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Insanity = Scalp Psoriasis
from Sandra T.

I'm going crazy!!  My scalp is making me feel like I'm going nuts!!  I just turned 50 and all of a sudden my scalp itches, has gotten crusty, has patches of ook — whatever!!  I've been to my doctor who sent me to a derm and she said Seborrheic dermatitis and gave me Olux which DID NOT help and I've tried everything from Head and Shoulders to TGEL to Vinegar to Listerine to Tea Tree Oil to Tegren and whatever else they have.  I went back to my doctor and she did a biopsy which says:

Ulcer, Extending to the Periphery, with associated acute inflammation at the surface, and mild perivascular and periofollicurlar chronic inflammation . Clinical correlation recommended.

My doctor acts like I'm doing this to myself, picking and making scabs.  Why in the world would I start something like that out of the blue at my age?  My head ITCHES and HAS CRUST AND SCALES.  Not a lot of flaking per se that falls loose on it's own, but if I use the comb it comes out.  Sometimes there are oozie patches beneath the scales.

I don't know what is going on and I can't get any good help!  Is there a good derm that specializes in SCALPS in Los Angeles???

My wrists and arms are growing sore from reaching up to my head and I'm doing it even during work now which is so not ok!!  I might also add that there are about 7 spots that seem to re-occur over and over.  Sometimes there are lumps or bumps under these scale spots.  The other day it felt like the side of my head was actually swollen in the glands near my ears. Then they disappear.

WHAT IS THIS and can you help???  I hope I don't sound like a rambling idiot which I'm sure I am at this point, and that this is still a good email for you....  I don't know what to do!!! 

Any response would be so greatly appreciated. -Sandra T.

*****

Ed’s Response:  What you are going through certainly SOUNDS like scalp psoriasis, Sandra, but I find it hard to believe it wouldn’t have been diagnosed by now; so, it very well may be something else.  Let me pretend for a moment, though, that it IS scalp psoriasis.

You’ve tried most of the palliatives that are good at controlling mild cases or preventing relapse (if used consistently).  The stubborn, oozing, recurring lesions that shed skin tissue that glombs up around and between hair strands and must be combed or brushed out are the most difficult to treat.  That’s because the “action” that’s causing the excessive skin growth is happening layers beneath the lesions to which you are applying medicines through topicals and medicated shampoos.  This method of application is pretty helpless to penetrate the glombs and get to the war zone beneath.

One way of helping your meds penetrate is overnight occlusion.  Has any doctor mentioned this to you?  It’s pretty standard practice for flakers with severe, recalcitrant scalp P.  It involves applying your medicine(s) before you go to bed then wearing a tight shower cap overnight.  If the shower cap is tight enough (some people tape it down around the edges) it provides a barrier to evaporation.  The meds don’t dry out, so they have time to “sink in.”  Also, natural perspiration of the scalp tends to moisten and tenderize everything, further promoting deep absorption and softening of the hard flakes and glombs.

Meds that psoriatics frequently occlude for scalp P include topical corticosteroids, salicylic acid, and derivatives of coal tar.  Those who favor more natural palliatives have occluded oils (everything from peanut and olive oil, to fish oils and Baby Oil) and a variety of herbals concoctions.

When I get severe scalp P, occlusion is the ONLY WAY I can make it succumb.  Once I’ve calmed it down, I can usually “maintain” with liquid hydrocortisone and salicylic acid.  I can get on — albeit irritably — with the “dandruff” caused by mild scalp P, but those “crusty ooks” you’ve got to pry off the hair shafts absolutely dominate me.  I can’t function so long as I feel that stuff on my head.  Even writing about it gives me the heeby-geebies.

Good luck to you!  -Ed

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