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- Presentation
Dermatology Pearls: Diagnosing Scalp Fungal Infections and Treating Xanthelasma and Sebaceous Hyperplasia with Dichloroacetic Acid
Description
The speaker shares dermatology pearls focused on two main topics: scalp fungal infections and the use of dichloroacetic acid for cosmetic lesions. For scalp scaling and itch in adults, the key lesson is not to dismiss fungus just because ketoconazole or other topical shampoos fail; ectothrix infections such as Microsporum canis and endothrix infections such as Trichophyton tonsurans can occur in older patients and require systemic treatment because topicals do not reach the hair follicle deeply enough. Diagnostic tools like KOH prep, fungal culture, PCR, and Wood’s lamp can prevent unnecessary biopsies. The second topic is dichloroacetic acid, also referred to as bichloroacetic acid, for treating xanthelasma and sebaceous hyperplasia. The speaker explains practical technique, including using a toothpick, protecting the eyes, expecting frosting and a moist wound afterward, and using simple wound care with Vaseline. He emphasizes that the method is highly effective but causes some scarring risk and possible pigment changes, so it should be used first in light-skinned patients while beginners gain experience. For sebaceous hyperplasia, he recommends starting with a few lesions away from the center of the face, then expanding treatment as confidence grows. He closes by encouraging clinicians to read original articles and mentions a rural dermatology access group for expanding care beyond urban settings.
View moreConclusions
- Adult scalp scaling that does not respond to standard anti-dandruff treatments may still be fungal infection, so bedside tests like KOH and Woods lamp evaluation can prevent unnecessary biopsy.
- Ectothrix scalp fungi are often Microsporum species, may fluoresce, and can be linked to animal exposure such as dogs.
- Endothrix scalp infection in adults can occur and is commonly due to Trichophyton tonsurans, and topical shampoos or creams alone are inadequate because scalp fungus requires systemic treatment.
- Dichloroacetic acid is presented as an effective, inexpensive, office-based treatment for xanthelasma when lesions are selected carefully and the eyes are protected.
- The technique for dichloroacetic acid treatment depends on precise application, conservative patient selection, and meticulous wound care to achieve good cosmetic healing.
- The same dichloroacetic acid approach can also work well for sebaceous hyperplasia, especially as an easy first case to build clinician confidence.
- These chemical treatments can cause scarring, pigment change, or milia, so they should be used cautiously, especially in darker skin types and when cosmetic timing matters.
- The overall message is that practical dermatology often improves through simple diagnostic and therapeutic pearls, careful technique, and willingness to learn from mistakes.
- Haygood LJ., JDBennett, and RT Brodell. "Treatment of xanthelasma palpebrarum with bichloracetic acid." Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 24.9 (1998): 1027-1031.#10.1111/j.1524-4725.1998.tb04297.x
- Rosian R., JB Goslen, and RT Brodell. "The treatment of benign sebaceous hyperplasia with the topical application of bichloracetic acid." The Journal of dermatologic surgery and oncology 17.11 (1991): 876.#10.1111/j.1524-4725.1991.tb03278.x