Q. Apart from getting injections, what treatments are available for seborrheic dermatitis?

Answered by
Dr. Rakesh Kumar Bahunuthula
and medically reviewed by Dr. Hemalatha
This is a premium question & answer published on May 06, 2017 and last reviewed on: Feb 10, 2021

Hello doctor,

Eight years ago, a car wreck shattered the windshield, and my head got injured with pieces of glass. They did not take the glass out, and I have also been dying my hair since I was 16. I developed fibromyalgia from the wreck, which is supposed to be relatively non-progressive, however as the years went by I started experiencing debilitating neck pain paired with even worse migraines. I did stretching, physical therapy, chiropractor, and even medication, but nothing seemed to help. Last year, a pharmacy refused to refill my Tramadol. I was in such a debilitating pain that I went home and stared at where my headache was coming from, and I noticed my hair was growing funny in certain areas. So, I started to comb close to the scalp, and the hair that where my natural color started coming out of my scalp and pain started being relieved. I also noticed that rubberized glass was coming out of so many areas in my scalp. At this point, I could see all of the places where there was glass lodged and each time I shaved an area to get the glass out, the pain lessened in a way I will never even forget. I went and just shaved my head.

After a few months, my scalp is so itchy, flaky, scaly, and pieces of glasses are still making their way out. So, I went to see a dermatologist, who said it is seborrheic dermatitis, but I have used everything you could use for that (Clobetasol, Ketoconazole, apple cider vinegar, Prednisone, some topical cream, Salicylic acid shampoo, tar shampoo, coconut oil, etc.). But still, I have to shave my head because my scalp is still very messed up. I think my follicles are damaged, so aside from getting injections at a dermatologist office, what treatments are available for that? Do you have a specific shampoo you recommend for repairing follicles?



Welcome to icliniq.com.

The diagnosis from your history would still be seborrheic dermatitis or sebopsoriasis or scalp psoriasis.

This is more of a cyclical problem, it tends to curb down with 2 to 3 months of treatment, but recurring back with a change in season or lifestyle. However, it naturally settles down as the age increases, usually around 30 to 35 years of age.

The pain, as you describe, could even be neurogenic in view of a past history of trauma to the skin. This could damage the nerve fibers, which have a very slow tendency to regrow and recover, resulting in chronic pain.

With regards to your scalp scaling, I would advise you to restart with a Ketoconazole, Zinc pyrithione, and coal tar combination shampoo. Initially, it would be recommended to start using it every alternate day for three weeks, with a gradual tapering in frequency. Thereafter, use it twice a week for next three weeks, and then weekly once for next three weeks along with the simultaneous introduction of your regular shampoo.

In order to repair the damaged follicles, you could take oral supplements containing Biotin and Pantothenic acid, daily one tablet for a month. Consult your specialist doctor, discuss with him or her and start taking the medicine after their consent.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Thank you doctor,

I appreciate that answer, but I have tried this exact regimen repeatedly over the course of a year, and no change in my scalp as far as healing has occurred. Can you please suggest some alternate treatment.



Welcome back to icliniq.com.

If there has been no improvement despite all the measures, then a strong possibility of scalp psoriasis needs to be considered.

I would appreciate if you could upload appropriate images of the present condition so that we can assess it better.

You can add a weekly dose of oral Fluconazole 150 mg, once a week for four weeks to the above regimen. Scalp psoriasis would need a different course of treatment.

For further queries consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

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