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What causes an itchy scalp that shed small piece of skin and some blood when scratched?

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Posted on Thu, 30 Aug 2018
Question: scalp dermatitis in 75 year old male bald on top. I have been having some type of problem with the skin on the top of my head where I have had no hair for many years. It does not bother much but occassionally it gets itchy and so I then scratch it and then discover small pieces of skin that will come out of the skin when I do scratch it. These can be ofter fairly big and deep to the point that when I pick on them, they will bleed. I am taking metoprolol for my blood pressure so maybe that is the problem? If so I wonder what BP med I should try next? I have been suffering from a statin drug induced SLE for about 20 years and have had to be on prednisone for the past 4 years to relieve my aches, pains and fatigue s/s so maybe that is responsible? I have cut the prednisone down now to 8 mg per day but decreasing the dose does not seem to have done much.
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Answered by Dr. Dr. Kakkar (1 hour later)
Brief Answer:
Diagnostic possibilities for itchy scalp scaly patches /plaques

Detailed Answer:
Hi

I am Dr kakkar (Dermatologist and Venereologist). I have noted your concern.

It could be either scalp DLE (Discoid Lupus Erythematous) which presents as patches/plaques with adherent white scaling, atrophy and depigmentation Or it may be Seborrheic dermatitis of the scalp which presents as dull red patches with yellowish greasy scaling and scalp itching.
I request you to kindly upload a few images of the affected area so that I am able to confirm and guide you better.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dr. Kakkar (12 hours later)
did you get the photos?
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Answered by Dr. Dr. Kakkar (29 minutes later)
Brief Answer:
Images not received

Detailed Answer:
Hi.
No. I didn't. I request you to kindly try and upload the images again in "Reports Section" or else you may mail me the images at YYYY@YYYY with the subject line of the mail as Attention :Dr.. Kakkar.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dr. Kakkar (10 hours later)
sent photos to your attention. Thanks! I think I have drug induced SLE secondary to lipitor with high levels of anti-dsDNA levels low positive
ANA and elevated ESR and CRP at times. Symptoms of that have been muscle and joint pain, stiffness and generalized fatigue all relieved with 10-40 mg prednisone daily. Now on 10mg per day and trying to taper. The rheumatologists gave me no answer but that I did not have SLE but I think they are all wrong.
doctor
Answered by Dr. Dr. Kakkar (3 hours later)
Brief Answer:
Seborrheic dermatitis

Detailed Answer:
Hi,
I have viewed the images.
I think you have seborrheic dermatitis. I can see yellowish/ greasy looking scale and erythema of the scalp.
I suggest you to use a Ketoconazole based shampoo e.g Nizoral or Nizral shampoo. Lather it well on to wet scalp and allow it to act for 7-10 minutes before rinsing it off. Use daily.
In addition to this I suggest you to apply a topical steroid lotion e.g Mometasone furoate lotion, twice daily.
Anti ds DNA is a specific marker for SLE.

Hope I have answered your query.
Take care
Dr. Kakkar S
Above answer was peer-reviewed by : Dr. Kampana
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Dr. Dr. Kakkar

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Practicing since :2002

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What causes an itchy scalp that shed small piece of skin and some blood when scratched?

Brief Answer: Diagnostic possibilities for itchy scalp scaly patches /plaques Detailed Answer: Hi I am Dr kakkar (Dermatologist and Venereologist). I have noted your concern. It could be either scalp DLE (Discoid Lupus Erythematous) which presents as patches/plaques with adherent white scaling, atrophy and depigmentation Or it may be Seborrheic dermatitis of the scalp which presents as dull red patches with yellowish greasy scaling and scalp itching. I request you to kindly upload a few images of the affected area so that I am able to confirm and guide you better. Regards