Scalp Allergic Contact Dermatitis: A Retrospective Analysis of Allergen Profiles and Distribution Patterns

Background: Scalp allergic contact dermatitis (ACD) is less frequent than at other body sites, underdiagnosed due to overlapping dermatoses, and understudied. This study characterized its epidemiology, clinical features, allergen profile, lesion distribution, and preexisting scalp conditions. Methods: A retrospective cohort (Sheba Medical Center, 2009–2023) included patients with clinically relevant patch test-confirmed ACD, categorized into 3 groups: (a) symptoms only (n = 17), (b) visible lesions without preexisting scalp disorder (n = 68), and (c) visible lesions with a preexisting scalp disorder (n = 16). Demographic, clinical, and patch test data were analyzed. Results: Scalp ACD represented 3.2% of patch test referrals (n = 101); 91.1% were female (mean age = 50). Common symptoms were itching and hair shedding, erythema, and scaling were the most frequent signs. Lesions involved only the scalp in 45% and extended beyond in 55%. Diagnosis was delayed by an average of 17 months. Patients had an average of 3.45 positive allergens; 50.5% were polysensitized. Nickel sulfate (47.5%), paraphenylenediamine (32%), and methylisothiazolinone/methylchloroisothiazolinone (14%) were most frequent. Allergen patterns varied by lesion distribution and preexisting scalp conditions. Conclusions: Scalp ACD predominantly affects middle-aged women and often extends beyond the scalp. Delayed diagnosis is common. Distinct allergen patterns, frequent polysensitization, and the influence of preexisting conditions highlight the need for targeted allergen avoidance strategies.