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Suggest remedies for sores on the scalp

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Posted on Sat, 18 Jun 2016
Question: In December I started getting sores on my scalp. I asked my primary about them and ahowed her. She diagnosed me w tinea capitis, i started Nizoral AD. No chnage after 1 month, so next I started terbinafine 1/x a day for 6 weeks. Requested a second course which i started and compelted, so a total of 12 weeks on terbinafine. However there has been no remission (just improvement) since starting them. The first sores were red and deep, new sores now just are smaller and scab quickly. They are all itchy and painful. I have exhausted my follow ups with her and she had suggested i follow up with a derm. However i cannot be seen until July or August at the one I called. I have dozens of pictures of the various sores over the months. I am not experiencing skin issues anywhere else.

The pattern is repeatable; a small area near a follicle gets red and puffy gradually expanding to the area around it. My hair was breaking (consistent w ringworm) but ive taken to shaving sore spots in an effort to contain them (it sort of works).

Any idea what is going on? Will include early and recent photos. I have dozens so hope this is a representative sample.
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Answered by Dr. Ilyas Patel (3 hours later)
Brief Answer:
Scalp folliculitis most probably

Detailed Answer:
Hi,

Welcome to HCM...

I read history and saw the photos you posted. After that I thought that most probably you may be having the skin disease called scalp folliculitis. You have itchy,painful,sore and crusted lesions on the scalp...which suggest scalp folliculitis. It does not seem to be tinea capitis,as not responded to oral antifungal you took.

Scalp folliculitis is an inflammatory disorder of the hair follicles in the scalp. The condition is also known as "acne necrotica miliaris" or "Proprionibacterium folliculitis".Scalp folliculitis is characterised by small, very itchy pustules on the scalp.. And they often become sore and crusted.

The exact cause of scalp folliculitis is not known.It may be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms...like
Bacteria (Propionibacterium acne or Staphylococcus aureus),Yeasts (Malassezia species),Mites (Demodex folliculorum)

I would suggest...

- shampoo with antiseptic like savlone or Antidandruff like ketoconazole shampoo
- application of antibiotics like fusidic acid gel, clindamycin solution, erythromycin solution
- application of topical steroid lotions like mometasone
- antihistaminics like levocetirizine till itch is relieved
- antibiotics like tetracycline,doxycycline or minocycline for long time
- tab isotretinoin 5 mg daily
- tab vitamin C 1000 mg daily
- tab zinc sulfate 200 mg daily
- avoid stress and anxiety
- have positive attitude and patience

You consult the dermatologist and have proper treatment as suggested above.

I hope this would give proper guidance in managing you scalp condition.

Thanks.

Dr.Ilyas Patel MD


Above answer was peer-reviewed by : Dr. Naveen Kumar
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Dr. Ilyas Patel

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Practicing since :1982

Answered : 4478 Questions

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Suggest remedies for sores on the scalp

Brief Answer: Scalp folliculitis most probably Detailed Answer: Hi, Welcome to HCM... I read history and saw the photos you posted. After that I thought that most probably you may be having the skin disease called scalp folliculitis. You have itchy,painful,sore and crusted lesions on the scalp...which suggest scalp folliculitis. It does not seem to be tinea capitis,as not responded to oral antifungal you took. Scalp folliculitis is an inflammatory disorder of the hair follicles in the scalp. The condition is also known as "acne necrotica miliaris" or "Proprionibacterium folliculitis".Scalp folliculitis is characterised by small, very itchy pustules on the scalp.. And they often become sore and crusted. The exact cause of scalp folliculitis is not known.It may be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms...like Bacteria (Propionibacterium acne or Staphylococcus aureus),Yeasts (Malassezia species),Mites (Demodex folliculorum) I would suggest... - shampoo with antiseptic like savlone or Antidandruff like ketoconazole shampoo - application of antibiotics like fusidic acid gel, clindamycin solution, erythromycin solution - application of topical steroid lotions like mometasone - antihistaminics like levocetirizine till itch is relieved - antibiotics like tetracycline,doxycycline or minocycline for long time - tab isotretinoin 5 mg daily - tab vitamin C 1000 mg daily - tab zinc sulfate 200 mg daily - avoid stress and anxiety - have positive attitude and patience You consult the dermatologist and have proper treatment as suggested above. I hope this would give proper guidance in managing you scalp condition. Thanks. Dr.Ilyas Patel MD