What Is The Cause And Treatment For Recurrent Lesions On Scalp?

Posted on Wed, 4 Mar 2015

Question: So my question is I keep getting these areas on my head they start out as tender then painful finally they develop a scab. Each time one goes away a new one seems to pop up. It seems like it is correlated with stress also. I know you can't tell me exactly what they are or if they are infections or well diagnos I am seeing my doctor in a few weeks and will have her examine them further but my question is can they be caused by stress? My mom had something similar when she was alive and I think they started at around the same age. I have tried tgel reducing how often I was washing more changing soaps nothing seems to make a difference. Mom has been gone for 10 years so it's not like I could have contracted something from her to cause it. Just curious. Thank you in advance

Answered by Dr. Hardik Pitroda (57 minutes later)

Brief Answer:
History and pictures required

Detailed Answer:
Hello,
Thank you for posting on HCM.
I can understand your apprehension regarding recurrent lesions on your scalp.
Considering your description, I would like to put forward differential diagnosis of bacterial folliculitis,seborrheic dermatitis, Folliculitis decalvans, Fungal infection(Tinea capitis).
Since the accurate diagnosis is not possible without actual clinical examination, I would insist you to post some good quality clinical pictures.You can mail pictures to YYYY@YYYY
with subject titled ' ATTN Dr Hardik Pitroda'.
Apart from pictures I would require you to provide certain history details like:

1. Any associated loss of hair? if yes, are there well defined patches of hair-loss?
2. Any associated scaling or flakiness in scalp?
3. Any itching?
4. History of exacerbation in particular weather?
5. Application of any hair-color or dyes or use of any cosmetics on scalp?
6. History of use of blow-dryers or hair straightening iron ?
7. Any history of Diabetes or any other immunocompromised condition?

Thanks
Dr Hardik Pitroda

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Pitroda (18 hours later)

1) no hair loss other than related. To me picking
2) no scales or flakes
3) itches when scabbing over after picking noal I know
4) no dyes or hair product, no blow drying curling or straightening have used same shampoo for years but tried suave and tgel and white rain when this started no improvement after 2 weeks with each
5) diabetic well controlled hgb a1c 5.9
Just last month.

I do pick as they annoy the heck out of me and it's like pressure builds up under it and once it opens it no longer hurts like it did. No drainage other than when I remove scabs and it bleeds. The pictures I sent you are one that popped up the day I posted it has been hardly messed with which is why I sent it. I have not picked at it except a few times. Was thinking of trying tea tree oil. I just know they bug me and I am a picker when I'm stressed or not thinking and it is embarrassing

Answered by Dr. Hardik Pitroda (26 hours later)

Brief Answer:
Oral antifungals, topical antifungal and corticosteorid

Detailed Answer:
Considering you history and pictures, I would like to treat you for seborrheic dermatitis.
Sebaceous hyperplasia is enlarged and swollen sebaceous glands which produces excessive sebum and this in turn can lead to dermatitis of skin called Seborrheic dermatitis. Excess sebum production promotes fungal growth and these in turn eventually contributes to seborrheic dermatitis.

I would suggest you a course of oral antifungal drug like fluconazole 150mg once a week for 6-8weeks.
Also in addition, I would like to add an antibiotic like Doxycycline 100mg twice a day for 20-30 days.

Mix and apply a lotion containing betamethasone plus clotrimazole and clindamycin lotion twice a day over scalp.

Use a shampoo containing povidone-iodine thrice a week for scalp wash (Betadine-AD shampoo)

Please do update me after 3 weeks of above therapy.
I am sure you will be fine with this treatment.
Let me know if you require any more assistance from my side.
Wish you best of health.
Thank you
Dr Hardik Pitroda
M.D Dermatology

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Pitroda (2 minutes later)

Thank you!

Answered by Dr. Hardik Pitroda (0 minute later)

Brief Answer:
Wish you good health

Detailed Answer:
You are welcome.

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar