Dr. Shama Naaz
Dermatology
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Patient's Query
Hello doctor,
About two months ago, I used a coal tar shampoo mistakenly because I thought it would help remove a reaction I had to fenugreek, where I was constantly itching and flaking. Then, about three weeks ago, I washed my hair with 100% kaolin clay, undiluted tea tree oil, and apple cider vinegar. I realized the tea tree oil gave me allergic contact dermatitis. My scalp was feeling inflamed, sore, itchy, and stinging. So, I went out to the pharmacy and bought a Hydrocortisone ointment and Levocetirizine for the allergy. I applied Hydrocortisone to the affected areas twice on Monday and once on Tuesday. I also took Levocetirizne on that same days. My inflammation is now gone, and my scalp is also cleansed. One thing I have been feeling on my scalp, however, is slight tingling on the areas I applied the Hydrocortisone ointment. The tingling is not that bad, and I do not always feel it. I just randomly feel it at times. So, my questions are, what is still causing that tingling feeling? Is it due to Hydrocortisone? How do I treat the tingling sensation so it can completely go away? Did I do something wrong?
Hi,
Welcome to icliniq.com.
Hydrocortisone ointment is a type of steroid. Most Hydrocortisone are mild, and they are used in the treatment of eczema, insect bites, and, in your case, for treating contact dermatitis. There are points to be kept in mind while using Hydrocortisone ointment. It should not be applied to broken skin. There should not be any infection over the area. If you are using it twice a day, there should be a gap of eight to twelve hours between the application. For contact dermatitis, one-week treatment is sufficient. Some patients get a burning or stinging feeling after putting on the cream. This stops happening after you have been using the cream for a few days. Also, you can change to the cream form of Hydrocortisone. The cream form is milder than the ointment. I hope this helps.
Patient's Query
Thank you doctor,
You have made things much clearer for me. I will switch then to a cream version of Hydrocortisone. Can I use the cream version for about a week? Do I still have to keep taking Levocetirizine for a short course, although my inflammation is gone? Or do I only take it if I am experiencing symptoms?
Hi,
Welcome back to icliniq.com.
Yes, you should use Hydrocortisone cream for a week. And if you experience any itching on your scalp, then you should use Levocetirizine. Else it is not required.
Patient's Query
Thank you doctor,
I have decided to share my scalp photos with you just to be sure that everything is fine. How to upload them?
Hi,
Welcome back to icliniq.com.
You can upload pictures, in the second page , where you get the message upload reports or any medical files you have in regards to your health concern by clicking on “choose files to upload”.
Patient's Query
Thank you doctor,
I have uploaded the pictures.
Hi,
Welcome back to icliniq.com.
Thank you for uploading the photographs (attachment remove to protect patient identity). Your photo shows no oozing or erosions over the scalp, no fluid or pus-filled lesions present, no hyperpigmentation or skin peeling, no sign of secondary bacterial infection, slightly red areas are seen over the frontal and temporal regions. Yes, your scalp skin seems to be responding to treatment. It looks healthy. You can continue Hydrocortisone cream over the red and itchy areas for one week. Take Levocetirizine tablet only if you experience intense itching, and refrain from driving or using heavy machinery after taking Levocetirizine. Please do not scratch your scalp. Gently dry your hair with a soft towel and avoid using a hairdryer over involved areas. And refrain from using products that triggered the inflammation in the first place. You can follow up after one week or if you develop any new symptoms.
Patient's Query
Hello doctor,
This query is in regards to some side effects I have been noticing with the Hydrocortisone treatment. When I apply the cream, I have been noticing that I become tired more easily or I may have some light headedness sometimes, or will have to use the bathroom. I am just curious to know if these are normal side effects, or should this be taken as a concern? Should I continue the treatment for the one week course? Thank you very much in advance.
Hi,
Welcome back to icliniq.com.
Mild Hydrocortisone creams are very safe. But, if you are experiencing any lightheadedness or tiredness, I think you should stop using it, you may be sensitive to this formulation. Since, you have used the cream for four to five days, it should be sufficient to subside the inflammatory symptoms, along with body’s natural tendency to fight of inflammation. After stopping Hydrocortisone cream, you should keep monitoring your symptoms and take care to prevent fall or injury. If it does not go away or symptoms keep on increasing, you should visit your physician (to rule out any other cause of tiredness and lightheadedness). And if there is any other questions you have regarding the treatment or any new symptoms , please let me know. Thank you.
Patient's Query
Thank you very much doctor,
Yes, my inflammation is gone, my only concern were the symptoms. The symptoms would only occur when I would apply the ointment or cream. Also, sometimes in one area of my scalp, I still feel itchiness where I applied the cortisone treatment. Specifically in the lower back areas. I would also like to know, does this eventually go away after a few days when stopping the cortisone treatment? Also, if there is any advice you can give me for the itchiness? Thank you again in advance!
Hi,
Welcome back to icliniq.com.
Yes, the itching will go away after some days. According to your history, you might be sensitive to Hydrocortisone. So, after stopping it, there will be improvement in your symptoms. You can also take one tablet of Levocetirizine at night time, to relieve itching in your scalp. It is important to avoid scratching. Because once you scratch, it will cause more itching, forming an itch-scratch cycle. Please follow up after 3 days or earlier, if there are any new symptoms. Thank you.
Patient's Query
Hello doctor,
There is another symptom that I forgot to mention when I spoke with you last. There is some swollen areas in the back of my scalp. I stopped using the Hydrocortisone cream since I last spoke to you. I am curious to know whether massaging your scalp while washing your hair contribute to more irritation? I do not scratch my scalp, but I massage it, and I recently washed my hair yesterday. Is there anything else I should be doing to combat the Hydrocortisone irritation besides taking Levocetirizine? Overall, my symptoms are just some swollen areas and itchiness. I do not feel inflammation and my scalp is clean for the most part. I also notice I feel the itchiness more during the evening. Thank you again for your assistance throughout all of this.
Hello,
Welcome back to icliniq.com.
You are experiencing some swelling over your scalp, is it like a visible bump or just smooth uniform swelling that you feel when you touch your scalp. Is there any pain or tenderness when you apply pressure over the swelling? After stopping Hydrocortisone cream, do you notice any decrease in your symptoms or is it the same? Yes, it is fine to massage your scalp, but gently. And do not worry, the itching will go away in some time.
Patient's Query
Hello doctor,
Yes, there is actually pain in the area of my scalp that feels swollen. I believe there is actually some inflammation there. It just has been feeling tender, painful, irritated, and itchy. When I apply water to the scalp, it relieves the pain and itchiness temporarily, but then usually in the evening and at night, the pain will return. My skin is extremely sensitive, so I have been staying away from any topical creams or ointments. After stopping the Hydrocortisone, my symptoms have not really decreased. I still feel the pain in the same area of my scalp, it’s mostly in the lower middle area of my scalp, and sometimes I feel it on the lower left and right side of my scalp. When I first noticed the allergic reaction with the tea tree oil, it was in those same areas as well that I felt the pain and irritation. Do you think maybe I need something more potent that I can take orally for the pain and irritation?
Hi,
Welcome back to icliniq.com.
Usually contact dermatitis resolves within one to two weeks, and the standard treatment given is anti-itch medication, mild steroid creams and avoiding the allergen. But sometimes, there may be some complications that is associated with contact dermatitis like secondary bacterial infection due to damaged skin barrier. In that case, you will feel pain or pus filled lesions in your scalp. There are ways of detecting a secondary bacterial infection- by getting a physical examination done and a blood test, total leucocyte count (which is raised in infection), also a blood culture and sensitivity test (to determine the choice of antibiotics to be taken). If there is any confirmed infection with proper antibiotics, the infection will get better in seven to ten days. Thank you.
Treatment plan
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Dermatology
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