Sebborheic Dermatitis...

[CJMPre-Med]

I'm not sure if we're supposed to be soliciting advice here, and I don't mean to take up any doctor's or resident's time with this, but a quick question:

For the past decade or so, I've been diagnosed by several dermatologists with sebborheic dermatitis of the scalp, which causes my scalp to itch something fierce. There are no lesions or scales or anything at all, only the itching, and I guess some white flakes if I don't wash (and scratch) it for several days. In addition, though I'm not sure it's related (although it did start when the condition started, at around age 16), it causes my hair to fall out from the root (with a white bulb on it). I recall my regular dermatologist saying that the condition somehow "chokes" the follicle, which then causes the hair to be extruded. Well, luckily for me, I started out with an incredibly thick head of hair, but now as I get older I find it more and more irritating even though nobody notices (but I do).

I've been to several dermatologists for this, since what my regular dermatologist prescribed never worked (the usual tar-based shampoos, some prescription shampoos, fluocininone (sp?) drops for the scalp, some waxy gel to rub on the scalp etc.), and they all gave me the same diagnosis and the same shampoos/medications. Nothing EVER worked; the itching has never stopped for even a week since I was 16 years old. My dermatologist said it was (or can be) caused by stress, and she favored that explanation since this condition appeared right after an extremely traumatic/trying period in my life.


I suppose my question is two-fold: first, are all these symptoms (itching, hair loss, duration of symptoms (10 years) etc.) consistent with a diagnosis of sebborheic dermatitis, or could it be something else (note that there is no puss or lesions or anything of that nature; my scalp appears clean to inspection unless I don't wash it for 4-5 days, in which case I get some flaky buildup similar to dandruff). Secondly, does anyone know of ANYTHING that would put a halt to this condition besides the previously mentioned meds/shampoos which proved to be ineffectual? I'd prefer the entire thing to just disappear (the itching + hair loss), but I'd like to stop the hair loss moreso, as I've only got a finite amount. Luckily, nobody notices it, but who knows in 4 or 5 years if the rate of loss continues (and I lose a LOT of hair, relatively speaking).

As an aside, the hair loss is, in all likelihood, related to the condition seeing as to how it began precisely when the itching did (early 16), and the rate of fallout increases the more it itches. Also, neither my dad nor either of my grandfathers is balding; though I realize that something being contemporaneous doesn't imply causality, it still seems the most plausible explanation in my opinion.


Any help at all would be greatly appreciated, and I again apologize if this is in any way inappropriate. I can assure you I am not soliciting advice out of cheapness or not wanting to see a doc. In fact, I have been to over 7 dermatologists in my lifetime for this, though I haven't been to one in the past 5 years or so-- I just sorta gave up on it and resigned myself to having this condition, because nothing ever worked. And these were competent and well-regarded dermatologists, too. Thanks again in advance.

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[dermpa02]

<<I suppose my question is two-fold: first, are all these symptoms (itching, hair loss, duration of symptoms (10 years) etc.) consistent with a diagnosis of sebborheic dermatitis,>>

Yes, but see below.

<<or could it be something else (note that there is no puss or lesions or anything of that nature; my scalp appears clean to inspection unless I don't wash it for 4-5 days, in which case I get some flaky buildup similar to dandruff).>>

Absolutely yes.

Please consider finding a derm provider who will take the time to investigate further. Seborrheic dermatitis should not cause hair loss. Of course, you could be the cause of your own hair loss by intense scratching, but there might be something else going on within the hair follicle. Depending on what your scalp actually looks like, a biopsy might be in order. Possible diagnoses would include various inflammatory disorders, mild psoriasis, or just plain ol' lichen simplex chronicus (though I've not ever seen that at the scalp). Is the flaky buildup you mention on the scalp itself, or stuck to the hair shafts? Is the itching all the time, or mainly at night? As you can see, there are lots of questions that need to be answered (not here though...), and that doesn't even bring up the subject of unusual self-induced pathologies.

Find someone who will take you seriously....

hth,
Phil

 

[CJMPre-Med]

<<I suppose my question is two-fold: first, are all these symptoms (itching, hair loss, duration of symptoms (10 years) etc.) consistent with a diagnosis of sebborheic dermatitis,>>

Yes, but see below.

<<or could it be something else (note that there is no puss or lesions or anything of that nature; my scalp appears clean to inspection unless I don't wash it for 4-5 days, in which case I get some flaky buildup similar to dandruff).>>

Absolutely yes.

Please consider finding a derm provider who will take the time to investigate further. Seborrheic dermatitis should not cause hair loss. Of course, you could be the cause of your own hair loss by intense scratching, but there might be something else going on within the hair follicle. Depending on what your scalp actually looks like, a biopsy might be in order. Possible diagnoses would include various inflammatory disorders, mild psoriasis, or just plain ol' lichen simplex chronicus (though I've not ever seen that at the scalp). Is the flaky buildup you mention on the scalp itself, or stuck to the hair shafts? Is the itching all the time, or mainly at night? As you can see, there are lots of questions that need to be answered (not here though...), and that doesn't even bring up the subject of unusual self-induced pathologies.

Find someone who will take you seriously....

hth,
Phil

Thanks so much for taking the time to respond. Although I do, in fact, believe that my regular dermatologist was taking me seriously, I see what you're saying. I had a biopsy done about 6 years ago for an unrelated incident (I had a rash), and it didn't indicate psoriasis, which is what she was looking for (though I'm not sure if scalp psoriasis would be indicated by a biopsy of the forearm ).

As for my scalp, well, the flaky buildup (when I've allowed it to occur, which is rare) is spread out, not localized to the hair shaft as far as I can tell; I've examined some of my hair after it's fallen out and there was no dandruff or anything on it save for the white bulb at the tip. As for when it itches, well, that's another question I had (my previous post was conceived in great haste, as illustrated by its brevity ) -- although the incidence and intensity of the itching is pretty uniform throughout the day, I notice that when I am not in my room or house (but mostly my room), the severity of the itching lessens dramatically (although if I don't wash my hair/scratch the scalp for 4 days or so it'll itch like the dickens no matter where I am). This led me to hypothesize that perhaps it is an allergic reaction to dust, as my room tends to get pretty dusty as compared to the rest of the house, and certainly as compared to outside or at school (I'm lazy AND busy-- a deadly combination ). I have a history of severe allergies, shots and all, though I was weaned off injections at around age 13, after having gotten them for the better part of 10 years. My mother says, however, that the one allergen which I continued to test strongly positive (comparatively) for even towards the end was dust, and that my allergist told her that nothing could be done about it beyond what he had already done. So I'm wondering if allergens could have this effect on my scalp (as an aside, I tend to have itchy skin in general, and this, too, seems to lessen when I leave my room).


Now, as for why I didn't have this Einsteinian idea sooner, well, it's because when this condition arose, my room WAS cleaned regularly (by myself and my mother), and so there was not nearly as much dust as I'm sure there is now (yes, I'm clean- I bathe and brush my teeth, I just don't get around to dusting much ). So it never occurred to me until recently when I noticed the whole "leave the room, stop the itch" trend.

Also, though yes, more hair definitely does fall out when I vigorously scratch my head (either during shampooing or whenever), a lot of hair ALSO falls out even at night when I'm sleeping, with the evidence found on my pillow and sheets, and also when I'm blowdrying my hair etc. Now, this might be due to mere mechanical shear as my head rolls around on the pillow, but I dunno...


I realize I'm getting pretty far afield with this next point here, but I'm just trying to give you an accurate picture of the situation: I recently noticed that I shed a lot of chest and tummy hair, too, which ends up on my undershirts. Now, I'm not sure what is considered a "normal" amount of hair loss from different bodily regions (and so I don't know if it is "excessive"), and I don't ask my father if he notices the same, but perhaps this indicates a general weakness or some malady concerning my roots or the strength of my hair? Nutritional, perhaps? I mean, my diet has slipped in recent years, and my dad is always quick to point to that as the cause of my hair loss, but he totally forgets that all this started when I was a healthy, fit 16 year-old eating normally; so I tend to dismiss such a simplistic explanation, for good or ill.


Have you encountered cases where this sort of thing is brought on by stress? Because a couple of dermatologists told me that. It would stand to reason, then, that when the stress left, so should the condition, no? Though I haven't worked out those underlying issues 100% yet, I'm generally content now and well past what happened over a decade ago. Maybe it's subconscious, I dunno...


At any rate, thank you so much for your time even if you choose not to respond to this latest post (I just noticed your "not here though" comment at the end of your post as I reread it-- sorry ). I suppose I'll get myself back to a dermatologist again after all these years of empty hopes regarding getting rid of this nuisance of a condition. Maybe some new drugs have come to market in the interim or something, who knows. Thanks again.

 

[Spartacus]

Thanks so much for taking the time to respond. Although I do, in fact, believe that my regular dermatologist was taking me seriously, I see what you're saying. I had a biopsy done about 6 years ago for an unrelated incident (I had a rash), and it didn't indicate psoriasis, which is what she was looking for (though I'm not sure if scalp psoriasis would be indicated by a biopsy of the forearm ).

As for my scalp, well, the flaky buildup (when I've allowed it to occur, which is rare) is spread out, not localized to the hair shaft as far as I can tell; I've examined some of my hair after it's fallen out and there was no dandruff or anything on it save for the white bulb at the tip. As for when it itches, well, that's another question I had (my previous post was conceived in great haste, as illustrated by its brevity ) -- although the incidence and intensity of the itching is pretty uniform throughout the day, I notice that when I am not in my room or house (but mostly my room), the severity of the itching lessens dramatically (although if I don't wash my hair/scratch the scalp for 4 days or so it'll itch like the dickens no matter where I am). This led me to hypothesize that perhaps it is an allergic reaction to dust, as my room tends to get pretty dusty as compared to the rest of the house, and certainly as compared to outside or at school (I'm lazy AND busy-- a deadly combination ). I have a history of severe allergies, shots and all, though I was weaned off injections at around age 13, after having gotten them for the better part of 10 years. My mother says, however, that the one allergen which I continued to test strongly positive (comparatively) for even towards the end was dust, and that my allergist told her that nothing could be done about it beyond what he had already done. So I'm wondering if allergens could have this effect on my scalp (as an aside, I tend to have itchy skin in general, and this, too, seems to lessen when I leave my room).


Now, as for why I didn't have this Einsteinian idea sooner, well, it's because when this condition arose, my room WAS cleaned regularly (by myself and my mother), and so there was not nearly as much dust as I'm sure there is now (yes, I'm clean- I bathe and brush my teeth, I just don't get around to dusting much ). So it never occurred to me until recently when I noticed the whole "leave the room, stop the itch" trend.

Also, though yes, more hair definitely does fall out when I vigorously scratch my head (either during shampooing or whenever), a lot of hair ALSO falls out even at night when I'm sleeping, with the evidence found on my pillow and sheets, and also when I'm blowdrying my hair etc. Now, this might be due to mere mechanical shear as my head rolls around on the pillow, but I dunno...


I realize I'm getting pretty far afield with this next point here, but I'm just trying to give you an accurate picture of the situation: I recently noticed that I shed a lot of chest and tummy hair, too, which ends up on my undershirts. Now, I'm not sure what is considered a "normal" amount of hair loss from different bodily regions (and so I don't know if it is "excessive"), and I don't ask my father if he notices the same, but perhaps this indicates a general weakness or some malady concerning my roots or the strength of my hair? Nutritional, perhaps? I mean, my diet has slipped in recent years, and my dad is always quick to point to that as the cause of my hair loss, but he totally forgets that all this started when I was a healthy, fit 16 year-old eating normally; so I tend to dismiss such a simplistic explanation, for good or ill.


Have you encountered cases where this sort of thing is brought on by stress? Because a couple of dermatologists told me that. It would stand to reason, then, that when the stress left, so should the condition, no? Though I haven't worked out those underlying issues 100% yet, I'm generally content now and well past what happened over a decade ago. Maybe it's subconscious, I dunno...


At any rate, thank you so much for your time even if you choose not to respond to this latest post (I just noticed your "not here though" comment at the end of your post as I reread it-- sorry ). I suppose I'll get myself back to a dermatologist again after all these years of empty hopes regarding getting rid of this nuisance of a condition. Maybe some new drugs have come to market in the interim or something, who knows. Thanks again.

CJM,

Have any of the doctor's thought of checking your thyroid levels, TSH, Free T4 and T3? Does anyone in your family have any type of thyroid disease. Hypothyroidism often causes telogen effluvium and will continue until the thyroid levels are corrected. It can also cause excessive shedding of body hair and dermatitis. I would really encourage you to talk to your doc about this possiblity.

Also, Omega-3 essential fatty acids are a good supplement for skin issues that you're describing. Omega-6 (Evening Primrose Oil) is also good.

 

[CJMPre-Med]

CJM,

Have any of the doctor's thought of checking your thyroid levels, TSH, Free T4 and T3? Does anyone in your family have any type of thyroid disease. Hypothyroidism often causes telogen effluvium and will continue until the thyroid levels are corrected. It can also cause excessive shedding of body hair and dermatitis. I would really encourage you to talk to your doc about this possiblity.

Also, Omega-3 essential fatty acids are a good supplement for skin issues that you're describing. Omega-6 (Evening Primrose Oil) is also good.

Thanks for the response. My sister is the only person in our family to have ever been diagnosed with any type of thyroid abnormality (sluggish thyroid), and that was when she was younger, so I dunno. But I'll definitely relate this to the dermatologist when I get around to going (I've been very busy ). I really need to start taking a multi-vitamin as well, just in case this is exacerbated by some sort of nutritional deficiency (my diet has deteriorated proportionately with my amount of free time ).


Thanks again.

 

[margaritaboy]

I'm no dermatologist, but what you have sounds exactly sebborheic derm to me. Although looking for alternatives and other answers may be helpful, don't over look the obvious either.

I have seb. derm. of my scalp as well, and have signs and symptoms almost exactly like yours. I've also used diffferent shampoos with variable success, and itching and flaking will increase depending on how long I go without using the shampoo.

One thing that has consistantly helped, when I've actually had the time to do it, is to let said shampoo to sit in my hair for long time (thirty minutes or longer), and massage a liberal amount of it in. After that, I have a longer period of time where my scalp is less symptomatic.

I also have some skin on my face with seb derm, which responds well to Clotrimazole cream applied twice daily. If it really flares up, then Clotrimazole with a little cortisone cream helps get it under control.

If you do have seb. derm., I'm not sure this will help or not, but I thought I'd chip in. Seb derm sucks.

Good luck!

 

[CJMPre-Med]

I'm no dermatologist, but what you have sounds exactly sebborheic derm to me. Although looking for alternatives and other answers may be helpful, don't over look the obvious either.

I have seb. derm. of my scalp as well, and have signs and symptoms almost exactly like yours. I've also used diffferent shampoos with variable success, and itching and flaking will increase depending on how long I go without using the shampoo.

One thing that has consistantly helped, when I've actually had the time to do it, is to let said shampoo to sit in my hair for long time (thirty minutes or longer), and massage a liberal amount of it in. After that, I have a longer period of time where my scalp is less symptomatic.

I also have some skin on my face with seb derm, which responds well to Clotrimazole cream applied twice daily. If it really flares up, then Clotrimazole with a little cortisone cream helps get it under control.

If you do have seb. derm., I'm not sure this will help or not, but I thought I'd chip in. Seb derm sucks.

Good luck!

Thanks for the insight. Sorry to hear that you've been going through the same thing. Does your hair fall out as well? Although the itching is annoying, I could tolerate it if I wasn't losing my hair, although like Dermpa says, it might not be related to the condition (although it started at exactly the same time). I dunno...I'm just annoyed-- it's been over a decade now with this nonsense. Lately, it seems like the longest I can go without shampooing is 3 days; after that, the itching becomes unbearable. Best of luck to you with it.

 

[(nicedream)]

Why would you go 3 days without shampooing anyway, or 1 day for that matter?

 

[margaritaboy]

Seb. Derm. is a chronic skin condition that has only symptomatic treatment for relief of symptoms. The severity of symptoms waxes and wanes, probably depending on climate, stress, etc. If you find yourself symptomatic, try increasing the frequency that you use the treatment.

I shampoo everytime I get in the shower, which is once a day at least. Even if my scalp is itchy/flakey, this usually is enough to keep it under reasonable control. If I use the 30 min. method I mention above, then I am less symptomatic for a longer period of time, but I still use the shampoo daily.

Hair loss is not a big problem for me. But as has happened on occation, I travel and forget to bring the shampoo with me, and after a few days my scalp goes nuts. Then I start to loose hair along with a lot of flakes.

Your hair loss could be seconday to seb. derm., scratching, advancing age, or other skin infections. Knowing that you have been to seven dermatologists, I lean toward the first three reasons.

Since we can't control our age, I recomend using a modest to moderate amount of the shampoo every day, if you are not doing so already. And try the 30 minute (or longer) method. One dermatology lecture I attended even said that you could sleep in the shampoo overnight!

 

[CJMPre-Med]

Why would you go 3 days without shampooing anyway, or 1 day for that matter?

Well, the prevailing wisdom among hair-care professionals is that you should only shampoo every other day, or three times per week at most. It has something to do with stripping the hair of nutrients and/or the excessive oil production which would ensue if one washed their hair more frequently (I seem to recall this).


MargaritaBoy, those sound like drastic measures. But hey, whatever works for you. I really don't have the time to be soaking my head for a half-hour a pop, myself. Also, my previous dermatologist(s) had said to use the medicated shampoos (and even T-gel when they told me to use it) no more than a few times/week, so I dunno. Yeah, the hair loss could be totally unrelated, as you mention (and as I mentioned in my initial post), but I just find it odd that they began at precisely the same time. Weird.


Anyway, I'm gonna get to a doctor one day soon hopefully. Thanks for the advice and the commiseration.

 

[margaritaboy]

Well, the prevailing wisdom among hair-care professionals is that you should only shampoo every other day, or three times per week at most. It has something to do with stripping the hair of nutrients and/or the excessive oil production which would ensue if one washed their hair more frequently (I seem to recall this).....but I just find it odd that they began at precisely the same time. Weird.

Dude, you can use good old OTC Head or Shoulders or Selson Blue (sp?)everyday. It isn't going to kill you or your hair (at least not more than seb derm), in spite of whatever hair care specialists have told you. And I'm not sure what is so extreme about the treatment I've described. Simply TRYING it is going to be far less costly than going from doctor to doctor.

As I said before, hair loss can be secondary to seb. derm., especially if it is not well controlled. Hence, your hair loss would have began PRECISELY when it started, and I don't find it a coincidence that your hair loss description mirrors my own when my seb derm flares up.

I would encourage you to go to a dermatologist, especially if uncomfortable with your previous diagnosis, or the results of your prescribed treatment regimen.

Good luck!

 

[CJMPre-Med]

Yeah, sorry-- I misunderstood what "secondary to" meant. I wasn't familiar with that phrase in terms of diagnosis. I thought it meant "unrelated", but now I see that it means that it's a "secondary symptom of", I suppose.