Common Dermatologic Conditions with Dr. Temitayo Ogunleye

Well, on a somewhat related note, I guess, I want to just throw in a question about psoriasis really quickly while we're on the scalp.

But then I do have another question about eczema.

But I think sometimes I've found that when I'm looking at the scalp, it can be challenging to know, is this eczema? I mean, presumably there's a history of eczema.

Or are we actually talking about psoriasis? Because...

Psoriasis, in terms of similarity with eczema, I mean, there are certain parts of the body that are favored and the appearance should be different, but how do you approach that?

When thinking about like psoriasis, atopic dermatitis or eczema, and even seborrheic dermatitis, which you're going to see much more commonly on the scalp.

Initially, I don't think it makes that much of a difference to differentiate because the treatment is the same for most of them, right? You're going to do a topical steroid.

Maybe you'll choose one of these non-steroidal kind of creams or foams that are available.

But most of those non-steroidal creams and the steroidal creams have broad efficacy for all three.

So I think initially, if you have questions of whether it's psoriasis versus atopic dermatitis versus seborrheic dermatitis, and you don't have evidence elsewhere on the body to help you make that differentiation, where like, you know, they don't have nail pitting, they don't have psoriasis, they don't have a history of atopic dermatitis.

at least initially, I don't think it's important to make that differentiation.

I think that you can treat and then you can decide based on response to treatment.

So if you have something that's not responding to treatment, it may be more important to consider doing a biopsy to try to figure out what the actual diagnosis is.

Is there any other way I would suppose I'm kind of thinking about, like, would you say that maybe you might see psoriasis more commonly along the hairline versus in the center of the scalp versus eczema or seborrheic dermatitis? Is there any kind of distribution that might be helpful for us to think about?

Distribution, not always, but appearance, yes.

So Typically for psoriasis, it's going to be a little bit thicker.

And psoriasis, you know, we always describe it as well demarcated.

So oftentimes psoriasis, if you're going to have a plaque or a thin patch of psoriasis on the scalp, you're going to see a border that's kind of very well demarcated.

And that's going to be in comparison to either atopic dermatitis or seborrheic dermatitis, where it usually is a much more poorly demarcated like eruption where You'll see some redness, you'll have some scale, but it'll just be scattered in different places rather than having a spot where you could almost draw out the border of a psoriatic plaque or patch.

So that would be probably one of the major differences.

Oftentimes you're much more likely to see plaques with psoriasis where you have thicker areas of involvement.

You're much more apt to have maybe thicker scale where it's a little bit more of that, what we call micaceous scale, which is kind of like more of like a silvery scale.

And interestingly enough, psoriasis is more likely not to be itchy.

So definitely people with scalp psoriasis can have itching, but there are definitely people with psoriasis on their scalp that have very minimal symptoms.

So if you see someone with kind of a rash on their scalp and it's not that itchy, I might consider that it'd be more likely to be psoriasis compared to atopic dermatitis or seborrheic dermatitis, which is usually itchy.