Visual Diagnosis: An Adolescent Male With Severe Facial Swelling and Scalp Infection

• Published in: Pediatrics in review Vol. 36; no. 11; pp. e39 - e42
• Main Authors: Riney, Lauren C, Shah, Meera, Lopez Domowicz, Denise A
• Format: Journal Article
• Language: English
• Published: United States 01-11-2015
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Clindamycin - therapeutic use; Dermatitis, Allergic Contact - diagnosis; Dermatitis, Allergic Contact - drug therapy; Dermatitis, Allergic Contact - etiology; Diagnosis, Differential; Facial Dermatoses - diagnosis; Facial Dermatoses - drug therapy; Facial Dermatoses - etiology; Hair Dyes - adverse effects; Hair Preparations - adverse effects; Humans; Male; Methylprednisolone - therapeutic use; Scalp Dermatoses - diagnosis; Scalp Dermatoses - drug therapy; Scalp Dermatoses - etiology; Staphylococcal Skin Infections - diagnosis; Staphylococcal Skin Infections - drug therapy; Superinfection - diagnosis; Superinfection - drug therapy
• ISSN: 0191-9601; 1526-3347
• DOI: 10.1542/pir.36.11.e39

Scalp eruptions are common in infants, children, and adolescents and the etiology can be broad. Allergic contact dermatitis can result after multiple non eventful uses of a hair care product, including shampoo, relaxers, and coloring agents. Symptoms of allergic contact dermatitis include intense pruritus with weeping, pain, and stinging sensations. Signs on physical examination include swelling with scaly erythematous plaques as well as bullae with vesicles and pustules in severe cases. The forehead, eyelids, and postauricular areas also are subject to swelling. Definitive diagnosis of allergic dermatitis involves patch testing to determine the specific allergen. Education about avoidance of the allergen and recommendations for allergen-free products are the most important aspects of managing patients with allergic contact dermatitis. Treatment depends on the severity and extent of involvement. First-line treatment is topical corticosteroids, followed by topical calcineurin inhibitors. For more extensive dermatitis, systemic corticosteroids are beneficial.