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Hair Loss/Seborrheic dermatitis and hair loss

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QUESTION: I have been having severe hair loss for the last 6 mos with seborrheic dermatits .  It had gotten significantly better with nizoral shampoo and then I had a flare up from a hair product that made my scalp severly inflamed.  My derm put me on oral prednisone taper for 20 days and clobetsol and zinc spray.  This happened 5 weeks ago.  I still have itching and some burning in a couple places behind my ears going up the side of my head on each side.  I don't dare use too much topical steroid as I know it can thin the skin.  I am seeing an increase in hairloss which I am assuming is from the inflammation.  My question is what do you recommend for treatment and once the dermatitis is under control will the hair loss stop soon or will I shed again for the next 6 mos.  What do you recommend to your patients for supplemental hair or scalp covering as my head is so sore.  I am an administrator in a hospital and need to be in the public.  I'm hoping that once it is under control I can wear a hat?  It's snowing here now in the east and my little kids want me to sled ride and my head gets very cold.  Any help you can give me is much appreciated as this is affecting my quality life as you can imagine. Thank you!!!!

ANSWER: Michelle,
  You do not say what the hair product was that caused such a prolonged reaction. My guess is that it may have been an allergic reaction to hair dye but whatever the reason you can continue to use clobetasol on the scalp for months without fear of thinning the skin. That would be my recommendation for a contact dermatitis due to an allergic reaction to hair dye. If your dermatitis is due to seborrheic dermatitis which could not be controlled by Nizoral shampoo every other day I'd suggest asking your dermatologist if you could take Nizoral 200mg pills daily for two weeks then two of those pills only once a week for example on a Monday morning for two months.  The treatment for seborrheic dermatitis in my opinion should be directed at killing the yeast which causes it by using oral and topical Nizoral and the cortisone lotion should be used to help take care of the secondary symptoms.  Your hair loss should recover nicely in a few months after getting over the contact dermatitis and seborrheic dermatitis.

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QUESTION: Thank you so much .  My derm won't give me the nizoral pills, but she told me to use the nizoral 2 percent three times a week, clobex shampoo twice a week.  Tarsum shampoo once a week and demasmoothe once a week and another topical lotion steroid at bedtime.  Does this seem like an appropriate course to you? And yes. It was a hair dye.  Will I see more hair fall from it or wouldn't have seen that by now ?  It's been 6 weeks since the flare up.  Thank you !!!

Answer
The course of treatment is a standard therapy for what you have described and if the majority of the Seborrheic Dermatitis is being controlled by the regimen I see no reason to change it. I think your dermatologist has seen the Seborrheic Dermatitis improve on the treatment program laid out for you and the other issue is the PPD dye.  The real problem you are dealing with is the allergic reaction to hair dye.  When you describe that as "I had a flare up from a hair product" it makes me think you do not appreciate the damage hair dye allergy can do. The allergic contact dermatitis persists over a month due to dye still being in your hairs and being released to the skin around the area. The oral taper of Prednisone over a three week period is also a pretty standard therapy with a potent steroid such as clobetasol to take care of the condition as you are weaned off the oral cortisone. I doubt you will see more shedding at this point. It will take six months to see the regrowth of the hairs lost so you will have to be patient.

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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