SCALP TENDERNESS

The cause of scalp tenderness is usually obvious when there is dermatitis or inflammatory disorders of the skin such as herpes zoster, pediculosis, tinea capitis, infected sebaceous cyst, and impetigo.

The tenderness is more subtle in temporal arteritis unless there is associated homolateral blindness or obvious enlargement of the superficial temporal artery. Tenderness in the occipital area is usually due to occipital major or minor entrapment by the posterior cervical muscles. This is common after flexion-extension injuries of the cervical spine or cervical spondylosis. Referred tenderness from trigeminal neuralgia, sinusitis, otitis media, mastoiditis, and disorders of the teeth may occur. When a patient presents with scalp tenderness, especially at the top of the head, and the physical examination is normal, the diagnosis of psychoneurosis should be entertained.

DIAGNOSTIC WORKUP

When there are obvious skin lesions, cultures, potassium hydroxide preparations, or biopsies will usually establish the diagnosis. A skull x-ray should be done to exclude fracture, rickets, syphilitic periostitis, and primary and secondary tumors of the cranium. A sedimentation rate should be done to exclude temporal arteritis, especially in the elderly. If the physical examination and diagnostic workup are normal and the patient persists with the complaint, a referral to a psychiatrist is in order.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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