Dr Flo, I have had big pus-producing pimples on my head for almost a year and they have eaten up my hair. I have seen doctors and dermatologists and the pimples usually disappear on treatment but come back after that. What is my problem? Fredrick
The recurrent pus-filled lesions on your scalp and accompanying hair loss could be due to several skin conditions. One of them is fungal infection (Tinea capitis, otherwise known as ringworm), which also leads to hair loss. Sometimes, a pus-filled lesion called a kerion forms due to the inflammation triggered by the fungal infection. This infection does not respond well to antifungal creams and requires oral antifungal medication. If there is a kerion, you may have to be on antifungal medication for up to six months.
Another condition is folliculitis decalvans, a long-term condition that causes inflammation of the hair follicles (roots of the hair). This leads to itching, pus-filled lesions, swelling, scars and hair loss. There is no known cause and it has no cure. It can be managed with antibiotics to clear the lesions, steroid creams, isotretinoin and photodynamic therapy.
Another possible cause is eosinophilic folliculitis. This is common in people with a weakened immune system e.g. due to HIV infection. There is inflammation of the hair follicles with resultant itching and pus-filled sores. When the sores heal, they leave darkened skin. It is recurrent, but not contagious. It is managed with medicated shampoos and creams and oral medication.
The symptoms may also be due to other conditions that lead to hair loss like lichen planus, lupus, hormonal disorders or inflammatory skin conditions, if the itchiness leads to sores that become infected and develop pus.
It would be advisable to be followed up by one dermatologist. Skin scrapings can be examined and a punch biopsy of the affected skin done. Once you get the exact diagnosis, you will get the appropriate treatment. You also need to report to the doctor if you have symptoms affecting other parts of your body because the symptoms could be related.
Dr Flo, how do you deal with scabies? Concerned Reader
Dear Concerned Reader,
Scabies is caused by a very small bug called the human itch mite. It gets into the top layer of the skin to live, feed and lay eggs. It burrows under the skin producing thin lines. When the skin reacts to the bug, an itchy rash develops.
It is very infectious, because the mite can travel from person to person or from clothes, beddings or furniture. When the mite is deposited on a surface or clothing, it can survive for three to four days without being on a human. It can affect anybody, regardless of income level, race or level of cleanliness.
The mites like to burrow in the skin between the fingers, around the nails, at the wrists and elbows and on skin that is usually covered by jewellery or clothing. It can take a few days to several weeks to develop the itchy rash after infection. Itching occurs mostly at night, and many people develop a rash. This rash looks like many bumps forming a line. Some people get patches of scaly skin, while others develop thick crusts. Scratching a lot can cause sores or wounds to develop, which can then get a bacterial infection.
Scabies should be managed by a skin specialist (dermatologist). It can be diagnosed from examination and also from identifying the mite and/or the eggs from a skin scrapping under a microscope.
Different medications can be used e.g. 5% permethrin cream, 1% crotamiton cream, 25% benzyl benzoate lotion, 5-10% sulphur ointment and 1% lindane lotion. For most of the medications, you apply the medicine just before going to bed and wash it off in the morning. Take a bath then massage the medication onto clean dry skin and leave it on for eight to 14 hours, then wash it off. Apply the medication to the entire skin from the neck and below, including between the fingers and toes, and under the nails. Children and the elderly may need to have the medication applied to the face and scalp, but avoid the eyes, nose and lips. The treatment can be repeated after a week. Sometimes, oral medication (ivermectin) may be prescribed. Other medications that may be used include anti-histamines or steroids to relieve the itching and antibiotics to clear any additional bacterial infection. Other people who have been exposed should also be treated even if they do not have the symptoms yet, because scabies is very contagious.
In addition, you need to clean all your clothes, towels and beddings with hot water then dry in the sun or in a dryer. Another option is to put all your clothing and beddings in a plastic bag and tie it tight for a week then clean them. Furniture and carpets also need to be cleaned and/or vacuumed. Do not treat pets because the mite cannot spread to animals.
Dr Flo, I get painful sores on my fingers every time I wash clothes. I have tried using different soaps but I still get the sores. I have visited different hospitals and when I take medicine the sores do not appear, but they return after I finish the dose. What is my problem and can you please recommend a doctor I can see to solve this? Carol
Your skin seems to be sensitive to the chemicals in the cleaning detergents and/or laundry soaps.
The prolonged exposure to water and the friction associated with washing clothes may be worsening the irritation. This is called irritant contact dermatitis which means that the substance you are exposed to irritates the skin.
This cannot be completely cured. The only permanent solution is to avoid exposure either by completely avoiding the task or by using appropriate work gloves. It might also help to wash your hands with warm water soon after laundry and use a mild soap. You can also try using a barrier cream and apply moisturising lotions to your skin regularly.
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