Itchy, painful scalp and hair loss

by Lilly

I started having an itchy spot at the top of my head some 20 years ago. I didn't think much of it because it would come and go. At first I thought it was nerves because I found myself at times scratching in that spot whenever I'd get upset. Soon it became involuntary and seemed to itch even when I wasn't upset. It really started to concern me when I was about 29 years old and a hairdresser rubbed in a little bald spot and asked if this was my nerve center.

I went to a couple of dermatologists one white and one black. I include race because girlfriends told me that a white dermatologist really wouldn't be able to help me. I was told the itching and hair loss was due to follicular dermatitis and was prescribed antibiotics. I was also told that I would not lose my hair eventhough there was hair loss.

I'm 38 years old and about 5 years ago I was told that I had Brachs pseudopalade. (not sure of spelling) The hair loss evident. It has started to thin and break off.

Is there any treatment for my condition?

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Jan 08, 2009
An Explanation for Chronic Hair Loss at Top of Scalp
by: Seymour M. Weaver, III, M.D.

The itchy spot that you describe at the top of your head is characteristic of neurodermatitis which is a localized area of an eczema like condition that starts out with symptoms including itching, soreness, tingling, or sometimes burning or tenderness. Oftentimes the scalp itself looks perfectly normal, but the symptoms can be quite severe.

If this condition progresses, the hair can break off in the area, and on a longer term basis, the skin can become thickened and darkened which is then called lichen simplex chronicus typical of chronic eczema due to friction and rubbing.

You mentioned the term pseudopelade of Broq. This is a form of a scarring alopecia (hair loss with permanent balding) and it is usually different from neurodermatitis. A skin biopsy can help with determining an exact diagnosis if necessary.

Topical steroids, intralesional injections, and oral antihistamines can provide relief from neurodermatitis. Once the symptoms stop, the hair can grow back. Stress and anxiety can aggravate the condition, so you would also have to work on being cool, calm, and collected.

A dermatologist of every ethnicity with experience and exposure would be able to help you with your scalp condition. I happened to have trained in Los Angeles with exposure to several of the top African American dermatologists in the country who were graduates of Howard University Medical School, so I received a wealth of experience and knowledge early in my career. I have had an African American deramtology trainee come to my office before because he was training in a program in Wisconsin and saw very, very few African Americans as patients during his three years of training. He learned more in two weeks at my office than he had learned during the three years of his training program. If any physician of any ethnicity trained with the teachers that I had or spent time in my office, they could be quite competent in treating ethnic hair disorders.

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