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P-Problems for New Teacher
from Richard S.

Dear Ed:  Many thanks for your site which has provided me with many laughs since I first stumbled across it. It really is refreshing to hear that there are others who understand the suppressed rage provoked by a much loved and over fussy grandparent brushing your shoulders down in public!

I live in the UK and am training to be a teacher. My new profession has thrown up interesting P-related problems. I spend a lot of time pointing at students' work which immediately reveals my nail P. Also, children being children, they frequently ask what is wrong with my head. I'm glad that I have the confidence to be able to answer them directly and put up with the occasional "f*** off scabby" shouted from across the playground! But lets just say it doesn't make my day any easier trying to find secluded corners to de-flake my shoulders!

I'm 23, have had scalp P since around 17 and developed plaques on my arms, legs and back about two years ago. I am currently taking Dovobet with good effect but, as reported, a diminishing return with each re-application following a break. Dovobet can't (to my or my GP's knowledge) be used on the scalp, so this remains an enraged area.

I am visiting a new derm tomorrow and am really hoping for UV treatment as, being single, application of topical cream to my back is near impossible. I don't really know how effective this is or how it works and would be interested to hear of any reports.

In the meantime, keep up the good work, keep up the honesty.

Keeping the flakes flying in the UK.  -Richard S., Cambridge, England.


Ed’s Response:  Scalp P can be a tough problem, Richard.  Fortunately, treatment options are growing, though I can’t speak to the availability of anything in particular in the U.K. 

The most exciting new product I have found for scalp P is Olux Foam.  This is a favorite topical corticosteroid — clobetasol propionate — in a base of deep-penetrating, fast evaporating foam (with a concentration safe for the scalp).  It leaves no greasy or oily residue in the scalp so can be used any time of day.

Fluocinonide solution is another scalp treatment for P.  My personal experience has been fluocinonide works to keep P at bay, but not well at getting rid of stubborn scalp lesions.  In other words, I do something else to calm my scalp down, then use fluocinonide as a preventative at the first subsequent itching.

I’m not sure whether Dovobet would be prescribed for scalp P or not.  I know Dovonex by itself, which is a part of Dovobet, can supposedly be used on the scalp.  But betamethasone (the other part of Dovobet) is one of those corticosteroids typically considered too strong for scalp use.  (Strong corticosteroids tend to thin skin at the area of application and, since scalp is already “thin,” these corticosteroids are avoided — mostly likely because they are not readily available in a mild-enough form.)

The most common “intense” scalp treatments are overnight occlusions, usually of tar-derivatives, salicylic acid, or some compound of both.  Until the advent of Olux Foam, I always achieved good results occluding a specially compounded combination of tar and salicylic acid (search on “scalp cocktail” here for more references).  This therapy means going to bed wearing a shower cap and hoping it doesn’t come off during the night, as the tar in the compound will stain linens and even if it doesn’t stain it is a goopy mess.  But it’s always worked for me, and usually after only two or three nights.

I applaud your courage facing your students with your raging P.  While they undoubtedly take advantage of every opportunity to make you feel weird, I hope you’re taking occasional advantage to set them straight on matters of chronic incurable conditions like ours.  (Though, in my heart I know it must be tempting to grab hold of the most obnoxious and say, “Now I’ve touched you!  You’ve got it, too!”)  -Ed

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