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HomeAnswersCosmetologyscalp psoriasisI have persistent dandruff despite treatment. Why?

Why bleeding and crusting while removing flakes from my scalp?


The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At February 24, 2018
Reviewed AtMay 27, 2024

Patient's Query

Hello doctor,

I am suffering from two major problems from the past three years. Acne and marks and Sticky oily dandruff. Scalp flakes do not get dislodged even after shampooing. I have to dig my comb into the scalp to remove the flakes which lead to bleeding in certain areas and forms crusts. I have opted for light glycolic acid peels but did not make any difference and had few sittings of Nd: YAG laser hair removal. I have been through several treatments which made only things worse. I keep my face and hair very clean. I shampoo hair on alternate days, change pillow covers, wash face twice a day, and apply sunscreen while going out. I workout every day and follow a clean diet barring oily foods. Yet my face is oily, dull, full of blemishes and I get painful pimples. I want to remove my acne blemishes and revive my dull face. Take care of my super oily hair. Please help me. This is taking a toll on my confidence.

Answered by Dr. Shaunak Patel


Welcome to icliniq.com.

You have been following all the right advice. Continue the same for the face. As for the scalp, I think since it does not get resolved with antidandruff medication and there is crusting involved, my diagnosis would go in favor of scalp psoriasis. However, I cannot guarantee it before a personal examination. I suggest using Ionax-T solution (Coaltar Topical and Salicylic acid Topical) on your scalp at night one hour before bedtime and sleep. On the next day shampoo with Keraglo-AD shampoo (Ketoconazole, Ichthyol Pale, and D-Panthenol). Repeat this process for 10 days. You will see a difference. Based on your progress we shall change some medicines after two weeks. For the face, I suggest Peroduo gel (Adapalene Topical and Benzoyl Peroxide Topical) twice and Spongy-sal facewash (2 % Salicylic acid). Continue capsule Sotret 20 mg (Isotretinoin) once at night for 10 days and followup positively after 10 days.

Patient's Query

Hi doctor,

Thank you for the reply,

Do I have to apply the Ionax-T solution daily? Any precautions or tips I should know when applying Peroduo gel? Kindly let me know alternative brands in case I am not able to get them in my city.

Answered by Dr. Shaunak Patel


Welcome back to icliniq.com.

Lonax-T is of Galderma, Peroduo gel is by Ajanta pharma and Keraglo-AD shampoo by Ipca. All are reputed national companies and easy to find at a popular pharmacy who keeps dermatology meds. Lonax-T should be applied on to the scalp directly like how it is written on the label. Keraglo-AD shampoo should be kept on the scalp for two minutes after foaming and do not mix it with water when applying. Apply directly on wet scalp. Take liberal quantity. Apply Peroduo gel over and around the acne at night and then once comfortable, start in morning too. Avoid sun exposure and rubbing of the face while doing facewash. Peroduo might sting initially or you may feel hot and dry over the skin but that resolves as your skin adjusts to the cream. Do not worry about it. In case of extreme redness and burning, make it alternate days application. Update me your progress after 10 to 12 days for the further plan of action.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shaunak Patel
Dr. Shaunak Patel


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