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GauravMD
GauravMD, Dr
Category: Dermatology
Satisfied Customers: 9896
Experience:  MBBS, DCH, DNB (MD), with special interest in Dermatology
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I have an itchy scalp I've had it for a very long time its

Customer Question

I have an itchy scalp I've had it for a very long time its getting worse and worse
JA: When did the itchiness first appear? Have you used any medication for this?
Customer: it comes every now and then it's very itchy yes, I dd no improvement,
JA: Got it. Have you seen a dermatologist about the itchiness?
Customer: no, I didn't
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Dermatologist should know?
Customer: no, I dint think so.
Submitted: 11 days ago.
Category: Dermatology
Expert:  GauravMD replied 11 days ago.

Hi,

This is Dr Gupta,

I am sorry to hear about your itchy scalp,

The likely reason could be seborrheic dermatitis or Eczema,

I would recommend a trial of anti-dandruff shampoo like Nizoral as needed for this condition,

If there is no improvement, best to get prescription steroid treatment after meeting your doctor,

In the meanwhile use hypoallergenic mild hair care products to reduce the itching and take Cetirizine tablet as needed,

Please let me know if you need more information,

Warm regards

Customer: replied 11 days ago.
i used dandrazol 2%shampo didn't help also i used Betnovate scalp application no improvement my GP said its eborrheic dermatitis
Expert:  GauravMD replied 11 days ago.

Hi,

Thanks for getting back,

There are many things that are now used in this condition, your GP may not be conversant with these,

For example

With the understanding of the role of Malassezia in SD, antifungal agents have taken on an important role in its treatment. Ketoconazole 2% cream applied twice daily for four weeks has been shown to be as effective as hydrocortisone 1% cream in treatment of SD at multiple body sites.18 In a randomized, double-blind trial of 459 patients with SD treated with ketoconazole 2% gel or vehicle once daily for 14 days, there was a significantly higher rate of successful treatment (25.3% vs. 13.9%,P=0.0014) and significantly greater reductions in erythema, pruritus, and scaling in ketoconazole-treated patients.19 A 2% foam formulation of ketoconazole has been shown to be significantly more effective than vehicle for treatment of SD on the face, scalp, and body, and equally as effective as ketoconazole 2% cream.20

Ciclopiroxolamine 1% cream, twice daily for 28 days followed by once daily for 28 days, was compared with vehicle for the treatment of SD in a randomized, doubleblind trial that enrolled 129 patients.21 At the end of the maintenance phase, complete disappearance of erythema and scaling was found in 63 percent of the ciclopiroxolamine-treated group and 34 percent of the vehicle-treated group (P<0.007).21

In an open-label study of sertaconazole nitrate 2% cream, 59 percent of 20 subjects with mild-to-severe SD were successfully treated, with improvements in scaling, erythema, induration, and pruritus.22

A randomized, double-blind study demonstrated that metronidazole 0.75% gel is as effective as ketoconazole 2% cream in treatment of facial SD, with a similar side effect profile.23

For patients with persistent SD resistant to topical agents, oral antifungals may be an option. Oral itraconazole given in a dose of 200mg/day for one week, followed by a maintenance dose, resulted in clinical improvement of SD symptoms in two open-label trials.24,25

Corticosteroids. Hydrocortisone and a wide variety of other low- to mid-potency corticosteroids have been used successfully in the treatment of SD. A double-blind study that compared hydrocortisone 1% cream with ketoconazole 2% cream in 72 patients with mild-to-moderate SD found that the two agents produced similar rates of response and similar reductions in scaling, redness, itching, and papules.26 In a 12-week, single-blind, randomized, comparative trial, hydrocortisone 1% ointment was found to be equally as effective as tacrolimus 0.1% ointment in reducing the symptoms of facial SD by physician assessment, although tacrolimus was superior by patient assessment.27

Combination antifungal/anti-inflammatory. Promiseb® Topical Cream (Promius Pharma, LLC, Bridgewater, New Jersey) is a nonsteroidal prescription medical device with anti-inflammatory and antifungal activity approved for treatment of SD.28 In an investigator-blind, parallel-group study, 77 patients with mild or moderate SD of the face were randomized to combination antifungal/anti-inflammatory cream or desonide 0.05% cream twice daily for up to 28 days.29 Severity of symptoms declined significantly from baseline to Day 14 and Day 28 in both groups.29 Treatment was successful (clear or almost clear) in 85 percent of patients using combination antifungal/anti-inflammatory cream and 92 percent of patients using desonide cream (P=not significant) and the two products had similar safety profiles.29

Calcineurin inhibitors. Topical calcineurin inhibitors have immunomodulatory and anti-inflammatory properties that make them useful in the treatment of SD.27

Tacrolimus 0.1% ointment was found to be as effective as hydrocortisone 1% ointment in the treatment of SD, required fewer applications during the 12-week study period because of clearing of symptoms, and was rated more favorably by patients.27

In a randomized, open-label trial, pimecrolimus 1% cream was compared with betamethasone 0.1% cream in 20 patients with SD who were instructed to discontinue treatment when symptoms cleared.30 By Day 9, all patients had discontinued treatment.30 The two drugs were equally effective at reducing symptoms of erythema, scaling, and pruritus, but symptom relief was sustained longer in the pimecrolimus group.30 In comparative trials, pimecrolimus 1% cream has been shown to be as effective as hydrocortisone 1% cream and ketoconazole 2% cream in the treatment of SD, with higher rates of adverse effects.31,32 Pimecrolimus 1% cream was found to be significantly more effective for treatment of facial SD than methylprednisolone 0.1% cream or metronidazole 0.75% gel when applied twice daily for eight weeks, with fewer adverse effects and a lower rate of recurrence than metronidazole.33

I would recommend that you ask for a referral to a dermatologist & read more here

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579488/

Let me know if I can be for further assistance,

Warm regards & stay safe