Halo scalp ring: a form of localized scalp injury associated with caput succedaneum

Halo scalp ring with purulent drainage in a newborn

We present the case of a 2-week-old male infant who repeatedly presented to the pediatric emergency department for fussiness and drainage from a head wound. The infant had an ultimate diagnosis of halo scalp ring, a rare dermatologic condition that is treated conservatively. This condition shares characteristics with infectious processes and must be differentiated from more serious illness to minimize unnecessary and expensive medical treatment.

Halo scalp ring in a premature newborn and review of the literature

Unusually prolonged pressure on the scalp by the cervical os during or before the delivery may result in a distinctive pattern of annular alopecia that has been referred to as halo scalp ring. This rare form of hair loss is most commonly a temporary, non-scarring process that is attributed to caput succedaneum. We report a new case of halo scalp ring in a premature newborn. Review of previously reported cases suggests that prematurity is an important, previously unrecognized, risk factor for developing a halo scalp ring.

Alopecia Associated With Birth Injury

BACKGROUND

Alopecia after birth-related caput succedaneum is an extremely rare complication.

CASE

The case of a child with permanent alopecia due to birth-related caput succedaneum is presented. After delivery with vacuum extraction, caput succedaneum at the left occipitoparietal region of the neonate's head was noted, which subsided within a week, leaving a circular necrotic crust and finally a circular bald area. At age 4, the child was referred at a tertiary center for the management of alopecia. Treatment initially consisted of the expansion of the hair-bearing skin adjacent to the bald area, which was excised at a second stage and covered with the expanded skin. A pleasing esthetic result was achieved.

CONCLUSION

Neonatal alopecia is a rare birth-associated complication. Premature rupture of the membranes, prolonged second stage of the labor, and prolonged vacuum extraction time may be important features in the pathogenesis of this complication. In case of permanent alopecia, excellent esthetic results can be achieved with the use of reconstructive plastic surgery techniques.

Erosive pustular dermatosis of the scalp after perinatal scalp injury

We report four infants born with necrotic caput succedaneum that led to a scarring alopecia with ongoing inflammation and persistent scale-crust. These lesions did not significantly improve with topical or oral antibiotics, but did respond somewhat to topical corticosteroids. Alopecia with chronic erosive scale-crust and a moderate response to topical corticosteroids are findings consistent with a diagnosis of erosive pustular dermatosis of the scalp.

Alopecia areata in infants and newborns

Alopecia areata is a common cause of nonscarring hair loss in children and adults. In newborns and very young infants, however, it is thought to be extremely rare. In this article we describe five cases of alopecia areata in patients less than 6 months of age and briefly discuss the pertinent differential diagnosis of infants and newborns with both patchy and complete hair loss. We propose that alopecia areata may be more common in this age group than the literature suggests.

Disorders of the hair and scalp in children

A wide variety of disorders involving the scalp and hair exist that may be encountered in the pediatric and adolescent population. An approach to the differential diagnosis of many of these conditions can be considered once the patient is found to have either alopecia, scaling, or tumors of the scalp. Certainly other causes of scalp or hair disease exist but the more common disorders can be appropriately considered in this manner.