Brief Answer:
Follow the instruction in detailed answer

Detailed Answer:
Hello,

Welcome and thanks for posting your query to XXXXXXX

As per your query your wife has hair fall with itching and boils and dandruff over scalp. You have not mentioned the exact time period since the problem is present in your wife.

As per the description of the problem the best possibility appears to be case of moderate to high "Pityriasis capitis". I can see that a lot of mediations and shampoos had been taken with investigations done which shows high ESR.

To explain you elaborately - medically speaking our skin is a multiple layered structure. Our skin gets renewed every day. The layer which is present on the top today will be fallen off tomorrow in the form of dead skin known as scales. This process is not actually visible on normally. So we can say we are just one day old from our skin most superficially.

Now in some persons when it is renewed at a faster pace there is a heap of scales which we call as dandruff. Because of hygiene and scalp hair this dead skin in form of scales gets entangled and trapped. It varies from person to person and also on other of factors which makes the difference inter-individually.

The scalp skin also secrets oil continuously and the secretions of oil glands are deposited on the local area. These secretions itself lead to subsequent blockage of the glands and so lead to mild inflammation of the area. There after the continuous secretion and the mild inflammation leads to yellowish dry crusting of the area. So it leads to the inflammation of the oil glands and hair roots and ultimately boils. So whenever the favorable conditions for the boils is present such as flaking, more oil secretion, heat and humidity with continuous scratching or touching the local area, these boils can come and go repeatedly.

The irritation at local part causes intense desire to itch and due to itching the area is denuded of skin leading to exposure of red raw areas of skin with excoriation and redness of the skin.

IN our clinical practice this is quite a common condition which we see regularly in patients with scalp problems. The only thing which I can see is raised ESR- it means raised Erythrocytic sedimentation rate- which is a marker of some chronic infection. This could be because of the long term scalp infection or might be some other problem too.

Now for the betterment kindly follow the suggestions below:

- The most important thing you should tell her is not to touch, pinch, pop or squeeze the area by any means. So again I write in capital letters" NO SCRATCHING & NO TOUCHING". This is the most important part in her condition because there are raw areas of skin which can get infected and irritated because of mere unnecessary touching.

- Let her do saline water compression meaning 1 glass of water with pinch of salt in it and then cotton soaked in the water and compressing for 5 minutes. You can take warm or cold water according to your comfort. Do it for at-least 2-3 times in day. It will loosen the dry flake, which will fall off easily.

-Let her wash her scalp daily. You will say she is already doing it. But my way of application is- it is to be done twice in a single bath. It means when you are washing your scalp apply first time shampoo for washing the hair part only, then rinse it off immediately with water. Reapply the shampoo again immediately, leave it for around 5 minutes, do a good gentle massage by your fingers for around 2 minutes and then wash it off. By doing so for around 7 days you will get good benefit.

-The other way if you can not do two time wash is apply your shampoo ( diluted with water) for around half an hour before bath like an hair oil. And then rest of the second application and bath as told above. You can reduce the frequency of twice application after 2 weeks and then can optimize it according to your own need. If you are not getting any better then can also do it two times in day for time being- yes you read it properly two times per day. It is same like how many times you generally brush your teeth- you say one time, but those who have some problem with teeth do brushing twice also. In the same manner to reduce the flaking - the latest dermatological view is you can gently wash your hair two times.
- Stick to one good shampoo which is suiting your hair, don’t change the shampoos frequently. If you are using any conditioner also then to be used over the strands of hair only and not over the scalp skin.

- Do not use any kind of hair oil or any oily or creamy stuff any time on your scalp.
- Let her comb her hair at least 2 times a day and most importantly at night time so that the dust particle and other of dead skin is taken off.
- Maintain scalp hygiene. Do not apply any hair oil or any home remedies as can irritate the skin.

- You can give her any antihistamine tablet by mouth such as desloratadine or levocetrizine for itching and irritation. It can be taken for one time if itching is less or for two to three times if the irritation is more. desloratadine can be taken in day time while levocetrizine can be taken in evening or night time.

- If she has bit of pain then she can take pain killer tablets in the initial part for few days.

- So the above measures can be done for atleast 7 days to reduce the acute effect. Once you get relief from all these measures done judiciously and prudently then can apply and take certain antifungals and keratolytics (medicines reduce and removing excess scaling) under dermatological advice.

For the hair fall it can be because of this infection in scalp as well as a nutritional problem. You can make her dietary plan below:

1. Let her eat at least 3-4 different fruits saplings per day. Every fruit is good but you can make a combination of sour with sweet fruits such as oranges, papaya and other of seasonal fruits.
2. Pulses are good source of proteins. So everyday let her have a small bowel full of mixed pulses. Add green leafy vegetables additionally in the pulses which contain lot of iron and vitamins in it.
3. Sprouts are the best source of fibers, minerals vitamins and proteins too. so add it at-least alternate day if you can not make in her everyday's part of meal.
4. Over night soaked and peeled almonds will give you good vitamin E which is good for the hair growth.
5. Milk and milk products should be included in everyday's schedule.

The most important part in her treatment is prevention of aggravating factors which I have already enumerated. Let her not at all scratch any area on the scalp as it may lead to infection over the skin.
So with simple measures you can take care of her problem without much of the efforts.

Hope I have answered your query. If you have any further questions, I will be happy to help or if you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health.

Regards,

Dr Sanjay Kumar Kanodia
(MD- Dermatology)

---