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Dr. Andrew Rynne

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Suggest treatment for persistent white patches on scalp

Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 7664 Questions

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Posted on Wed, 27 Aug 2014 in Skin Hair and Nails
Question: Hello Doctor, I am 30 years old and I have white patches on my scalp...I take head bath everyday but in no time the white patches reappear. If I scratch the white patch, the patch will come off as a powder and the place turns red or the whiteness persists. The scalp when shaved looks absolutely ugly with the silvery patches all over. There is slight itching. When I last consulted my dermatologist, he told me that I should have some exposure to sun (I work in night shifts and hence absolutely no exposure to sun), exercise and change my life style. He also told me that the problem is psycho somatic and I should learn to avoid stress from work etc. I have been having this problem for the last 7 years but I did not pay much attention. He gave me castor oil and some shampoos and told me that I need to maintain hygienic conditions for my pillows. I used them but I found no improvement and then I did not consult him again. These white patches are only on the scalp...nothing on my ears, fingers or finger nails. Please let me know if you want to see the pictures of my scalp for a better assessment. Also, please suggest any medicines that I should use so that the problem does not re-appear. Is it something to do with the failure of ones immunity that one falls prey to such infections? Please show me a permanent cure for this. Thanks.
doctor
Answered by Dr. Kakkar S. 8 minutes later
Brief Answer:
Possibility of psoriasis

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query, I would keep a possibility of scalp psoriasis. Though I would prefer a few photographs for confirmatory diagnosis

Psoriasis affects the scalp with well defined plaques with adherent, thick scaling.

Normal shampoo wont benefit much in psoriasis affecting the scalp. For scalp psoriasis, I prefer to start my patients on a medicated shampoo e.g coal tar+salicylic acid based shampoo.

Along with medicated shampoo, I also ask my patients to apply a potent topical steroid lotion with or without salicylic acid, twice daily.

Since psoriasis is a steroid responsive dermatosis, it responds very well to topical steroids, which must be gradually tapered to prevent a rebound flare.

Besides topical steroids, topical Vitamin D analogues like calcipotriol lotion can also be used for scalp psoriasis.

These are prescription medications, I would suggest that you consult your dermatologist before trying these out.

Unfortunately the disease can relapse after seemingly complete cure. The course of psoriasis is indeed marked by remissions and relapses and available treatment options can only induce the disease into remission, rather than permanently cure it.

Regards
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Kakkar S. 31 hours later
Thanks for your reply doctor. I will send you the pictures for your confirmation. Will you prescribe exact medicines for my condition? It is disappointing to know that there will be relapses and I appreciate your honesty in telling me that there is no perfect and permanent cure.

Hello Doctor, I am not able to upload the pics of my scalp here (in the upload reports section). Is there another e-mail or something that I could mail them to?
Regards,
XXXX
doctor
Answered by Dr. Kakkar S. 6 hours later
Brief Answer:
Upload Photographs

Detailed Answer:
Hi.

For uploading of photographs you may go to the reports section OR else you may email the photographs at YYYY@YYYY with the subject line as "Attention Dr. Kakkar".

If you still find any difficulty you can mail me directly on YYYY@YYYY

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 10 hours later
Dear Dr.Kakkar,
Thanks for your response. I am sending you the photographs. Please see if they help in confirming your preliminary diagnosis of my condition as "Scalp Psoriasis". Please suggest the medicines that I need to start using. Thanks.
Regards,
doctor
Answered by Dr. Kakkar S. 18 minutes later
Brief Answer:
Scalp psoriasis

Detailed Answer:
Hi.

I have reviewed the photographs.
Yes, this is 'scalp psoriasis".
I would suggest using Protar Shampoo, every Alternate day
Topically you may apply Topisal-6% lotion twice daily to the affected area/patches for 2 weeks.
An oral antihistamine e.g cetrizine 10 mg once daily would provide symptomatic relief from itching.

Follow up after 2 weeks

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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