteristic trichoscopic findings.
  • To emphasize the importance of accurate diagnosis and treatment.

Main Methods:

  • A case report of a 70-year-old male with a year-long history of asymptomatic red scalp.
  • Clinical examination revealing diffuse erythema, papules, and pustules.
  • Trichoscopic examination identifying vascular polygons, "caterpillar hair" vessels, linear arterial branching, and hairpin vessels.

Main Results:

  • The patient was diagnosed with scalp rosacea based on clinical and trichoscopic findings.
  • Significant improvement was observed after two months of oral tetracycline therapy.
  • Distinct trichoscopic patterns aid in differentiating scalp rosacea from other conditions.

Conclusions:

  • Accurate diagnosis of scalp rosacea is crucial to avoid inappropriate treatments and establish prognosis.
  • Early recognition and treatment with systemic antibiotics like tetracyclines are vital.
  • Increased awareness among dermatologists and trichologists is needed for better management.