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disproportionally affect females and children in a crosssectional analysis of NEISS 2000–2018 Dear Editor, There were 486,000 burn injuries presented to the United States (US) emergency departments (EDs) as per the report provided by the American Burn Association in 2016. Since the epidemiology of scalp burns has not been studied, our objectives were to analyze the characteristics of affected patients. A retrospective analysis of burns was performed using the National Electronic Injury Surveillance System (NEISS) database from January 1, 2000, to December 31, 2018, with keywords “burn,” “scalp,” and/or “hair.” For each case, date, gender, location, disposition, diagnosis, and source were collected. Chi-square tests compared scalp vs. overall burn categorical variables with P < 0.05 considered statistically significant. Of 97,986 total burns, there were 590 scalp burn injuries (0.60%). Most patients with scalp burns were female (51.52%), exceeding the proportion of females in the total burn population (46.05%, P < 0.05). The average age of patients was 22 years old, with children under 18 years old accounting for a larger proportion of scalp burns (59.49%) than total burns (48.41%, P < 0.05). Most scalp burns occurred at home (73.55%), with a larger percentage requiring hospital admission (12.71%) than total burns (7.14%, P < 0.05) (Table 1). Thermal burns were most common, with scald and flame burn most frequent in children (49.28%) and adults (54.81%), respectively. There was hair involvement in 20.34% of scalp burns, and the most common sources per age group for scalp burns with hair involvement were candle/wax (35.38%) and hair-related products (20.00%) for children and hair-related products (29.09%) for adults (Table 2). Despite the scalp and hair making up a small proportion of body surface area and accounting for less than 1% of total ED burn injuries over a two-decade period, there was a significantly higher admission rate for scalp/hair burn injuries compared to the total burn population. This trend may suggest that scalp and hair burns were more severe, requiring longer treatment and monitoring than burns of other skin areas. The majority of the scalp burns were thermal burns, particularly flame and scald, which can cause immediate deep wounds, compared to contact burns from hot appliances, which were common sources of overall skin burns. We found that more than half of patients with scalp burns were children, which is even greater than the proportions of burns of all skin areas in children reported in several epidemiological studies (33%–50% prevalence). Females were more prone to scalp burns compared to males in our study. This may be because females generally have longer hair, making scalp/hair burns more likely, and a higher likelihood of contact burns from heated hair products/devices Figure 2 Extra-palmoplantar eruptions, pathological presentation, and clinical presentation postoperatively (a) Extrapalmoplantar eruptions on the lower limbs. (b) Pathologically, Munro’s microabscess and capillary dilation of the dermal papilla were found, but the elongation of the rete ridges was mild, and spongiosis of the epidermis were found. (Hematoxylin and eosin, 950). (c,d) By postoperative year 1, the rash had resolved completely