Scalp -- "scabs", dry, eczema, or...? Losing hair? Please help.

Very sorry about the re-post here, I just read about the Expert forum. Here is the post I made to the general forum:

I have had an itchy scalp with "dandruff" flakes for the last several months and it has been progressively getting worse. (With dry winter conditions?)

On my doctor's advise, I have tried many different shampoos for this--fist Head and Shoulders, then a corticosteroid shampoo ("Capex"? expensive, hard to use, didn't lather), then Nizerol (sp?), then a coal-tar based shampoo.

While trying all these shampoos, my scalp has begun to feel very tight and/or burn (especially as it dries after a shower) and is now covered with fairly large, thick white "scabs"/plaques which are irritating and are holding clumps of my hair in place.

If I run my hands through my hair over the bathroom sink, a depressing number of hairs seem to be falling out. I wonder if this is permanent or not. I would hate to lose hair or end up with bald/thin patches because of this episode.

I am not convinced that any shampoo will help me much now because of the scabs... how will it get through? And I am reluctant to wash my hair/scalp now because the process of washing and towel drying might cause me to lose more hair.

Right now I am on a short course of prednisone prescribed by my doctor since this problem is possibly eczema/psoriasis. I have turned off all heat in my apartment and am limiting myself to showering every 2-3 days to avoid distressing my hair/scalp. I have been reading through the internet for solutions but am not convinced about the accuracy or applicability of the advice I find.

Aside from finding and treating the underlying cause of this problem (possibly simply dry scalp from electric heat??) it seems important to get rid of these scabs/plaques without causing hair loss.

Any advice is appreciated. The earliest appointment I could get with a dermatologist was next month.

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum and thank you for your post!

Because of inflammation, thick squama, pruritus and consequent hair loss, there are two diseases your dermatologist will look into first: Psoriasis, and Dermatitis seborrhoica.

You are right, for any medicine to act locally you have to remove that thick squama. What dermatologist recommend is the use of shampoos with keratolytic action (it should be gently rubbed into wet scalp and left for several minutes before washing it off), and oil based anti-inflammatory agents. Very affordable and widely available among them is extra virgin olive oil. For example, if patient is not sensitive to olive oil, it can be rubbed into scalp in the evening, and washed off next morning.

After gently washing, try to dry it gentle as well (without rubbing hair with towel). You should wash your hair regularly and patiently, as it will speed up the process of removal of squama.

You are already under physicians’ care, and that is good news. The most efficient therapeutic strategy for you will be the one based on detailed medical history (including lifestyle habits), and clinical examination. If that information proves not to be conclusive, the biopsy is next diagnostic tool to be utilized.

Wishing You Optimal Health,
Dr Jasmina Jankicevic

[Mot425]

Quick comment: I have been suffering from minor eczema for the last 12 years. I will get small patches (on my forearms, chin, behind an earlobe, and some other places) which generally disappear with 1-2 applications of clobetasol cream. This is why my doctor thinks my scalp problems are likely eczema related although he admits the possibility of psoriasis and/or dry scalp.

[Mot425]

Thank you Jasmina. I have an appointment with a dermatologist in 2 weeks. Should I try to remove the squama now or can it wait? Mainly I am concerned about hair loss at this point. Do the conditions you mention result in permanent hair loss? Thanks again.