Approach to the Problem
White specks in the hair may be a manifestation of systemic disease or of localized scalp disease. It is important to check other parts of the body for signs of disease as white specks in the hair may not always be from disease limited to the scalp. Once properly identified, white specks in the hair can usually be treated effectively.
Key Points in the History
• Extensive application of hair products can present as white, nonpruritic flakes close to the scalp.
• Tinea capitis is a common cause of white specks in the hair and/or alopecia in children of African descent, but it is uncommon in children of other race/ethnicities.
• Tinea capitis is acquired through personal contact with spores from a lesion.
• Seborrheic dermatitis, also known as cradle cap in infants, may also occur in adolescents during puberty.
• Seborrheic dermatitis in infants usually involves the scalp but may extend to other areas of the body. It typically resolves by 7 to 8 months of age.
• Atopic dermatitis is common in infants and may involve the scalp. Patients often have a family history of asthma, allergies, or allergic rhinitis.
• Children with atopic dermatitis affecting the scalp often complain of itchiness or scratching.
• Head lice infestation, a relatively common cause of itchy scalp, is usually a disease of school-aged girls. It is uncommon in children of African descent, and occurs in all socioeconomic groups. Head lice are acquired through close contact with an infested person. Although less commonly than previously thought, acquisition may also occur through contact with infested items such as hats, headsets, combs, brushes, and bedsheets.
• Psoriatic lesions may occur over the entire body. Thirty to forty percent of affected patients have a family history of disease.
Key Points in the Physical Examination
• Round patches of inflammation with flakiness and alopecia are typical with tinea capitis.
• Occipital lymphadenopathy is commonly seen with tinea capitis, which helps to distinguish it from other causes of white flakes.
• Diffuse tinea capitis may resemble seborrheic dermatitis and present as diffuse scalp dryness without alopecia or erythema.
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