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Suggest treatment for scaly plaques on scalp

Answered by
Dr. Nishad BN

General & Family Physician

Practicing since :2009

Answered : 5202 Questions

Posted on Mon, 2 Nov 2015 in Skin Hair and Nails
Question: A couple years ago, I started getting unexplained, spontaneous "scab formations" at three different areas of the scalp. The scabs have never been painful and did not cause itching; and I only noticed them when I would eventually feel them running my fingers through my hair. At some points, I would actually "pick" at the scabs with my fingernails to wear them down in the interest of trying to get rid of them, which sometimes would cause minor bleeding, but still no real pain to speak of. The scab formations would continue to grow back until eventually they all just vanished on their own without any intervention from me. Then more recently, about two months ago, I had another single scab formation occur near the lower left portion of the skull on the scalp, which I believe is where one of the original three scabs had formed initially some two years ago. In this case, rather than "picking" at the scab, I began using daily (sometimes twice daily) applications of over-the-counter hydrogen peroxide solution with a cotton-tipped swab in the interest of effectively "oxidizing" the scab material to go away. The oxidizing with hydrogen peroxide DID WORK to get rid of the scab at least by a margin of about 98%, but it took a month of such daily applications before the scab was mostly gone. At the same time, the hydrogen peroxide WOULD CAUSE mild discomfort to the area in the form of a "stinging" sensation; and the fact of this stinging sensation indicated to me that the nature of the scab formation in the first place was considerate of a form of open sore. I obviously have no explanation for why the scabs would form on the scalp and I have not gone to see a doctor about the condition. I do know that this situation amounts to a type of "dermatitis" condition, in which case if I was to visit a doctor it would likely need to be a dermatologist. I am glad the hydrogen peroxide worked to drastically remove the scabbing, but of course the use of hydrogen peroxide has also succeeded in bleaching out a reasonably sized portion of my hair in the area about the size of a "silver dollar," even though the actual size of the scab formation was probably never larger than a half-inch in diameter... Any answers about what this condition might be, or what good cause this type of condition, would be appreciated. Please note that in the past I have tried using different types of hair shampoo in the interest of seeking to determine if it might be a form of allergy condition, but nothing has helped except to use the hydrogen peroxide. For well over two years now, I have been using the "Johnson's Baby Shampoo" product to cleanse my hair, which is stated to a "hypoallergenic" compound. Thank you!
Answered by Dr. Nishad BN 11 hours later
Brief Answer:
Can be scalp psoriasis.

Detailed Answer:

Thank you for asking HCM.

I have gone through your query. Your problem can be most likely scalp psoriasis. A consultation with dermatologist will be helpful to rule out this. He may do scraping of lesions for pathology examination.

Using medicated shampoos containing corticostroids like clobetasol, salicylic acid and ketoconazole is helpful for this. When you have active lesions you have to use it everyday. When it subside you can make it twice weekly. It should be applied and leave it for 5 to 10 minutes before washing it.

Hope this may help you. Let me know if anything not clear.
Above answer was peer-reviewed by : Dr. Sonia Raina
Follow up: Dr. Nishad BN 2 days later
Yes, I had considered "scalp psoriasis," with the exception that based on any research I've done on the subject of psoriasis, it always tends to at least cause an "itching" sensation and may also be painful. That was why I noted here that there have never been any symptoms of either itching or pain. On the other hand, the scabs have tended to become thick, encrusted and very tough, which I know is often a characterization of scalp psoriasis.

I have a half-sister who has suffered very severe skin psoriasis over her forearms and sometimes escalating to her neck area, which has afflicted her for well over 20 years. (If her scalp is also affected by the condition, then she has never said anything about that and it's not obvious.) Her symptoms tend to flare up on and off from less severe to more severe, but for the most part there are always visible signs of her psoriasis.

In my sister's case, as with any others I'm aware of, there is always severe itching that accompanies the symptoms and she is constantly using medication to alleviate the itching. Also in her case, the condition is limited to red, scaly skin that takes on the appearance of being "sun-burned," but I have never noticed any scabbing.

I wasn't surprised when I found that using hydrogen peroxide solution worked effectively to oxidize the scabbing away on my scalp, since I know that it will oxidize just about anything if it's used long enough. I also use a further water-diluted form of common hydrogen peroxide from time to dissolve "ear wax" in my ears. So far the scabbing in the area of my scalp where the hydrogen peroxide was used has not began to resurface, but it's also been less than two weeks since I stopped using it.

Have you ever heard of "scalp psoriasis" that does not itch?
Answered by Dr. Nishad BN 3 hours later
Brief Answer:
In that case it can be seborrheic dermatitis.

Detailed Answer:
Welcome again.

Thank you for your follow up query.

Itching is usually present in scalp psoriasis. Your problem can be seborrheic dermatitis. This share almost same properties. But cannot be there also.

Treatment for seborrheic dermatitis is almost same like scalp psoriasis. Topical steroids and antifungals works for this also. You can use the one with clobetasol , ketoconazole and salicylic acid.

Hope this may help you. Let me know if anything not clear.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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