Differential Diagnosis for a 20-year-old Female with a Sore on the Scalp
- Single most likely diagnosis:
- Folliculitis: Given the patient's history of having her hair done recently, folliculitis is a likely diagnosis. This condition is an inflammation of the hair follicles, often caused by bacterial or fungal infections, and can be exacerbated by hair treatments. The symptoms of itching, burning, and scabbing are consistent with folliculitis.
- Other Likely diagnoses:
- Psoriatic scalp plaque: Although the patient has a history of psoriasis and does not take medications, the description of the sore does not perfectly align with typical psoriatic plaques, which are usually well-demarcated, erythematous, and scaly. However, given her history, it's a consideration.
- Contact dermatitis: This could be a reaction to hair products used during her recent hair treatment. The itchy, burning sensation and the progression of the sore are consistent with contact dermatitis.
- Tinea capitis (ringworm of the scalp): This fungal infection can cause patches of hair loss, itching, and redness. The scabbing and shedding every two days could be indicative of this condition, especially if the patient has been in close contact with someone who has it.
- Do Not Miss diagnoses:
- Squamous cell carcinoma or other skin cancers: Although rare in a 20-year-old, any non-healing sore or lesion should prompt consideration of skin cancer, especially if there's a history of excessive sun exposure or use of tanning beds.
- Kerion: A severe form of tinea capitis that can lead to significant inflammation and potentially permanent hair loss. It requires prompt antifungal treatment.
- Discoid lupus erythematosus: An autoimmune condition that can cause scarring hair loss, and the lesions can be itchy and burn. It's less common but important to consider due to its potential for scarring and systemic implications.
- Rare diagnoses:
- Alopecia areata with secondary infection: While alopecia areata itself causes hair loss without the scabbing and shedding described, if the area becomes secondarily infected, it could present with similar symptoms.
- Trichotillomania with secondary infection: This is a psychological condition where a person pulls out their own hair. If the area becomes infected, it could present with sores, scabbing, and itching. However, the history provided does not strongly suggest this diagnosis.