Mystery in PA

(Philadelphia, PA)

Hello Dr. Weaver,
I am an African American female (27 years old) who is currently battling the onset of hairloss.
A few years ago I began to notice gradual thinning at the crown of my head, as well as, a marked change in the texture of a patch of hair toward the back. The patch of hair was very dry and brittle. Also, I noticed that it grew out very 'frizzy', never grew beyond a few inches in length and did not 'relax' when perm was applied. The change in texture seemed to gradually spread across the back, but the hairs remained in tact. And, this may be unrelated, but I must add that I had come in contact with a nephew who had ring worm. I never presented symptoms and was never treated for any such disease.
I was not one to wear extensions (braids or weaves), but washed my hair frequently and often used a hood dryer for styling.
During the past year I began to suffer from severe itchy scalp and continued thinning and within the past two months (as if almost overnight) I experienced the onset of extreme thinning. I don't have any smooth, completely bald patches, but an increasing area of the crown of my scalp is extremely thin, with brittle short hairs remaining. The thinning has not abated and continues to spread across the crown; however the front, sides and back hairs remain healthy, strong and soft.
Not long ago I visited a dermatologist who diagnosed my problem as scarring alopecia due to chemical processing. Though I agree that I suffer from an 'alopecia related issue', I don't know that he was thorough in his diagnosis. He rendered the diagnosis at a glance (literally); with no questions asked, no concern w/ my history, no examination, no hair sample taken, nothing! He advised that I discontinue chemical processing, prescribed Cutivate lotion and scheduled a follow-up appt in 2 months, w/ the possibility of steriod injection therapy. My questions areas follows:
1) Is it possible to diagnose a case without as much as an examination of my scalp?
2) Is it possible that I suffer from an undiagnosed infection of the scalp (kerion) that may require oral/topical antibiotics, in additon to, steriod treatment?
3) Are Cutivate, and possible injections, effective treatment for the diagnosed condition?
4) Would this stop the progression of hair loss?
4) Is regrowth possible?
5) What treatment would you suggest given my symptoms?

Thank you for providing a forum for such an important and deeply personal issue. Any information you provide is appreciated. :)


1)A scalp examination is required to make an
accurate medical diagnosis.
2)A kerion is a type of fungal scalp infection
associated with puffy, inflamed, nodules on the
scalp, so this seems to be different from what
you are experiencing. It would be necessary to
take a skin scraping from the scalp to diagnose
a fungus infection
3)The cutivate lotion and injections are both
for anti-inflammatory purposes which should
relive the itching and
4)Once the itching stops and the scalp heals,
this can lead to hair regrowth. You mention
that you were told that you have scarring
alopecia and no examination was done, since the
scarring would only be detectable by visible
examination or touching your scalp and checking
for thickening and hardening of the skin.
Ususally if scarring is present the hair loss
can be permanent
5)I do not have enough information to suggest an
alternative treatment plan at this time, since
there are multiple factors taking place at the
same time such as the itching almost overnight.
You may need bloodwork or other testing to
completely assess your hair loss.

SM Weaver, III, M.D.

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