Scalp Itch That Refuses to Go Away

[bigman]

For years I've suffered from an annoying scalp itch/rash. About 4 years ago I was treated for raging candida, jock rash and toenail fungus. The medication included lamisil (3 regimens) and super anti-biotics. While the toenail fungus and jock rash abated completely, a scalp problem lessened but did not completely leave. Symptoms include 1) tiny pimples/pustules that are rock hard and seem to relocate across my scalp, 2) when these pustules are scratched they offer small, hard debris, puss, and often blood (the dry pieces have a yellowish/orange hue), 3) after a while I can peel large pieces of dry skin that are usually 1/8" to 1/4" that are flat and look like I could identify something if I had a microscope. My pillow case looks like dark dirt was rubbed on it. The itch/rash has not responded to oregeno oil, dozens of types of shampoos, topical anti-biotics, etc. Often the inside of my ears itch - particularly in the morning - and, when I use a Q-tip, I can see dry blood on Q-tip. I can't help scratching, especially in the morning. Often what I'm "picking at" just won't budge. When it does, it's usually the top of a dried pustule that is a piece of dry skin (mentioned above). The worst locations of the rash are the very top of the scalp and the where my hair meets the back of my neck.
I'm hoping for some suggestions as to the source (and solution!!!!!!!!) of this incredibly annoying itch. Thanks.

[Alan Rockoff, MD]

Your scalp condition does not sound in any way fungal.  My patients who have similar symptoms usually have an issue with stress and picking.  One thing is for sure--unless you stop picking, period, you will not get better, no matter what anyone prescribes.  I usually prescribe topical steroid gels, though occasionally antibiotics are of benefit, though primarily if cultures show the presence of bacteria.  If such a culture has not been done, it should.  But again, you have to stop scratching away "large pieces of dry skin."

Best.

Dr. Rockoff