skin/scalp biopsies

[darabeth]

My son is 20 years old. 2 months ago his scalp started to burn,lasting 2-3 weeks. Now he has a scalp rash and hair loss. It has never itched. The dermatologist has ruled out psoriasis and taken two biopsies. Could you please tell me what she is looking for and what to pay attention to when we get the results? She also mentioned preventing further scarring and permanent hair loss. Can she tell that that is the case already? Also autoimmune was mentioned. Both sides of the family have autoimmune conditions. Thank you for your help. I did not ask them in front of him because he was very upset without thinking of worse case scenarios.

[Alan Rockoff, MD]

To be honest, I'm really not sure what the dermatologist is looking for.  There are few hair loss problems in 20-year-olds that have a rash and aren't psoriasis or something related. There are scarring scalp conditions which are rare, but perhaps that's what the dermatologist thinks us going on.  If so, treatment ought to be indicated, based on the biopsy findings. I think you need to discuss this with the dermatologist and find out what the biopsies showed and what the current working diagnosis is.  Of course, your son is not a minor, so he'll have to do the asking, but like any patient, he won't find out what he's got unless he asks and has a thorough discussion with the doctor.  I would think that the doctor will want to have such a discussion too.

Best.

Dr. Rockoff

[jenny101]

Hi there, I dont know but I have been going through the same thing now since May of this year. It just started up one night and got worse the burning was so bad I was in tears. Following this was hair loss near my ears and all over. My hair texture changed almost over night and it got very gray. I cant put anything in my hair or on my scalp. To be honest with you this has destroed my life since it started. I am in constant pain. Been to the dermatologist about 6 times since it began with no luck. I had blood work donw 3 times, everything is ok. So I have no idea. My once beautiful  hair is thinned like an old ladies and its dry as can be. The luster is gone and there is very little shine. Its borken all over my head and hard to comb through. Please let me know if your son gets any more answers. I would like to hear what his out come is. As my dermatologist will not do a scalp biopsy because she thinks its alopcia. alopecia doesnt hurt. I would also like to know if he had redness in the scalp like a sunburn. I do!

take care
Jennifer
***@****

[Englishman]

I'm not an expert, but could it be a food allergy or nutritional deficiency. I know a few people with chronic problems that their GP had not worked out the source of for years - they turned out to have coeliac disease.

Best of luck.

[darabeth]

Jenny, that sounds awful. I can see how it would have a major impact on your life. On our 'bright side' as a boy he wears hats all the time and, unlike you, he's not in any pain, not for months. I will certainly let you know what the biopsies say. If you would think it would help, your peace of mind if nothing else, insist on a biopsy. I hate to tell you how many times I have insisted on a certain test and being told it was a waste of time and turning out right. We don't all fit into the 'normal' symptoms boxes. Good luck, life is just not fair, eh?
Celiac disease? Oh great, something more to worry about. <wry smile> Thanks Englishman. I'll ask the dermatologist if she's testing for that too.

[darabeth]

Aww come on doc, we're not clueless. We both googled up lupus. Either SLE or DLE. What I was hoping you would give us is alternatives and discussion tips. Of course we will have the discussion but it is difficult to have a diagnosis thrown at you unprepared so you don't know enough to ask the right questions. Is it definitive, can they tell which it is, is there a range that says the level of involvement? Can a dermatologist take one look and rule out allergies or infections or vitamin deficiencies?

[darabeth]

Aww come on doc, we're not clueless. We both googled up lupus. Either SLE or DLE. What I was hoping you would give us is alternatives and discussion tips. Of course we will have the discussion but it is difficult to have a diagnosis thrown at you unprepared so you don't know enough to ask the right questions. Is it definitive, can they tell which it is, is there a range that says the level of involvement? Can a dermatologist take one look and rule out allergies or infections or vitamin deficiencies?