What's Your Assessment?
What's Your Assessment?
This 7-year-old African-American child presented with her parents to the dermatology office for evaluation of "ringworm and hair loss." The mother stated the patient had been treated for "the same ringworm since she was 2 years old" at a pediatrician's office. Her treatments varied over the past 5 years, the most recent being selenium sulfide shampoo. Her mother could not recall the name of other treatments but did remember her daughter taking "something by mouth" about a year prior to this office visit. Of primary concern to the mother was hair loss. The patient had several occasions of mild hair loss in the past 5 years, but over the past 12 months the hair loss was progressive. In recent weeks, the patient complained of mild scalp pruritus and scalp tenderness, even crying when her hair was brushed or combed. On occasion, the patient's mother noted bleeding and pus formation in the affected areas. Her mother did keep the patient's hair styled in loose braids. She denied using hot combs, tight braids, or relaxers in the hair.
The patient is otherwise a healthy, happy, well-adjusted first grader who does well in school. The patient also attends a child care group after school for 3 hours, 3 days a week with children ages 10 months to 10 years of age. She does not appear to be emotionally affected by the hair loss, but is afraid to be examined due to the discomfort in her scalp. She is not taking medication. There are no siblings or pets at home.
History
This 7-year-old African-American child presented with her parents to the dermatology office for evaluation of "ringworm and hair loss." The mother stated the patient had been treated for "the same ringworm since she was 2 years old" at a pediatrician's office. Her treatments varied over the past 5 years, the most recent being selenium sulfide shampoo. Her mother could not recall the name of other treatments but did remember her daughter taking "something by mouth" about a year prior to this office visit. Of primary concern to the mother was hair loss. The patient had several occasions of mild hair loss in the past 5 years, but over the past 12 months the hair loss was progressive. In recent weeks, the patient complained of mild scalp pruritus and scalp tenderness, even crying when her hair was brushed or combed. On occasion, the patient's mother noted bleeding and pus formation in the affected areas. Her mother did keep the patient's hair styled in loose braids. She denied using hot combs, tight braids, or relaxers in the hair.
The patient is otherwise a healthy, happy, well-adjusted first grader who does well in school. The patient also attends a child care group after school for 3 hours, 3 days a week with children ages 10 months to 10 years of age. She does not appear to be emotionally affected by the hair loss, but is afraid to be examined due to the discomfort in her scalp. She is not taking medication. There are no siblings or pets at home.