Evaluating a Scalp Growth and Atopic Dermatitis in a 20-Year-Old Female — Village Dermatology Katy & Houston, Texas

Written By Honey Cisneros

By: Dr. Ashley Baldree

Young adults often present with a combination of dermatologic concerns involving both growths and inflammatory skin conditions. This case report highlights a 20-year-old female evaluated at Village Dermatology, serving Katy and Houston, Texas, for a scalp growth, eczema flares, and post-inflammatory hyperpigmentation (PIH).

Chief Complaints

  1. Growth on the left central parietal scalp

  2. Rash on the hands and left leg

The patient reported:

  • A moderate, asymptomatic growth on the scalp

  • Flaking rash on the hands and left lower leg

  • Concern about dark discoloration (PIH) left behind after rashes

She had been previously treating eczema with triamcinolone.

Clinical Examination

A focused examination evaluated the:

  • Scalp

  • Face

  • Hands

  • Left lower leg

The patient was well-appearing, alert, and in no distress.
Findings included:

1. Scalp Lesion

A solitary lesion on the left central parietal scalp concerning for:

  • Neoplasm of uncertain behavior

  • Nevus

  • Lipofibroma

2. Active Atopic Dermatitis

Erythematous, eczematous patches on:

  • Left proximal pretibial region

  • Left ulnar dorsal hand

  • Right ulnar dorsal hand

3. Post-Inflammatory Hyperpigmentation

Ill-defined hyperpigmented patches in the same areas where eczema was present.

Diagnosis & Assessment

1. Neoplasm of Uncertain Behavior

Given the uncertain nature of the scalp growth, a biopsy was recommended.

Biopsy Procedure

  • Shave biopsy of the lesion

  • Local anesthesia with lidocaine + epinephrine

  • Dermablade used to obtain specimen for H&E

  • Hemostasis with Drysol

  • Petrolatum applied post-procedure

The patient will be notified of results within 2 weeks.

2. Atopic Dermatitis

The patient had persistent eczema despite 2 months of topical steroid use.
She was experiencing an active flare.

Treatment Plan

  • Fluocinonide 0.05% cream for the body

  • Fluocinonide 0.05% solution for the scalp

  • Daily moisturization with CeraVe cream

  • Discussed long-term options:

    • Continued topical therapy

    • Dupixent injections (biologic therapy)

Steroid counseling included:

  • Avoiding prolonged use

  • Avoiding high-potency steroids on face, groin, or skin folds

  • Possible side effects: atrophy, telangiectasias, hypopigmentation

3. Post-Inflammatory Hyperpigmentation (PIH)

PIH was present secondary to eczema flares.

Counseling Included:

  • PIH fades naturally but may take months to years

  • Strict sun protection recommended

  • Goal is first to control active eczema, then address pigmentation

Patient Counseling

Topics reviewed during the visit:

Skin Care for Eczema

  • Use lukewarm showers

  • Apply moisturizers immediately after bathing

  • Use unscented cleansers and detergents

  • Avoid excessive hand washing

  • Keep nails short to reduce scratching

When to Contact the Office

  • Worsening rash

  • Signs of infection (yellow crusts or cold sores)

  • Darkening or spreading hyperpigmentation

Follow-Up

The patient will return in 1 month for evaluation of:

  • Biopsy results

  • Eczema response to treatment

  • PIH improvement

Why Early Evaluation Matters

Young adults often overlook concerning skin growths or chronic rashes.
At Village Dermatology, serving Katy and Houston, we provide:

  • Expert evaluation of suspicious lesions

  • Personalized eczema treatment plans

  • Guidance on pigmentary disorders such as PIH

This case highlights the importance of comprehensive dermatologic care in patients with overlapping concerns.

Honey Cisneros
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