cyst? or folliculitis? or what?

[pi54]

I am a 49 y/o white male who has psoriasis and am going bald on the crown of my head.  I use Dovonex and Cormax solutions and T/Sal shampoo to treat the scalp psoriasis.  My problem is last week I was diagnosed by an immediate care physician with an infection on my scalp on Monday and put on E-mycin for 7 days.  I had been experiencing a very painful lump on my bald spot which was acting like a big pimple, but without a head on it.  By Wed I was in so much pain from the bump, I went to my dermatologist who said it was not an infection, but a cyst and he deadened it and removed it and said I didn't need the E-mycin.  Then on Thursday night another very sore spot appeared about an inch away from the cyst that had been removed and I ended up in the emergency room July 4th where still another physician said it was "acute folliculitis" and deadened it and aspirated it (although he said he didn't get much out).  He said I needed to be on antibiotics and prescribed yet another one called clindamycin which I elected (with the pharmacist's concurrence) not to take because of the high cost.  The pharmacist said I'd be OK just going back on the E-mycin until I could see my dermatologist on Monday.  When the dermatologist heard what had happened he examined the new spot and said to just finish the E-mycin and I'd be OK.  Today I got a haircut and my stylist commented I had several small places that looked very oily and had small pockets of pus or oil around where the cyst and the other thing were.  She admitted she was not qualified to give medical advice but said I should check with a dermatologist to see if there is a medicated shampoo that might help keep my scalp from being so oily and that might minimize the occurrence of whatever I've been experiencing.

This has bee a frustrating experience for me with all the different opinions from 3 different doctors.  Can you recommend any shampoo or lotion for this?  If it is prescription, I will call my dermatologist and ask if he will write it for me.  I don't want to have to keep going and getting these cut out and aspirated....the pain is almost unbearable with the lidocaine injection I have to get before the procedures.  I don't know if this has any bearing, but I do take Monpril, Diovan HCT, and Tricor for BP and cholesterol.

Any advice will be greatly appreciated!

[Alan Rockoff, MD]

Actually, my advice is not to get so many opinions.  Most folliculitis is not actually infected.  Topical (external) antibiotics seems to help, and on rare occasions aspiration is needed.  The idea that "oil buildup" contributes to "blocked pores" is one of those plausible-sounding factoids that have no basis.  Psoriasis, but the way, has nothing to do with what you've been experiencing recently.

My advice is to call or visit the dermatologist to find otu what is actually going on.  In all my years, I've never had a case of someone who needed repeated aspirations of scalp cysts, and those cysts I have removed from the scalp have been, without exception, noninfected cysts that were just lumpy annoyances.

So please ask your dermatologist to clarify what you actually have.  This will no doubt require another visit.  However, the most I can imagine you have is a sterile folliculitis (pus without bacteria) which can be treated with external antibiotics and perhaps the occasional pill (but no needles.)

Best.

Dr. Rockoff

[Toronot]

So how exactly does one go about telling a girl what those weird bumps on one's penis are, nonchalantly?  How common are they, really?  Enough that most girls already know they're common?

Thanks.

[Alan Rockoff, MD]

They are common.  They're just bumps, and if anyone asks, you can say so.

Dr. Rockoff