Severe Acne or something else?

[Zizza]

I have two boys, ages 17 and 21.  For the last 4 years, the older one has had a severe scalp rash that resembles acne, with small pustules and overall very red skin, with the majority of the pustules on the back of the head and neck.  In the last year, the younger one has developed a scalp condition with large yellowish itchy, oily flakes and patches over the entire scalp, most noticeably around the hairline and above the ears.  Both boys have ongoing face and neck acne problems, with both pustules and blackheads, and reddened skin.  I have several pictures of the scalp problems.  I am most likely going to take them to a dermatologist but right now I can't afford it at all, so any help would be appreciated, so that maybe I have some idea of what we are dealing with.  I'm worried that the skin problems are seriously affecting their self-esteem, so I want to get this better NOW!!!

[Vanessa Lacuesta]

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Hi.

For both scalp problems, differentials may be seborrheic dermatitis and a tinea capitis or fungal infection. Seborrheic dermatitis may present with yellowish greasy flakes which affect the scalp and other areas of the body like the face and the chest. Fungal infections of the scalp on the other hand may be more "angrier" looking. They may present with reddish plaques, some itchiness and crusting over the involved areas. I suggest that you have these assessed by a dermatologist when feasible. A fungal infection of the scalp may need oral and topical antifungal medications. Seborrheic dermatitis on the other hand ,in mild forms, may require vigorous and frequent scrubbing. Medicated shampoos containing selenium sulfide may be used .

For a possible fungal infection, avoid borrowing hair brushes and towels. These infections may be transmitted through direct contact.

Is there anyone else in the family with similar scalp conditions?