Seborrheic dermatitis - NO control (2y)!

Hello,

Please help me with the treatment of my seborrheic dermatitis (scalp).

1) Objective findings: Scalp is red, scaly (+ most of the time small 'cakes' of skin) and feels just a little rough. My doctor also scraped some of my skin off and had it tested for fungus - it was pitysporum ovale positive (like 80% of the population).

2) Subjective symptoms: 24 hour/day persistent itching and burning sensation, very uncomfortable, never fades.

3) Probable cause: Chemical straightening of hair (from the treatment and to this day my scalp has been inflamed)

4) Diagnosis: Seborrheic dermatitis (all doctors agree).

5) Treatment (several dermatologists and general practitioners):

     - Shampoos: Ketoconazole 2% (on average twice a week for 2 years), tar (2-3 different types), other shampoos (zinc etc - 5-6 different types),  

     - Hormones and lotions: Diprolen gel (14 days) and a cutane solution of adrenal hormones (interval treatment 6 weeks; according to pharmacist this solution was the strongest available (prescription). 10 days of terbinafine cream (rubbed into scalp)

     - Pills: Broad spectrum antibiotics (3 months; folliculitis suspected, later ruled out), nizoral pills (3 weeks), fluconazole (50mg/day for 5 weeks), itraconazole (200mg/day for 9 weeks)

-probably forgot something...

6) Outcome of treatment: Very characteristically (and contrary to the promises) my SD is not controllable at all (not even by adrenal cortical hormones), and I can find no correlation between medication (of any kind) and my symptoms. They are consistent and annoying! Even tried 6 weeks without any treatment what so ever – no change in symptoms.

7) Other stuff: No other illnesses, no family or personal history of skin disorders, in good shape, excellent diet. Due to the nature of my symptoms, the SD has a very negative impact on my life.

I beg you, help me!!

Best regards

[Alan Rockoff, MD]

This does sound like seborrheic dermatitis, but with a strong emotional overlay, since even thick, crusted seborrhea or psoriasis doesn't itch as much as you say you do.  Chemical straightening can possibly trigger this condition, but it can't cause it to persist indefinitely.  In my experience medicated shampoos don't do much.  If strong cortisone preparations like the ones you've used don't help, it's best to try applying them overnight under a plastic shower cap.  Ask your doctor about Derma-Smoothe FS scalp lotion 0.01%  I have yet to see it fail.

Fungal treatments and diet generally have no role in treating this condition.

Best.

Dr. Rockoff

[stanb]

If conventional topical therapies have not been successful, you may benefit from low dose Accutane taken for an indefinte period.

Read this article for more information:
http://www.aafp.org/afp/20000501/2703.html