What is wrong with my scalp? :(

[GammaGeorge]

Hi, I have very nasty problem, I think it is a chronic scalp folliculitis and I've been suffering from it since many years [7-8 years]. I'm 25 years old caucasian male. As you can see on the photos, these are some red bumps [and 99% of them are filled with white pus] that often hurt. I had cultures done back in 2008 and it showed only regular propionibacterium acnes type I.

I tried few treatments: my first treatment was Doxycycline [3 months 100 mg every other day] it helped me instantly and cleared 100% my scalp. But right after I finished taking doxycycline problem came back in full force.

Second treatment was low dose isotretinoin - 4 months on 10mg and 4 months on 20mg [8 months in total]. Isotretinoin cleared my scalp 100% just after one week. I was obviously very happy, because during 8 months of my thereapy I didn't had a single pimple on my scalp. Unfortunately, everything came back 6 months post isotretinoin treatment.

I did blood tests because I thought that it can be high sugar or low iron problem, but my sugar is in norm and my iron is even slightly increased [maybe due to some internal infection?].

I don't know "where to go" from here. I mean I took isotretinoin and I was sure that it will help me for good. But unfortunately everything came back.

So what can I do right now? Another antibiotic course? More other skin tests? More different blood tests?

This is a current photo of my scalp:

http://img29.imageshack.us/img29/2116/scalp2e.jpg

[Bhupinder Kaur, MD]

Hello,
You can get a bacterial and fungal culture of the wound swab or scalp scrapings. Biopsy scalp on the area can also be done to confirm the diagnosis.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[GammaGeorge]

Thank you doctor, I started taking Azithromycin one week ago [500 mg thrice weekly for 12 weeks] due to it's low side effects profile. I can already see improvement. I am also using shampoo with ciclopiroxi olaminum [15mg/g].

And to be honest - I don't have much faith in doctors where I live. Most of them only prescribe antibiotics and thats it. While I'm sure I should undergo some scalp biopsies or other scalp tests. If you could suggest anything I would be very grateful.

I just know one thing - I don't want to take isotretinoin again [even though I took it in low dose] because this drug is way too destructive to the whole system.

And again - thanks for your reply doctor.

[Bhupinder Kaur, MD]

Hello,
It can be due to folliculitis or perifolliculitis scalp. Perifolliculitis scalp is characterised by small, very itchy pustules within the scalp, often most troublesome on the frontal hairline. The scalp should be washed with a mild normal shampoo as often as desired. Antidandruff shampoos containing antifungal agents such as ketoconazole or ciclopirox are sometimes helpful. Apart from that you need topical and oral antibiotics, antihistamines, oral steroids and topical tretinoin.

My sincere advice is to get it examined from a dermatologist. It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.