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What causes bald patches on the scalp?

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Posted on Tue, 24 Nov 2015
Question: Hello, My son is 21 and had a scalp infection (looked like pimples, eventually crusty and a few of them infected.) It appeared to be folliculitis I believe. He took a 10 day course of antibiotics and it resolved quickly. A couple months later, it came back. This time, a few larger, red, swollen and painful areas with a few crusty areas. Less pimple like appearance. He again went on antibiotics. He took all of them and it healed within a week or so. One month later, the infection appeared again. Not as bad. Some red, swollen bumps. Only a couple of pimples. His doctor prescribed two months of antibiotics this time. (Doxycycline - I believe it has been this antibiotic all three times.) My son has taken the antibiotics for one month, and today I noticed a quarter sized area bald spot on the back of his head which appeared very suddenly! The skin is smooth and hair free. He also has two-three other areas which are round and losing most of the hair. He currently has several reddened areas on his scalp. No oozing or open areas of any kind. His hair looks quite thin in the crown area, which is where most of the lesions have been.

The soonest I can get him in to see a dermatologist is 2 weeks and I am very scared that some permanent hair loss or damage will happen. Should anything be done immediately to prevent permanent damage?

Thank you!!
doctor
Answered by Dr. Asmeet Kaur Sawhney (48 minutes later)
Brief Answer:
He has developed alopecia areata, no need to worry

Detailed Answer:
Hi
Welcome to healthcaremagic
I have gone through your history and can understand your concern.
Your son probably has folliculitis decalvans which is a chronic form of folliculitis. It is normally treated by antibiotics as seen in your son's case.
You have mentioned about bald patches appearing on his scalp which are circumscribed, smooth and are not associated with any scarring. These smooth patches appear in a disease called alopecia areata which is associated with autoimmunity and atopy.
You don't have to take too much stress about it as it has spontaneous remission in majority of the patients with limited involvement of the scalp and if the hair loss is of short duration. You can easily wait for 2 weeks for dermatological consultation.
There are many medicines available to treat this condition most commonly being corticosteroids: topical or intralesional. Since you are unavailable to visit the dermatologist for 2 weeks I suggest you to start applying cortisone cream on the bald patches. It will be available as over the counter medicine in your country.
I hope to have answered your query.
I would be happy to clarify any further doubts.
Regards
Dr Asmeet
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (15 minutes later)
Thank you so much for the fast response! I can get the over the counter cortisone cream but it there a prescription cream you would recommend that would work better? I can ask his primary care doctor who would probably be willing to prescribe that. I am wondering if this may mean he could have a serious autoimmune disorder? He has been dealing with a lot of minor medical issues since taking zyprexa 12/14-1/15. Should I be concerned about a serious autoimmune disease? Thank you SO much!!
doctor
Answered by Dr. Asmeet Kaur Sawhney (22 minutes later)
Brief Answer:
Don't worry!!It is not associated with any serious autoimmune disease

Detailed Answer:
In such cases I recommend my patients high potency steroids like mometasone lotion to be applied on the affected areas twice daily. It is a prescription medicine and hopefully your doctor will prescribe it.
No you don't have to take stress as it won't be associated with any serious autoimmune disease. Mostly it is associated with vitiligo or some thyroid disorder and that too in a minor percentage of patients.
I hope this alleviates your fears.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (20 minutes later)
He is suffering from hypothyroidism that has been very difficult to manage for the last 11 months. He has had tsh results ranging from 4-10 and he is finally down to 2.5. Would this be a concern? Thank you so much for alleviating my fears. This is a great service and worth every penny!
doctor
Answered by Dr. Asmeet Kaur Sawhney (33 minutes later)
Brief Answer:
Hypothyroidism might be associated with alopecia areata

Detailed Answer:
Hypothyroidism might be associated with alopecia areata; but now his TSH level is normal. His hypothyroidism is under control right now and you continue with the medicines.
The prognosis of alopecia areata won't differ even in the presence of hypothyroidism .
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (21 hours later)
Thank you very much!
doctor
Answered by Dr. Asmeet Kaur Sawhney (1 hour later)
Brief Answer:
Welcome!!

Detailed Answer:
Welcome!!
Good luck!!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (13 hours later)
Can I ask you another question about his scalp infection? I'm wondering if he is on the right antibiotic for it. I noticed his scalp is still red in areas. He has been taking the current antibiotic for one month. It is doxycycline. There is no drainage or open areas, just red areas. Thank you!
doctor
Answered by Dr. Asmeet Kaur Sawhney (6 minutes later)
Brief Answer:
Continue with doxycycline

Detailed Answer:
Hi! There are many antibiotics that are prescribed for scalp folliculitis, doxycycline being one of them. It is a safe antibiotic and your son can take it for another month. However the onset of action is slow and that is the reason why the red areas are still persisting.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (16 minutes later)
Ok, thank you so much! I noticed the red areas are also the same areas of hair loss. I dont know if I mentioned that before.
doctor
Answered by Dr. Asmeet Kaur Sawhney (4 minutes later)
Brief Answer:
Welcome

Detailed Answer:
Welcome!! Redness is sometimes seen in bald areas due to disease activity.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. Asmeet Kaur Sawhney

Dermatologist

Practicing since :2007

Answered : 5006 Questions

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What causes bald patches on the scalp?

Brief Answer: He has developed alopecia areata, no need to worry Detailed Answer: Hi Welcome to healthcaremagic I have gone through your history and can understand your concern. Your son probably has folliculitis decalvans which is a chronic form of folliculitis. It is normally treated by antibiotics as seen in your son's case. You have mentioned about bald patches appearing on his scalp which are circumscribed, smooth and are not associated with any scarring. These smooth patches appear in a disease called alopecia areata which is associated with autoimmunity and atopy. You don't have to take too much stress about it as it has spontaneous remission in majority of the patients with limited involvement of the scalp and if the hair loss is of short duration. You can easily wait for 2 weeks for dermatological consultation. There are many medicines available to treat this condition most commonly being corticosteroids: topical or intralesional. Since you are unavailable to visit the dermatologist for 2 weeks I suggest you to start applying cortisone cream on the bald patches. It will be available as over the counter medicine in your country. I hope to have answered your query. I would be happy to clarify any further doubts. Regards Dr Asmeet