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Itchy, painful scalp. Thinning hair, headache, body odor. Tried sulfate free shampoos. Taken zinc. What to do?

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Practicing since : 2006
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Hi there..
I write to you from western Canada.
It is very dry where I live. I am 23 yrs old and I am suffering from an itchy, and painful condition of the scalp.
Hair has been thinning drastically for 3 yrs now. It looks terrible. It has all thinned out in the front & is starting to thin out atop my head close to the front
My head is always itchy and I have been prone to terrible headaches.
My skin will also leak a horrible musty sweat like smell. In the mornings it smells kind of like an elderly man, it's quite gross and embarrassing as I have become suddenly self aware. I'm pretty sensitive to scents.

This is driving me absolutely mad and all I want is my life back rather than being in discomfort, as well as disgust with my own appearance. I am at a loss of what I should do; I have tried many sulfate free shampoos containing silver, sulfur (colloidal/ msm-> internally as well), salicylic acid, ketoconazole, b-complexes (niacin, pyridoxine, panthenol, biotin -> all internally as well), saw palmetto (internally as well), Zinc (internally as well), azaelic acid and of course aloe and jojoba which is default in most of these formulated products.

Thank you for your time,
Posted Tue, 9 Apr 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 1 hour later
Thanks for writing to us.
From the description given and image attached, it seems you are having androgenetic alopecia or male pattern baldness along with itchy dry scalp. Due to severe itching and scratching of scalp, there might be oozing from scalp which has led to slight musty smell.
As far as treatment is concerned, firstly treatment of dryness and oozing of scalp is required. Use any antibacterial shampoo daily for few days to wash scalp. Apply a mild steroid lotion like flutivate E lotion over scalp twice in a day. Take tablet cetirizine to alleviate itch. Also use warm olive oil once in a week for 2 hours prior to washing scalp to combat dryness of scalp. Once the dryness and oozing has subsided, you may stop the above mentioned treatment for dryness and begin with minoxidil 5 percent solution 1 ml twice in a day and tablet finesteride 1 mg daily.
All these are prescription drugs and hence a dermatologist's follow up is necessary. For the same book an appointment with a doctor near by.

I would also like to tell that your alopecia or hair loss seems to be advanced and you might not have desired results with topical therapy. In such cases hair transplantation is the only option.

Hope I have answered your query. Should there be any other query, feel free to write back.
Take care
Above answer was peer-reviewed by
Follow-up: Itchy, painful scalp. Thinning hair, headache, body odor. Tried sulfate free shampoos. Taken zinc. What to do? 10 hours later
Hi Dr. Pathak.

I do appreciate that you have taken the time to respond to my query.

Unfortunately, having to use minoxidil as well as finasteride, the outcomes were less than favorable - even using both, consistently for over 2.5 yrs. I work in pharmacy, and even my supervisors who are pharmacists are strong to oppose those two particular treatments. I should not that the smell actually started to develop during my use of 5% rogaine brand minoxidil foam, used BID consistently.

As for olive oil... I was under the impression that the fungus causing the mild dandruff as well as extreme itch sensation thrives off of the fatty chemical makeup present in specific oils such as olive? Would it be more appropriate to use jojoba?

It's frustrating that I'm the only one on either side of my family experiencing hair loss, as NONE of my aunts, uncles, great aunts & uncles, grandparents nor my parents or even cousins have had this problem.

I will take your suggestion for using a 2nd gen. antihistamine such as cetirizine to help with the itch.

flutivate E appears to be an India brand of fluticasone.. Here in Canada, It is more common to see betamethasone valerate used in scalp specific lotion preparations.. Would you feel comfortable with weather or not this could be as effective? I am aware that glucocorticosteroids may have positive effects upon hair follicles.

I am considering transplant, but I am also somewhat reluctant- as it is an expensive procedure which would require me to take time off from work, and if I am currently experiencing this issue on my scalp- I am unsure weather or not it is possible of it re-occuring. I hope you understand my concern.

Again, I'd like to thank you and express my appreciation for taking the time to review my query. I hope that my response makes my ordeal a bit easier to understand.

Answered by Dr. Kalpana Pathak 19 hours later
Thanks for writing back.
It's a pleasure interacting with people from our own medical fraternity!
Androgenetic alopecia is governed by genetic, hormonal as well as environmental factors. Almost 60 to 70 percent males develop it at some point of life. If family members have such pattern of hair fall, chances to get the same almost double up. But sometimes one may have it without having familial occurrence of such kind of hair loss.

As you have already used the medical therapy without significant result, the only option left is surgical approach. Hair transplant is the best option for you .

Now coming to your second concern. Use of minoxidil can lead to dryness, redness and itching of scalp as it has a potential to induce contact irritant dermatitis of scalp. The same can be treated by stopping minoxidil and applying steroid based lotion. Flutivate is fluticasone a milder steroid as compared to betamethasone. You can use whichever is available

Fungus flares up when you oil your scalp daily or leave oil in scalp. Once a week oiling would not flare fungus. I suggested antibacterial shampoo instead of antifungal as you are having oozing from scalp and from the images attached i could not appreciate greasy flakes over scalp. If you are having seborrheic dermatitis which is characterised by red itchy scalp as well as greasy scaling, you may alternate an antifungal shampoo with antibacterial wash. Antibacterial wash is prescribed just to control the ooze, once its gone you may stop using the shampoo. Using steroid lotion along with antifungal shampoo would give better results. To alleviate the itch, take tablet cetirizine.
Hope that helps.
Take care
Above answer was peer-reviewed by
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