Ask the doctors: Itchy scalp could be a fungal infection
Q: For almost two months now, I've had bumps on the back, sides and crown of my head. They itch all the time — and even more when I get hot. When I scratch, I see white or brown flakes. My dermatologist insists it's dermatitis. He has prescribed clobetasol and antihistamines, but they do nothing. Neither does UV light treatment. How can I get the help I need?
A: You have our sympathy for the situation you have described. We see this as a case of your symptoms being treated without a clear understanding of the root cause. This can result in delayed, incorrect or missed diagnoses. At best, you, the patient, continue dealing with uncomfortable symptoms. At worst, it can lead to serious health problems depending on the root cause.
Let's begin with dermatitis. Dermatitis is a general term for inflammation of the skin. It can happen when something causes the skin to rally the immune system. There are several possible causes of this response. It could be an irritant in the environment, an allergen or a genetic difference that affects the skin's response.
Symptoms include itching, redness, rash, bumps, dry or scaly patches, and peeling or flaking skin. In more serious cases, it can cause a thickening of the skin. It can even trigger blisters.
You've been asked to try treatments for several of these possible causes of dermatitis. Clobetasol is a very strong topical medication. It's often prescribed for eczema, psoriasis and other inflammatory conditions.
The UV light box can ease symptoms by slowing abnormal cell growth. This treatment can help in some types of plaque psoriasis. Antihistamines would help if your symptoms were from an allergy. Since you have had no change in your symptoms in two months, it seems it's time to look beyond these possible causes.
You described a localized condition, only in areas of hair growth. We wonder if your doctor has discussed the possibility of a scalp-based fungal infection, such as dandruff or folliculitis? In these instances, we would recommend that our own patients try using an antifungal shampoo.
If that provides any relief from your symptoms, it would be a good starting point. This could lead to additional treatments, such as other topical or even oral antifungal medications.
We weren't able to include a portion of your letter that mentioned you had a skin biopsy that came back negative. We wonder if, rather than a biopsy, this was a skin scraping for ringworm? If so, ringworm tests can produce false negatives. A retest for ringworm using a combination of methods would be a good idea. A retest should include a polymerase chain reaction (PCR) test. A PCR test can detect fungal DNA.
As we often tell our readers and our own patients, you can also always get a second opinion. A different doctor may have wider experience with your condition and bring a fresh approach.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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