Photo Quiz

Swelling and Erythema of the Scalp on a Teenager

 

Am Fam Physician. 2016 Nov 15;94(10):836-842.

A 16-year-old boy presented with swelling and erythema on the scalp that had worsened over the previous four weeks. Three to four months prior to the development of the swelling, he noted a red circular rash on the same area of his scalp. The rash resolved with application of an over-the-counter antifungal cream. After resolution of the rash, the swelling and erythema began, and the area became painful. He did not have a fever or chills, and there was no discharge from the site. The patient was otherwise healthy and active, and was a member of his school's wrestling team.

Examination of the scalp revealed an area of erythema and induration (Figure 1). The scalp was tender to palpation but not fluctuant. There was no cervical or occipital lymphadenopathy. Ultrasonography showed no fluid collection in the lesion.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Id reaction.

B. Kerion.

C. Pustular psoriasis.

D. Staphylococcal abscess.

Address correspondence to Sommer Aldulaimi, MD, at sommer.aldulaimi@bannerhealth.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Fuller LC, Child FJ, Midgley G, Higgins EM. Diagnosis and management of scalp ringworm. BMJ. 2003;326(7388):539–541....

2. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. 2006;77(2):93–99.

3. Cheng AG, DeDent AC, Schneewind O, Missiakas D. A play in four acts: Staphylococcus aureus abscess formation. Trends Microbiol. 2011;19(5):225–232.

4. Evans MP. Id reaction (autoeczematization). Updated August 5, 2016. Medscape. http://www.emedicine.medscape.com/article/1049760-overview. Accessed September 8, 2016.

5. Borges-Costa J, Silva R, Gonçalves L, Filipe P, Soares de Almeida L, Marques Gomes M. Clinical and laboratory features in acute generalized pustular psoriasis: a retrospective study of 34 patients. Am J Clin Dermatol. 2011;12(4):271–276.

6. Kemper AR, Dolor RJ, Fowler VG Jr. Management of skin abscesses by primary care pediatricians. Clin Pediatr (Phila). 2011;50(6):525–528.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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