I Have Very Scaly Scalp With Flakes Coming Off. Where

Posted on Wed, 24 Oct 2018

Question: I have very scaly scalp with flakes coming off. Where the flakes are, there is hair loss. It also shows as white silvery patches. It is made worse when I apply leave in conditioner to damp hair, after I have sweated at the gym or if I moisturise my damp face with a heavy cream.. (only damp, not dry). Please help, I am at a major loss as to what this is and how to treat it

Answered by Dr. Arnold Zedd (4 hours later)

Brief Answer:
Scalp problem

Detailed Answer:
Hello and welcome to Ask a Doctor. I am sorry for the delay. I have read your query and here is my advice.
Thanks for sending pictures of your scalp. Unfortunately most of the pictures were blurred.
Dandruff is one of the most frequent causes of scaling of the scalp. Patches of scaling can also be on eyebrows, ears, folds of nose. Sometimes associated with itching. The skin under the scales is red. When a scale is removed, there are no bleeding points.
But you don't describe the scales as red.
Psoriasis is a chronic condition in which family history is often positive and there may have been
an infection and trauma to the scalp.
Adults with psoriasis are more likely to also be obese, have high cholesterol, hypertension, and cardiovascular disease.
The rash consists of bumps and flat areas that are pink to deep red and have an attached white to silvery scale. Removal of the scale causes bleeding points.
Nail involvement is common consisting of pitting of thickening and yellowing.
Do either of these description fit?

Hope I have answered your query. If you have any further questions, I will be happy to help.
I shall wait for you to reply.
Arnold Zedd, MD

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Arnold Zedd (1 hour later)

Thank you for your help. Neither of those quite fit exactly. For the first option, the dandruff. I do tend to get like flaky bits around my nose and on my chin too. For the 2nd option with psoriasis. I don't have a family history really. I have a family history of eczema but not psoriasis. My nails are actually pretty healthy and I have a healthy bmi.
Would it help to send clearer photos? Though I felt the 2nd one was quite clear?

Answered by Dr. Arnold Zedd (1 hour later)

Brief Answer:
follow up for scaly scalp

Detailed Answer:
Welcome back , XXXXXXX
Seborrheic dermatitis can produce scaling patches on scalp,ears, eyebrows, nasolabial folds, central chest, and beard area in males.
Please send clear pictures, and if possible, include
areas of hair loss.
When you lose hair, does the hair come out in clumps?
Arnold Zedd, MD

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Arnold Zedd (2 days later)

Thank you for your reply and sorry for my delay in replying. My schedule has been a little crazy at the moment. The hair comes out not so much in clumps but more individually or a few at a time. Always, there are white/ nudish clumps at the top of the hair. My hairline at the front is particularly affected. I tried to include more pictures. My camera is not the best (sorry!) but I tried to take it under a better light.

Answered by Dr. Arnold Zedd (20 hours later)

Brief Answer:
continuing with scaly scalp

Detailed Answer:
Hi, XXXXXXX Thanks again for your patience.
I want to help you even if it is slowly but surely.
I have re-read your communications and see there is a family history of eczema. This is a risk factor for scalp eczema.
You go to the gym; heavy sweating is a trigger for scalp eczema.
Irritation and itchy scalp can be treated with over-the-counter dandruff shampoo which gets rid of the flaky, scaly scalp skin. Should be used 2-3 times a week. Select a shampoo that has any of the following ingredients on the label: selenium sulfide, salicylic acid, or zinc.
Wash scalp thoroughly using warm, not hot,
water.
It often returns. Sun exposure may improve the flakiness.
The last photo that you sent was most helpful.
I hope this information is of help to you. If you do not have any further questions, you may close the chat and rate the answers.
Arnold Zedd, MD

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Remy Koshy