Differential Diagnosis for Scalp Scaly Fungal Infection with Discharges

• Single most likely diagnosis:
  • Tinea capitis (Ringworm of the scalp): This is the most common fungal infection of the scalp, especially in children, characterized by scaly, circular patches, and sometimes accompanied by discharge.
• Other Likely diagnoses:
  • Seborrheic dermatitis: A condition that can cause scaly patches, red skin, and stubborn dandruff, often accompanied by an oily discharge.
  • Psoriasis: An autoimmune condition that speeds up the life cycle of skin cells, causing cells to build up rapidly on the surface of the skin, leading to scaly patches and sometimes discharge.
  • Folliculitis: An inflammatory condition affecting the hair follicles, which can be caused by fungal or bacterial infections, leading to scaly skin and discharge.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Kerion: A severe form of tinea capitis that can lead to scarring and permanent hair loss if not treated promptly, characterized by an inflammatory, suppurative mass.
  • Meningitis (in rare cases of fungal infections spreading): Although rare, certain fungal infections can spread to the meninges, leading to meningitis, which is life-threatening and requires immediate medical attention.
• Rare diagnoses:
  • Favus (Tinea favosa): A chronic and contagious fungal infection of the scalp, characterized by the formation of yellowish crusts (scutula) and mats of hair, leading to scarring and permanent hair loss.
  • Piedra: A fungal infection that affects the hair shaft, causing hard, nodular lesions, which can lead to scaly skin and discharge if the scalp is involved.