Scaly Scalp Rash

Q. My son has this white covered spot on his scalp. At first I thought it was just like cradle cap, so I cleaned it. Then it looked like a ringworm, so i put some ointment on it. It continued to spread, so I took him to the doctor on Thursday. He said it was a staff infection, so he gave me some TMP/SMX. Now its been a week and a day and it doesn't look any better. It has me very worried and the school doesn't want him around other kids. What should i do?

A. Since it isn't getting better, you likely should return to your Pediatrician for a recheck. At this point, he might order both bacterial and fungal cultures of the area to get a better idea of what might be causing the spot.

In a school aged child, the most common things that would cause a scaly spot on a child's head include:

• tinea capitis - a fungal infection (ringworm) on the scalp, which would usually not respond to a topical antifungal cream or ointment and instead needs an oral medication, like griseofulvin
• bacterial staph infections - which if you are in an area where MRSA is common, treatment with Bactrim (TMP/SMX) would be appropriate
• seborrheic dermatitis - a greasy, red, scaly, itchy rash that can be found on a child's scalp, behind their ears, and on the sides of their nose. It is often treated with antidandruff shampoos and steroid oils and lotions, but is not very common before a child begins puberty.

Less commonly, children with psoriasis, dermatomyositis, and lupus erythematosus, may have a scaly red scalp.

In addition to seeing your Pediatrician again, it may help to begin using a medicated shampoo, including something like Selsun Blue, Head and Shoulders, Nizoral, or Neutrogena T/Gel.

Like with cradle cap, it is sometimes also helpful to try and remove scale from a child's scalp by rubbing it with mineral oil and then washing it out with a dishwashing liquid or a tar shampoo.