The cause of scalp tenderness can best be recalled utilizing the mnemonic MINT.
· M—Mental disorders such as pseudoneurosis can be associated with diffuse scalp tenderness.
· I—Inflammation would bring to mind herpes zoster, pediculosis, tinea capitis, cellulitis, an infected sebaceous cyst, and impetigo.
· N—Neurologic disorders associated with a tender scalp include temporal arteritis, occipital nerve entrapment, trigeminal neuralgia, and neoplasms that involve the cranium and meninges (i.e., meningioma).
· T—Trauma would suggest scalp contusions, fractures, and hematomas.
Approach to the Diagnosis
Most skin conditions should be easily diagnosed by inspection. A Wood's lamp inspection would assist in the diagnosis of tinea capitis. A KOH prep of scraping may be necessary. Skin biopsy will diagnose other skin disorders. A sedimentation rate and biopsy of the superficial temporal artery will diagnose temporal arteritis. If occipital nerve entrapment is suspected, a nerve block should be done to confirm the diagnosis. X-rays of the skull and a magnetic resonance imaging (MRI) may be necessary, but a neurologist should be consulted before ordering expensive diagnostic tests.