Q: I have a 6 year old daughter that is a patient at Lancaster Pediatric, and she is having an issue with her scalp. She has this powdery-dry whitepatches(sometimes red) on her sides of her scalp( that is the only place I see it) that can sometimes flake if you touch it and sometimes not. I messed with it one time, and her scalp bled in the places I was trying to remove it. When I comb or brush her hair she says it hurts( that’s also when I do not touch it at all, she complains it itches). At first glance, I thought it was dandruff, but I suspect its something else. I brought her a special dandruff shampoo( it helps with other scalp issues) that helps, but it still comes back within a few days. Its a bit frustrating because sometimes its there and sometimes its not. When its there it looks bad. I use a bit of oil which makes it disappear for a bit. I do not put harsh products in her hair. I use a kiddie shampoo , conditioner, and a lite moisturizer. Sometimes, I wash her hair with baking soda and apple cigar vinegar. Recently, I been using a dandruff shampoo.
A: That sounds like some version of a fungal scalp infection. There are many different kinds including seborrhea dermatitis (a big kid version of cradle cap caused by a form of yeast) and tinea capitis (ring worm in the scalp ). Some fungal infections in the scalp you can treat with anti fungal shampoos and creams, however others have to be treated orally with an anti fungal medicine called griseofulvin. It’s impossible to tell which it is without seeing it and maybe even sending a scraping off to the lab. However, since it is not a circular pattern it is more likely seborrhea. Try using Nizoral shampoo (an anti fungal shampoo sold in the dandruff section) every other day . In between put tea tree oil on the patches. Typically this combination will keep seborrhea at bay. Once gone it may come back, especially in the winter as our dry air triggers increased oil production in the scalp which allows the fungus to grow. If the above plan doesn’t work or it comes back repeatedly then we need to see her.
Hope that helps!