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Ask Dr. Muneeb Ali Your Own Question
Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 7415
Experience:  MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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I have severe itchy scalp on top of my head. I tried

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I have severe itchy scalp on top of my head. I tried steroids, doxepin, clobetasol lotion and still itching. It's been 3 years , please guide me
JA: How long have you been dealing with this? Does anything in particular seem to make the itch better or worse?
Customer: Almost 2 years. It started after I had a menginoma removed from my t-spine
JA: Anything else in your medical history you think the doctor should know?
Customer: I take gabipenton 3 x day- 900mg each dose

Hi,

Welcome to JA and thanks for this question. Im sorry to hear about your symptoms. Can i ask do you also have any lesions on the scalp? Any sores? Is the scalp flaky as well? Also apart from itching, have you also been experiencing weight loss?

Customer: replied 1 month ago.
No weight loss . No lesions that I've seen. Had biopsy said it was thickened scalp. I get sores and the top of my scalp is sore to touch. My derms office can't get on the same page. Dr says steroid shots in spots , that the clobetsol wont help. Docs PA says oral steroid plus clobetasol. I don't know what to do.
Sorry I wanted to say hair loss, anyway with the information that you have provided there are few conditions which can cause this. The first one is that you could have developed seborrheic dermatitis a severe case, another cause could be eczema which is causing the thickened scalp as well as the sores. In both of these cases if the topical steroids don't work then steroid injections are necessary to lessen the lesions and oral steroids to prevent their recurrence. There are two regimens here basically both your doctor and PA are right and both the regimens can be used, one is a conservative approach using oral steroids and topical steroids while the other is a more aggressive approach, both can work but if the symptoms are severe as in your case I would go for the injections which are effective in almost 90 percent of cases.
If you have the biopsy report that you can attach here I would be happy to take a look at it.
Do you have anymore questions?
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Customer: replied 1 month ago.
I don't have the report. I will make another appt and ask for the injection. Only thing oral steroid did was help me gain 5 lbs... lol. I rinsed with apple cider vinegar , later I washed with tea tree shampoo and put neosporin on my scalp. It seemed to help. What do you think that means? I feel like the clobetasol lotion makes my scalp dry..... could it be aggravating the spots?

Usually topical steroids should not worsen the problem unless the underlying problem is an infection which means that if it is afungal infection or even a bacterial infection. In that case you would need anti fungal medications rather than steroids.

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Customer: replied 1 month ago.
How is it determined to be a bacterial infection? If it is Excema what is the treatment? Do you think I need a new dermatologist?

A bacterial infection is diagnosed with the help of swab tests and cultures whereas eczema is treated with potent steroids which may be in any form, injections, oral or topical.

I think it would not hurt to get a second opinion, infact i think you do need another dermatologist.

Do you have any more questions?

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Would you like to know anything else? Any clarifications or additional questions that you might have, i would be happy to answer them for you. If done for now, please remember to leave a positive rating as that is the only way we are compensated for our time spent helping you. You can continue to ask follow-up questions even after the rating.

Dr. Muneeb Ali and 3 other Medical Specialists are ready to help you
Customer: replied 1 month ago.
I think I'm going to follow your advice and get another opinion. Thank you for your help!��