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Suggest treatment for severe dandruff and hair loss

DOCTOR OF THE MONTH - Jan 2014
Jan 2014
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Dermatologist
Practicing since : 2002
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Question
I have severe dandruff & lot of hairfall... the front side of my hair has already receded and thinning of hair has also happened. Recently due to dandruff, both sides of my noise have got cuts and specially in winters it became very bad. Also, my armpits & elbows have black spots... My scalp had lot of flakes and recently became very soft at back of my head and due to irritation, I peeled them leading to lot of redness and pain. I visited a dermotologist and he diagnosed Seboriasis and prescribed me the following: 1) Protar K Shampoo - daily, 2) Cap Cathex - BD 3) Topisol lotion in morning 4) XXXXXXX lotion in night, 5) Cap Accutret 10 mg OD 6) Syscan 150 mg - twice/wk 7) Novale soap.. The condition improved and then in my next visit, he advised to reduce Syscan, Accutret & topisol lotion by 50% dosage... but the condition worsened again and based on my next visit to same doctor, he again asked me to go back to original prescription.
Also he had asked me to get Insulin - Fasting & PP test done -- The result was - Fasting was within limits but PP was abnormally high -- to which the above doc advised -- XMet 500 mg -- initially OD for a week and then BD for next few weeks.
I went back to original prescription as advised above but redness has spread all over my scalp and there is lot of cuts around my nose and ears.
So today I decided to visit another Dermatologist and he mentioned that diagnosis is fine but some of the prescription is not 100% correct and has now advised me following -- 1) 8X and Sebowash shampoo, 2) Topisal 3% lotion in the morning, 3) Aczit 20mg - OD 4) Trulimax 500 mg - BD 5) Antoxid - HC - OD 6) Natvie - 200mg - OD 7) Spongysal facewash 8) Q-sera lotion - in night 9) LOGI hair - OD... Last 2 things are for hair regrowth as I have receding hairline and lot of hairfall.... He mentioned that insulin is not leading to black spots in underarm and elbows
Now I am confused if the previous medication was better or this one is better. I had consulted the latter Dermotologist in past as well and he had advised similar medicines earlier and things were well -- but I discontinued as there were too many medicines. Pls advise ... Thanks in advance
Posted Sat, 9 Aug 2014 in Skin Hair and Nails
 
 
Answered by Dr. Kakkar S. 57 minutes later
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
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for severe dandruff and hair loss 13 minutes later
Thanks you doctor for your response. Based on your response, it seems both the above prescription were good enough then still could not understand as why the redness did not get controlled based on medication from the first dermatologist doctor. Can you help advise as what could be the reason?

Today, I have started the dosage as per the second doctor which includes following medicines... i.e. 1) 8X and Sebowash shampoo - daily, 2) Topisal 3% lotion once in the morning, 3) Aczit 20mg - OD 4) Trulimax (or Azax) 500 mg - BD 5) Antoxid - HC - OD 6) Natvie - 200mg - OD 7) Spongysal facewash - 2 times a day 8) Q-sera lotion - in night 9) LOGI hair - OD...
I would be doing follow up with my doc within 10 days...

Two more questions I had is --
1) is it ok to take so many medicines? anything specific to be taken care e.g. I know Aczit (or Acutret) should be taken only after eating something.. so any suggestions there
2) I would be taking Azax 500 - twice a day for 10 days - is it ok because generally I have seen patients taking this only for 3 days and that too once a day?
3) I had done my Insulin Fasting /PP test -- My PP results were abnormally high while Fasting was ok.. the first doctor said that I should exercise and walk else it may be sign of diabetes?? - pls advise...
4) Finally, any thoughts on black spots in my underarm, elbows - can they be reduced? My second doctor said that it is grown darker because of my heavy weight -- so would exercise help to gain back?
 
 
Answered by Dr. Kakkar S. 14 hours later
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
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for severe dandruff and hair loss 3 hours later
Hi Doctor, Thanks for your response. Per your question on Azax, yes.. there is lot of scalp inflammation - lot of patches have become red/white and skin is coming out. Wherever I scratch them due to irritation, it starts paining as well... so guess doc would advised because of this... pls confirm -- but again I have been asked to take 500 mg twice a day...
Regarding Acne, as I mentioned above -- my nose sides and ears sides have got cut, .. also within ears there is lot of flak which when I scratch, some liquid comes out... and some small pimples sometimes on face -- so earlier also he ad recommended a facewash similar to this... He has advised to take this dosage for 10 days and review again

Regarding, Aczit - thanks... yes, am taking after a meal only.

Regarding black spots -- doctor also said that it is Acanthosis Nigricans(it is known as Pseudoacanthosis nigricans in those who are overweight). I told him that earlier doc had recommended Xmet 500 mg for raised insulin levels -- but he advised not to take it. Also he mentioned that black spots would may be get 10% down but would rarely go now even when I reduce weight... but I should be surely doing daily walk

Finally on Antoxid -HC, which is an antioxidant and Natvie which is a Vit E supplement --> he said I should take this... he always advises to take this... may be improve the immnunity levels...
Btw, this doctor is having around 40+ yrs of experience and is a renowned professor as well who has taught many doctors in XXXXXXX - that's what he says... he just looks at you and also keeps a lens with him to review and then gets on to write medicines... doesn't likes to talk too much...
So I always get confused and asking so many questions regarding my scalp issues...

Also, as per second doc, I have stopped using Protar K shampoo and now using 8X and Sebowash shampoo -- using daily for next 10 days as scalp and face (sides of nose & ears) are in really bad shape...

Do you also recommend any ointment to apply??... The first doc had first recommended to use Eumosome M and then later changed it to Onabet B -- to be applied on sides of nose, ears and also on armpits -- but the second doctor whose medicines I have started has not recommended any ointment and I forgot to ask him as well... Pls advise.
 
 
Answered by Dr. Kakkar S. 47 minutes later
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
Above answer was peer-reviewed by
 
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