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Unpleasant smell behind ears/where face meets hair

Hi doctor,

I wanted to ask a question regarding unpleasant smell arising from behind the person's ears and also the area where face meets the hair (the fringes of the face). I don't have this problem, it's actually the person I am dating that has it. Here are the facts about her followed by my questions:

- 29 year old tall, attractive, and active girl, no body smells anywhere else. She probably perspires a little more than usual as she is taller than average, but again, no bad smells otherwise. She maintains very good hygiene with showers, cosmetics, etc., but I have noticed the smell on and off regardless of showering, and it is sometimes even stronger actually soon after shower. Is this a bacterial issue? I don't understand why would bacteria not disappear after regular baths (i.e., if they wash away, they wash away, they should be still there)? What would you recommend could be a good way to handle the problem? Special shower gels, soaps, more body lotion applied in that area to mask the smell, etc.? Also, what could be a subtle way for me to bring that point in conversation?

- She has problems with hyper-active thyroid and some digestive issues (lactose intolerance, cramps, etc.). She is taking medication for the thyroid and recent blood work showed no serious problems arising from digestion. I have heard smell in the fringes of the facial area/behind the ears could be related to these problems. What is the mechanism that digestive problems can affect smell in this area? What can a person do to resolve this?

- As an example, sometimes after shower, her hair could smell nice and clean, but that pungent smell at the base is still there. It's such a Catch 22 situation as you can't judge a person by things they cannot control presumably, but then it's not something you can ignore. Is this something that is going to disappear over time or not?

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563773 tn?1374250139
Thanks for posting your query.

I can understand your concern for the smell on the mastoid area i.e. behind the ears where the face meets the hair.

There are many causes which can cause such smell but hyperthyroidism is less likely to cause such an offensive smell. Hyperthyroidism causes fine, brittle hair and hair loss.

Such a smell can be due to fungal and bacterial infections caused by a moist and oily scalp. Environmental factors such as over exposure to the sun and air pollution can build up dirt and grime on the scalp leading to foul odour. Moreover you have mentioned that your girlfriend is having the symptom of excessive sweating.

Excessive sweating or hyperhidrosis may be primary (without known cause and usually starts during childhood or adolescence and persists all life) or secondary (as part of an underlying condition like Hyperthyroidism or similar endocrine diseases and dermatological conditions like eczema, psoriasis). Since your girlfriend is having hyperthyroidism, it may be contributing to excessive sweating which may be causing accumulation of dirt and grime and hence the smell. However it is essential to rule out any bacterial or fungal infection of the scalp.

What you need to do is consult a dermatologist and get a KOH examination of the skin scrapings of your girlfriend’s scalp area and a biopsy of small skin sample done if the symptoms persist. KOH examination of the area will clarify whether it is due to fungal infection or not. The skin samples can be sent for bacterial culture also. If any f the infection is confirmed then specific topical antifungals or antibiotics can be started.

Till that time, she can wash her hair with medicated shampoo. Also ask her to wash pillowcases,hats  and body/hair towels every other day. She should also avoid using many hair products. Hair products like hairspray, gels, pomade and hair oils can increase the oil in your hair. The increase in oil will increase the odor.

Hope that this information helps and hope that you will get better soon.

Wishing you good health.

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