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Skin Care and Diseases

Crusty patches on scalp

06/04/2003

Question:

For about a month now, I have developed patches on my scalp that are itchy and consist of crusty build-ups. My hair gets greasy quickly (maximum of 2 days between washes) and the itching is worst when the hair is greasy. Can you give me more information: what causes it? is it a fungus? what can I do to clear it up? what can I do in the future to prevent it from happening?

Answer:

From your description, the suggested diagnosis would probably be seborrheic dermatitis. The greasiness of the hair and the crusts are consistent with that diagnosis. The cause of seborrheic dermatitis is not understood completely. It can occur in any age group but is most common in adulthood. The crusts contain bacteria and yeast and the most successful treatment to date has been the use of Ketoconazole 2% Shampoo on a three time per week basis. Some physicians supplement that with topical steroid drops. Cure is infrequent but control is frequently achieved. Other shampoos that are over-the-counter that do work for control are those that contain tar and some that contain heavy metals. Occasionally the same set of symptoms arise in psoriasis of the scalp and is called sebo-psoriasis. That may require the use of keratolytics such as salicylic acid to debride the scalp before other materials can be used such as steroids and tars. I would urge that you see your board certified dermatologist who can easily arrive at the proper diagnosis and prescribe very precise medications for you. Remember that this can be long-term. You did ask if this was caused by fungi. There are fungal infections of the scalp, most of which present as black dots from broken hairs and occasionally pustular lesions. There are several fungi found in Europe and forest areas in the United States that can produce scale. These usually produce flower-like scales around hairs and hair follicles and are malodorous

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Response by:

Charles L Heaton, MD
Professor
College of Medicine
University of Cincinnati