Williams Judith V, Eichenfield Lawrence F, Burke Bonnie L, Barnes-Eley Myra, Friedlander Sheila F
Department of Pediatrics, Division of Dermatology, Children's Specialty Group, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Pediatrics. 2005 Jan;115(1):e1-6. doi: 10.1542/peds.2004-1616.
To determine the prevalence and most common etiologies of scalp scaling in infants and prepubertal children and the specificity of head and neck lymphadenopathy for the diagnosis of tinea capitis associated with scalp scaling.
DESIGN/METHODS: A cross-sectional study of 300 children, 200 from an urban general pediatric practice and 100 from 2 urban pediatric dermatology practices, was conducted. Half of the subjects were <2 years old, and half were 2 to 10 years old. Demographic data, medical history, and clinical data noting the presence of scalp scaling and other scalp signs and symptoms, as well as adenopathy of the head and neck, were collected.
Scalp scaling was seen in 66 (22%) children. There was an insignificantly higher prevalence of scalp scaling in those <2 years old compared with the 2- to 10-year-old group. In those <2 years old with scalp scaling, the most common diagnoses were seborrheic dermatitis (thick, adherent, greasy scale predominantly in the frontal and/or vertex areas of the scalp) and atopic dermatitis/eczema. Among those 2 to 10 years old with scalp scaling, the most common diagnoses were nonspecific (fine, white) scaling, seborrheic dermatitis, and atopic dermatitis/eczema. Nine (3%) patients were culture-positive for a dermatophyte, all of whom were black, and grew Trichophyton tonsurans. More than half (52.7%) of all patients had head and neck adenopathy. The presence of posterior nodes was significantly associated with atopic dermatitis/eczema and marginally associated with a positive dermatophyte culture. The presence of scalp scaling plus posterior adenopathy was significantly associated with seborrheic dermatitis and a positive dermatophyte culture in the entire study population and with atopic dermatitis in the pediatric dermatology clinics.
Scalp scaling was common in children 0 to 10 years old. Infantile-type seborrheic dermatitis was noted in both age groups: it was 3 times as likely in children <2 years old (18%) than in those 2 to 10 years old (6%). Contrary to traditional teaching, seborrheic dermatitis can be found in preadolescent children. Atopic dermatitis/eczema was associated with scalp scaling in both age groups. Head and neck adenopathy was very common and nonspecific for any 1 diagnosis. Posterior adenopathy with concurrent scalp scaling was significantly associated with seborrheic dermatitis, a positive dermatophyte culture, and atopic dermatitis. In this nonselected pediatric population, scalp scaling with adenopathy was not associated exclusively with tinea capitis.
确定婴儿和青春期前儿童头皮脱屑的患病率及最常见病因，以及头颈部淋巴结肿大对诊断与头皮脱屑相关的头癣的特异性。
设计/方法：对300名儿童进行了一项横断面研究，其中200名来自城市普通儿科诊所，100名来自2家城市儿科皮肤科诊所。一半受试者年龄小于2岁，另一半年龄在2至10岁之间。收集了人口统计学数据、病史以及记录头皮脱屑和其他头皮体征及症状以及头颈部淋巴结肿大情况的临床数据。
66名（22%）儿童出现头皮脱屑。年龄小于2岁的儿童头皮脱屑患病率与2至10岁组相比略高，但差异无统计学意义。在年龄小于2岁且有头皮脱屑的儿童中，最常见的诊断是脂溢性皮炎（头皮额部和/或顶部区域有厚的、黏附性的、油腻的鳞屑）和特应性皮炎/湿疹。在2至10岁有头皮脱屑的儿童中，最常见的诊断是非特异性（细小、白色）脱屑、脂溢性皮炎和特应性皮炎/湿疹。9名（3%）患者皮肤癣菌培养呈阳性，均为黑人，培养出断发毛癣菌。所有患者中超过一半（52.7%）有头颈部淋巴结肿大。枕后淋巴结肿大与特应性皮炎/湿疹显著相关，与皮肤癣菌培养阳性有边缘相关性。在整个研究人群中，头皮脱屑加枕后淋巴结肿大与脂溢性皮炎和皮肤癣菌培养阳性显著相关，在儿科皮肤科诊所中与特应性皮炎相关。
头皮脱屑在0至10岁儿童中很常见。两个年龄组均观察到婴儿型脂溢性皮炎：年龄小于2岁的儿童（18%）患婴儿型脂溢性皮炎的可能性是2至10岁儿童（6%）的3倍。与传统观点相反，脂溢性皮炎可在青春期前儿童中发现。两个年龄组中，特应性皮炎/湿疹均与头皮脱屑有关。头颈部淋巴结肿大非常常见，对任何一种诊断都不具有特异性。枕后淋巴结肿大并发头皮脱屑与脂溢性皮炎、皮肤癣菌培养阳性和特应性皮炎显著相关。在这个未经过挑选的儿科人群中，头皮脱屑伴淋巴结肿大并非仅与头癣相关。
