Brief Answer:
sebopsoriasis/dandruff+androgenetic alopecia

Detailed Answer:
Hello and Welcome to healthcaremagic

I am Dr, Kakkar. I have gone through your concern and I have understood it.

Your main concern is dandruff and hair shedding+androgenetic alopecia

Seborrheic dermatitis/dandruff presents as scaling and itching of the scalp. Increased hair shedding is also a common complaint associated with seborrheic dermatitis/dandruff

For dandruff you can use an antidandruff shampoo e.g either 8X, Protar K OR Sebowash shampoo, which are all good choice antidandruff shampoo. I would suggest that you use either of these, thrice weekly OR even daily, for 2-4 weeks. Since dandruff is bound to recur, therefore rather than using a regular shampoo, people with dandruff should use an antidandruff shampoo (twice weekly for maintenance) to keep dandruff under check.

However if in case this proves insufficient in providing relief from dandruff then I usually ask my patients to use a topical steroid lotion e.g Topisal Or Elocon lotion (Mometasone is available as a lotion formulation) at the scalp skin twice daily for 2 weeks and once the dandruff is controlled I usually stop it and ask my patients to continue with just antidandruff shampoo for maintenance(twice weekly). However since topical steroids cannot be used for ever, therefore after the first 2-4 weeks of either topisal or elocon lotion, I usually ask my patients to use a topical calcipotriol lotion (calpsor lotion) which is good for dandruff as well as sebopsoriasis. The advantage of calpsor lotion is that it can be used even for a longer period unlike steroids.

Dandruff related hair fall is reversible and usually patients with purely dandruff related hair fall don't complain of a decreased hair density or hair volume.

Though controlling dandruff effectively would control your hair fall problem, however there is also another reason for your hair fall and decreased density, which needs to be treated i.e Androgenetic Alopecia is the most common cause of gradually progressive hair thinning and hair fall from the scalp. Usually there is a positive family history.

Seborrheic dermatitis and androgenetic alopecia are commonly found together and while patients may attribute hair fall to dandruff, androgenetic alopecia is also the reason for hair fall and decreased hair density.

Minoxidil and finasteride are FDA approved for androgenetic alopecia related hair loss and hair thinning. These drugs are available on prescription from a doctor and hence I recommend you visit a doctor before trying them. However since minoxidil can itself lead to dandruff, because it has an alcohol base therefore it is not advisable, hence you may use q -sera which is hair serum containing hair growth peptides.

Therefore for androgenetic alopecia in particular, q-sera(once daily at night) and finasteride tablets would be appropriate in your case along with daily or alternate day shampoo(either ketoconazole based OR 8X OR Protar K shampoo)+topisal or elocon lotion, once daily during the day) for 2-4 weeks followed by calpsor lotion, once daily during the day for maintenance of dandruff free scalp.

Hope this helps
Regards

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Brief Answer:
Dandruff+androgenetic alopecia+?acne

Detailed Answer:
Hi.

The prescription from your first dermatologist did show improvement, however it relapsed again once you reduced the dosage.

I feel that there is no need to take Azax unless you have some scalp infection(oozing and crusting). If required, it should be taken once daily in dose of 500 mg OR 250 MG twice daily.

I guess you also have acne judging from the fact that you were prescribed spongysal face wash for oily skin. Did your doctor start Azax for acne? If yes, you need to take it 3 consecutive days/week for 2-4 weeks.

Aczit is also mainly used for acne. It should be taken after a meal for better absorption.

Raised insulin levels can lead to hormonal fluctuations and therefore acne. In those who are overweight, typically have raised insulin levels. Therefore cweight reduction does help in those.

Black spots are most likely Acanthosis Nigricans(it is known as Pseudoacanthosis nigricans in those who are overweight). Raised insulin levels are implicated in its causation. Weight reduction and once daily Metformin 1000 mg once daily OR 500 MG twice daily (glycomet SR) was probably started for this reason since it controls insulin levels.

I feel there is no requirement for Antoxid -HC, which is an antioxidant and Natvie which is a Vit E supplement

Regards

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Brief Answer:
Seborrheic dermatitis

Detailed Answer:
Hi.

Fine. You can use 8X and sebowash shampoo on scalp.

Azax 500 mg should be once daily for 7-10 days.

Aczit once daily after meals.

Regarding inflammation and cuts on the sides of nose and ears, it is due to facial involvement with seborrheic dermatitis. You can apply eumosone -M or Onabet - B cream twice daily, it should work very well for facial involvement.

Regarding acanthosis nigricans, losing weight would surely help. I would also suggest Glycomet SR 100 mg once daily.

I agree the doctor must be renowned, knowledgeable and experienced. Regarding the reason for him not talking too much with his patients could be because the doctor must be really busy with lots of patients and can't spend too much time with his patients. All dermatologists use hand lenses by the way.

I don't think there is any role of antoxid-HC or natvie in seborrheic dermatitis or immunity per se. But anyways if you want take it, you may go ahead because taking these won't make things any worse for you if not better, except that you are the one who is going to pay for these.

Regards

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