What the hell is going on with my scalp?
March 10, 2016 7:48 AM   Subscribe

For the past 6 months, I've been in an on/off battle with my scalp - mostly the crown and a bit towards the back. It itches badly when I break a sweat (I workout daily), and then produces flakes in rough patches. The flakes build up (and re-build) incredibly fast - like overnight, in patches that are thick and dry. I've tried all the OTC products (T-Gel, T-Sal, Nizoral, Dermarest, Tea Tree shampoo, etc) - and they offer some temporary relief - but the flakes, patches, and sweat-itchiness continues. Please help!

I'm mid 30s, otherwise healthy female on no medication, no new products, no major life changes, and don't know what could have instigated this - have never dealt with scalp flakes, dandruff, or itchiness before.

I realize it's best to go to a dermatologist, but before I try that route, was hoping to find some explanation. There is definitely a sweaty-scalp connection - the symptoms are new, but I'm not new to exercise. What could be the cause of this sudden god-awful cycle? How do I end it for good?
posted by anonymous to Health & Fitness (22 answers total) 9 users marked this as a favorite
 
I wanted to say eczema sounds like the culprit, though Dr Google says the more correct term is "Seborrheic dermatitis", with a annoying shrug of "it just happens, see a dermatologist"
posted by k5.user at 7:56 AM on March 10, 2016 [2 favorites]


Sweat is a notorious eczema trigger.

If it is eczema, your GP can prescribe prescription shampoos that will give short-term relief.
posted by Year of meteors at 8:02 AM on March 10, 2016


I get eczema on my scalp, and it sounds a lot like this. The best thing I've found is a prescription steroid treatment called Betacap. Clears it up very quickly for me.
posted by pipeski at 8:04 AM on March 10, 2016 [1 favorite]


Nioxin Scalp Recovery line is very good and quite gentle. this has been successful when those T-Gel/Tea Tree options have been too harsh for me.
posted by calgirl at 8:21 AM on March 10, 2016 [1 favorite]


I had something that sounds similar, used a prescription topical steroid treatment (betamethasone, maybe). I went through a couple cycles of having it clear up and reoccur, until eventually I think I reduced enough allergy triggers to keep it from reoccuring (excema was not my only allergy symptom). In my case, tea tree oil and other essential oils only exacerbated my condition.
posted by muddgirl at 8:22 AM on March 10, 2016 [1 favorite]


if it is Seborrheic dermatitis I would try Scalpicin - that's what I use and after a few days it goes away. I periodically have to apply it again but it's helped a lot.
posted by brilliantine at 8:42 AM on March 10, 2016


I have similar issues. GP thinks it's either scalp psoriasis or eczema. I was prescribed betaderm (topical steroid), and it helped somewhat. Was just referred to dermatologist but still waiting for the appointment.

If you want to try a YMMV at-home-treatment routine, this seems to have really improved my condition versus JUST rubbing on the betaderm.

For the inflamed patches: Apple cider vinegar dapped on patches with cotton balls
Wash hair with Dead sea salt + water (or just something that's hypoallergenic for you)
Avoid blowdrying hair on high heat
Apply prescribed cream (though I've changed to witch hazel recently since I've used topical steroid for too long of a period)
Rub Aveeno Eczema lotion onto scalp as betaderm really dries the skin out.
posted by lucia_engel at 8:48 AM on March 10, 2016 [1 favorite]


My mom has insane scalp psoriasis. As in grow thin hair long to cover the patches bad. Her GP prescribed a bottle of $1000 goo that didn't have very good reviews. Yeah, no.

Because Polytar is no longer as good as it used to be or easy to find (I had to order some from Thailand), I found MG217, which has about the highest level of coal tar available. With every day use since October, her scalp is almost fully healed. But it is every day, and if she stops it starts to come back. Maybe when it is fully healed she can go down to a couple times a week. T-gel really doesn't have enough coal tar to do anything.
posted by monopas at 9:18 AM on March 10, 2016 [1 favorite]


Scrubbing my scalp with baking soda before shampooing helped clear up my scalp mess. And it feels good.
posted by not that girl at 9:24 AM on March 10, 2016


Yeah, that could be psoriasis, which is worth checking out with a doctor. Could be a bunch of other things, too, but I have minor psoriasis (and not-so-minor psoriatic arthritis) and your description matches my experience, although mine is in my ears, which I can't decide if it is better or worse.
posted by restless_nomad at 9:25 AM on March 10, 2016 [3 favorites]


I had this! Nothing I tried worked... until I discovered that I had a food allergy/sensitivity and adjusted my diet accordingly. Suddenly, scalp treatments actually had a noticeable effect and my issues have mostly died down.

I know that this is definitely not the answer for everyone, but if nothing else works you can always look into whether you have any allergies aggravating the situation.
posted by daikaisho at 9:32 AM on March 10, 2016


Seborrheic dermatitis, which seems most likely, is an ongoing and miserable struggle. The current working theory of this kind of skin problem is that it reflects an over-aggressive immune response to an overgrowth of one of more yeasts. So there are two major approaches: fighting the yeast and suppressing the immune response. I think a combination is best, although, given the extent of the problem, there's been surprisingly little good research into this disease.

Fighting the yeast: Assuming you're U.S.-based, you should be aware that OTC Nizoral only contains 1% ketoconazole. I've found 2% (prescription, or you can pick it up OTC in Canada) to be far more effective. While it's awkward to apply, butenafine hydrochloride cream (OTC as Lotrimin Ultra, marketed for athlete's foot) is another antifungal that some people find helpful. (I use it for my face.)

Suppressing the immune response: Scalpicin (the 1% hydrocortisone version) is probably your best OTC bet. There is a prescription cream called Elidel that is stronger (and you'll probably have to get advance authorization from your insurance company), but, again, it's awkward to apply a cream to your scalp.

I'd try some combo of these two until I could see a doctor. There are certainly other things it could be, and the most effective treatments are prescription.
posted by praemunire at 9:41 AM on March 10, 2016 [1 favorite]


If it is seborrheic dermatitis, I've had really great results with sea salt rinsing. Mine is on my face, so I apply with a washcloth - you could just rinse it through your hair. Mine also reacts really negatively to any sort of oil (I've read that oil feeds the yeast on your skin that causes the problem) After a day of no oil and a few rinses with sea salt water I see a dramatic difference, so you could try it for a day or 2 and see if it helps.
posted by Sabby at 9:58 AM on March 10, 2016


Changes in temperature and humidity will do it to you.

Keep using Nizoral regularly.

Also avoid refined carbs such as white sugar and white flour. Just don't eat them.
posted by My Dad at 10:05 AM on March 10, 2016 [1 favorite]


I had what sounds like the same thing: No previous scalp/dandruff problems, and then even though nothing else changed, I started having this flake build up on my scalp. I also tried T Sal/Tea tree oil/etc, and they only helped immediately after washing.

What's ultimately worked for me is using apple cider vinegar rinses every time I wash my hair. I use about 6 ounces of ACV (in a spray bottle with measurements on the side) and then I fill up to a total of 24 ounces with water. In the winter, I usually wash my hair every 2-3 days, roughly. I only shampoo once every 1 to two weeks. The rest of the time, I use a scalp scrubber thing to scrub my scalp under the shower sprayer, then I often put some conditioner on the ends, then I spray my hair with ACV, focusing on the scalp. I let that sit for 5-10 minutes, usually, then I rinse it out.

The scalp comb I use is actually marketed for dogs/cats, but it's similar and cheaper to the kind that is marketed to humans, and it works great. Not too harsh on either my scalp or my hair. I got this one from amazon.

This is very much YMMV (as you can see, a lot of people have tried different things), but this was the one thing that finally resolved my scalp problems. The conditioner (and shampoo on the rare occasions when I use it) are Shea Moisture (this is the specific line I use). I like them because they are mild and I feel like they don't irritate my scalp or cause build up on my scalp or hair. I also stopped using leave in products and I try to avoid using a hair dryer.

A side benefit is that cutting down on shampooing and using the ACV rinses has done really great things for my hair. It will probably take trial and error to figure out the right concentration of ACV and right frequency to make this work for you, assuming it works at all. At the very least, it's cheap to try, unlike a lot of the shampoos and other scalp treatments.
posted by litera scripta manet at 10:25 AM on March 10, 2016 [2 favorites]


Oh, and to answer the "what is going on" part of your question, IANAD/IANYD, but I decided it's probably some sort of Seborrheic dermatitis, and based on what I've read, it seems to be one of those things that just happens. I've also noticed my allergies and dry skin have gotten somewhat worse in the last couple years, so maybe this is something that can come on suddenly as we age.

Also, for me, sweat is definitely a trigger, as is the outdoor cold/indoor heat cycle of winter. Also washing my hair too frequently or not frequently enough can be a trigger. Basically it seems like anything that dries my scalp out too much or increases oil production can make things work. Fortunately the ACV rinse has more or less completely taken care of this.

(I'm female and late 20s, just fyi.)
posted by litera scripta manet at 10:33 AM on March 10, 2016


The flakes build up (and re-build) incredibly fast

That is practically the definition of psoriasis--as the Mayo Clinic says, "Psoriasis causes cells to build up rapidly on the surface of the skin." Scalp psoriasis is incredibly common and a dermatologist or even a primary care doctor could tell you for sure.

So, I use a topical steroid cream for flare-ups like this. You're not technically supposed to use it on your scalp but I do anyways. It's prescription through my GP. Psoriasis is an autoimmune disorder, so I find it flares up whenever I'm sick or sleep-deprived or the like. My skin is also sensitive to chemicals (including chlorine) so swimming and detergents can also be triggers. You say your lifestyle hasn't changed, but there may be something stressing your immune system, can you think of anything? Do you have other allergies with known triggers? Some things to think about.
posted by epanalepsis at 10:46 AM on March 10, 2016


I get minor scalp eczema like this, and I've had luck controlling it with grapefruit seed extract. Either that or the vegetable glycerin carrier it uses. Either way, I rub some into my scalp after showering, and spot apply if there's an outbreak.
posted by cmoj at 1:31 PM on March 10, 2016


I've fought this for 25+ years. According to my dermatologist it's genetic and can't be cured. The best you can hope for is control. I've found using clobetasol (prescription) 2X a week seems to keep it mostly cleared up. When it flares up occasionally I'll treat it 3 or 4 days in a row then back off. You can get resistant to clobetasol pretty easily, although the doc said I should be fine if I can stick to 2X a week.
posted by COD at 5:20 PM on March 10, 2016


I have similar scalp problems and have been diagnosed with seborrheic dermatitis, although when the flare was at its worst (first derm visit) they thought it was psoriasis. I use a combo of 2% ketoconazole shampoo, which treats the fungus but requires 3x/week maintenance for best effect (I have long hair and prefer to wash less frequently), and 0.05% clobetasol shampoo which suppresses the immune response and lets me stretch to 5-6 days between washes. I was on the clobetasol exclusively for a few years, 1-2x/week, and never developed any resistance but I didn't like feeling dependent on a steroid prescription. The ketoconazole doesn't start showing any effect for the first few weeks, IME.

Both of these shampoos are by prescription only, but my GP was willing to renew them as maintenance so you don't have to make indefinite specialist visits to the dermatologist. Btw, if you are paying out of pocket (vs. copay) for prescriptions, you may find that generic clobetasol is absurdly priced--try asking about a manufacturer's coupon price for name-brand Clobex, and/or call a few compounding pharmacies.
posted by serelliya at 1:34 PM on March 11, 2016


Could be psoriasis. If so, tar shampoos help. Any joint pain as well? Then you could be looking at the double whammy of psoriatic arthritis.

If possibly psoriasis, see a dermatologist. Treatable but best to get right on it.
posted by WinstonJulia at 2:03 PM on March 11, 2016


It does sound like the early stages of Psoriasis, which sounds like a big deal but really isn't. If you get it checked out by a dermatologist or doctor, it's totally manageable and the medicines keep getting better.
posted by stackhaus23 at 1:50 AM on March 12, 2016


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