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.

 Enlarge     Print

Figure 1.

Figure 1.


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

Address correspondence to Sommer Aldulaimi, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


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. 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.

A collection of Photo Quiz published in AFP is available at

Previously published Photo Quizzes are now featured in a mobile app. Get more information at

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. E-mail submissions to



Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Nov 15, 2017

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article