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Live Blog: The Red Scalp and Red Face Differential Diagnosis – Faculty: Whitney High, MD

In this live blog from the Annual Summer SDPA Conference in Las Vegas, Whitney High, MD, presented a lecture on “The Red Scalp and Red Face Differential Diagnosis.” Here are some of the highlights.

In this lecture Dr. High shared some pearls on naming and treating various common and not-so-common conditions. Some conditions Dr. High mentioned were rosacea, lupus, and seborrheic dermatitis.

Seborrheic Dermatitis
This condition appears after puberty with a “seborrheic” distribution on the scalp, eyebrows, and facial areas. Some of these can be puritic but this varies. You’ll notice red, sometimes white/yellow, and greasy rashes on these areas. Patients with seborrheic dermatitis may also be HIV/AIDS patients, or be individuals that have suffered a stroke involving the cranial nerves. For treatment Dr. High suggested low potency steroids, adding that, “You should try to avoid using high-potency steroids on the face.”

Dr. High offered that the main difference between rosacea and acne is that you will not see comodones in rosacea. No one really knows what causes this disease but it is common in certain ethnicities and only affects adults. Typically patients will have a mixed pattern of the four subtypes, which are erythematotelangiectatic (flusher/blusher), papulopustular, phymatous (seen only in men), and ocular rosacea. It is important to educate your patients about the pathology of the condition and help them to identify their triggers to minimize eruptions. Some triggers include alcohol, caffeine, tomatoes, or wind.

Lupus Erythematosus
“The thing about lupus,” said Dr. High, “is that all forms are photodriven. Vampires won’t ever show signs of lupus.” Various forms of lupus tend to be seen in specific demographics. Discoid Lupus Erythematosus (DLE) often affects young African and African American women where as Subacute Cutaneous Lupus Erythematosus (SCLE) is seen mainly in white women. Dr. High described DLE as fixed plaques with variable scarring, follicular plugs, hyperkeratosis, and pigmentary changes. When looking at SCLE, one will notice annular or psoriasiform plaques present on the sun exposed areas.

Image: Thomas Hawk

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