Apparently I have scalp psoriasis. What should I do now?
For the last year or so, I've had some pretty mean dandruff. Head and Shoulders does absolutely nothing for it. It's gotten a lot worse over the last few months, so I went to my dermatologist to get it checked out.
She seemed pretty sure that I have scalp psoriasis, even though I don't have psoriasis anywhere else on my body. I should mention that I hadn't washed my hair for a few days, so it probably looked particularly bad that day. She prescribed Clobex shampoo (.05% clobetasol) and a mousse called Luxiq (.12% betamethasone valerate). She also told me to use Neutrogena T-Sal shampoo and Nizoral shampoo (the over-the-counter variety) on alternating days for 8 weeks, and after that to only use the T-Sal and not the Nizoral. Before I left her office, she loaded me down with coupons and free samples for the medicines.
Anyway, when I was finished at her office, I went online and did some research on Scalp Psoriasis. The google image search I did scared the crap out of me. And then I did some research into the drugs that I was perscribed, and they seemed really powerful. I was particularly concerned about the Luxiq - according to one source, suddenly stopping the betamethasone can cause a "rebound reaction" wherein your condition suddenly becomes a heck of a lot worse. Also, some of the corticosteriods have the potential to "thin the scalp," which I'm concerned would lead to hair loss.
So I went to get a second opinion from another dematologist. She did not think that I have scalp psoriasis. She said that what I have is seborrheic dermatitis. Still, she prescribed me a generic form of the Olux mousse (.05% clobetasol) and told me to use it for two weeks. She said that I didn't have to worry about a "rebound reaction" when coming off it because she didn't think I had psoriasis. And of course, she gave me a ton of coupons and free samples of the medicines.
Finally, I went to get a third opinion from yet another dermatologist. He was of the opinion that I do have scalp psoriasis. When I asked him about the diagnosis of sebhorrheic dermatitis, he said, "Well, they both look very similar .... depends on what it looks like that day. If it's red, they say psoriasis." or something to that effect. He didn't seem to think that the Nizoral or T-Sal did any good. He proscribed me Taclonex (calcipotriene 0.005% and betamethasone dipropionate 0.064%), and told me to take it for about 4-6 weeks or "until it gets better." He wasn't concerned about a "rebound reaction." He did say to avoid scratching, because removing the scales "makes it worse." And before I left - wouldn't you just know it? He gave me a handful of coupons.
So here I am, totally confused. I don't know what's wrong with me or how bad things will get. Right now, I just have really bad dandruff and an itchy scalp (which may have been less itchy before I started washing my hair every day) How bad will this condition get? Will I lose my hair? Will I wind up with a head full of scabs? Will I wind up like these
poor unfortunate souls?
Should I take the medicines that have been prescribed to me? So far I haven't had any of the perscriptions filled. If I did take medicine for this, which one(s) should I take? I'm concerned about side effects. I'm concerned about a rebound reaction. I'm concerned about resistance and dependence. I'm concerned because all 3 doctors told me basically to "take it until the condition goes away," which sounded inexact and scary. I'm concerned because each one of these doctors gave me a handful of coupons and free samples - obviously the drug lobby has been hard at work here.
What should I do?
And... finally, I have to ask this - why do dermatologists always disagree? Every time I go to dermatologists to get second/third opinions, they ALWAYS disagree, they ALWAYS prescribe different stuff, and they ALWAYS give me lots of coupons and free samples.
(full disclosure - I use Clindagel (1% clindamycin) twice daily on my face for acne)