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Pinhead Scalp Sores: Differential Diagnosis and Workup

Six Common Causes

ConditionKey Features
FolliculitisPustules at follicular orifices; S. aureus common; pruritic/tender
Sebaceous HyperplasiaYellow-white, umbilicated papules; benign; sebaceous gland enlargement
Tinea CapitisScaly patches, broken hairs, lymphadenopathy; KOH prep + culture; pediatric peak
PsoriasisSilvery scale, Auspitz sign, Koebner; nail pitting, joint involvement possible
Seborrheic DermatitisGreasy yellow scale, erythema; Malassezia-driven; chronic relapsing
Contact DermatitisAcute: vesicles, weeping; Chronic: lichenification; history of allergen/irritant exposure

Diagnostic Steps

  1. Dermoscopy (comma hairs, dotted vessels, scaling pattern).
  2. KOH prep / fungal culture.
  3. Bacterial culture if pustular.
  4. Biopsy if atypical or refractory.

Treatment is etiology-specific: antibiotics, antifungals, topical steroids, calcineurin inhibitors, biologics (psoriasis).

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