Red Scalp Disease: An Underdiagnosed Entity.

Abstract

Introduction: Red scalp disease or scalp rosacea, an inflammatory dermatosis, is frequently misdiagnosed as scarring alopecia due to nonspecific trichoscopic findings and limited case reports. While facial rosacea is well-documented, rosacea affecting extrafacial sites, such as the scalp, remains underrecognized. Accurate diagnosis is crucial to avoid unnecessary treatments and to establish an appropriate prognosis.

Case report: A 70-year-old male with an asymptomatic red scalp for 1 year, unresponsive to topical treatments, presented to our clinic. Examination revealed diffuse erythema with papules and pustules. Trichoscopy showed vascular polygons, "caterpillar hair" vessels, linear arterial branching, and hairpin vessels. Diagnosis of scalp rosacea was made, and significant improvement was observed after 2 months of oral tetracycline therapy.

Discussion/conclusion: Red scalp disease is characterized by diffuse erythema, inflammatory lesions, and vascular changes. Patients often exhibit mild facial photosensitivity but may not show prominent facial rosacea symptoms. Distinct trichoscopic patterns can assist in accurate diagnosis. Early recognition and treatment with systemic antibiotics, such as tetracyclines, are crucial to prevent progression to more severe inflammation. Increased awareness among dermatologists and trichologists is essential to enhance the diagnosis and management of this condition.