Painful scalp. What could be causing this?

Discussion in 'Open Topic (General)' started by Little Star, Nov 15, 2010.

  1. Little Star

    Little Star New Member

    This is all so good to hear. I don't notice black dots, but along my hair line and in the part at my crown I have a ton of baby hairs so I know it is growing back, at least to some degree. I am assuming the derm will know what to look for so I'm hoping he sees buds that will indicate it's coming back!

    My derm finally returned my call last night. He said he may do a scalp biopsy to determine the cause of the soreness I'm feeling depending upon what he sees when he examines my scalp. He did say that if the steroids had irritated my scalp, I would have known because my scalp would have reacted to them during application, and the irritation would have gone away within two days of discontinuing use. But I still have a feeling that I probably have some kind of irritation/inflammation from using all of the products that I put on my scalp to get the Seb. Derm under control (steroids, T-Gel, Nizoral, Head & Shoulders, etc.) I remember that the T-Gel particularly irritated my scalp while I was using it. So perhaps my already inflammed scalp became more sensitive from all the products?

    I'm still confused by the fact that I have this scalp sensitivity, but I can't see any signs of redness/irritation. My mom looked at my scalp and said she saw a little pinkness in one spot but that my scalp looks normal for the most part. I think I did read that scalp inflammation is not always noticeable, especially to the untrained eye. I do remember that when my derm diagnosed me with dandruff and inflammation the first time around I had no idea I had it! So, I'm hoping it's simply inflammation, and my derm can prescribe something to calm it down. As of right now the hypochondriac in me is convinced I have some freak invisible scalp disease. LOL

    Yes, I am still on the Yasmin. I have taken it off/on for four years now and cannot go off it as it controls my severe cystic acne. My acne is just now finally clearing up. It has taken the BC four months to get it under control again. Luckily my hair doesn't seem to be sensitive to hormones as I have switched/stopped BC before without hair loss issues. It really saddens me that you have had to go through all of this because of two months on BC. I feel for anyone who has/had TE. Normally the trigger is brief but TE recovery takes years! If my hair grows back, it will probably take it two years to grow to its previous length/thickness. =(
  2. pilar

    pilar Member

    I don't know if I believe him. I've read that using steroids can thin your scalp, therefore making it more susceptible to irritation. Also, if you were using too many medicated shampoos on top of using the steroid, a combination of the two could have irritated your scalp. I have my appointment with my Derm Tuesday morning - I'll ask her what she thinks and let you know.

    Wow, our stories are so similar. The first time I saw my derm in September I went in because my scalp was itching, tingling and and a little red. During our visit she pointed out that I had inflammation and dandruff scales! I didn't even know I had dandruff. But during this visit my derm didn't think the inflammation was bad enough to prescribe steroids. She also didn't see the point in prescribing steroids since that would have no effect on the scales and that's what she thought was causing the inflammation and itching. It was until I used all those medicated shampoos and dyed my hair that the inflammation got really bad.

    My derm talked to me about scalp biopsies but she didn't feel like it was necessary. She did say that if by January she doesn't see enough re growth and I still have inflammation, then she might recommend doind a biopsy. But as of right now, she doesn't think I'll need it.

    Before going on Yaz, I had oily skin but only got 1-2 pimples per month. Nothing bad. Then after going off my skin went nuts! I had acne like never before and in places I didn't even know could break out! It's gotten better with time, so I feel like my hormones are barely balancing themselves out.

    I also think it's going to take 1-2 years to have all of my hair back. When TE first hit last November, my hair was 2-3 inches below my bra strap. It was so long, thick and pretty. A few weeks into TE, I cut it right below my shoulders. Since then I've trimmed my hair but it's grown and is now right above my bra strap.
  3. Little Star

    Little Star New Member


    I don't know if I believe him either. I would think he would know what he's talking about from all of his clinical experience, but this is also a guy who didn't warn me not to use the steroids past two weeks. I'm really thankful I was smart enough to research it independently and stop the steroids when I did. All I know is that my scalp did not hurt as bad as it does now until after the steroids and medicated shampoos so that's enough for me to draw my own conclusions.

    I sincerely hope my scalp did not thin from two weeks of steroid use as I have heard skin thinning is irreversible. I read somewhere that usually only long term use (repeated use after many months) can cause skin thinning. I hope that is the case! Thank you for offering to ask your derm. I would be very interested to hear what she thinks about my issue and the possibility that the steroid aggravated my scalp further.

    I think I may need to make an appt. with a different derm, as I'm not sure mine is very trustworthy, but I know getting into see one could take months, and I don't feel like I can wait that long.
  4. Little Star

    Little Star New Member

    Found another derm who could get me in December 6! So relieved. I am still going to go to the appt. with my old derm to see if he sees buds/growth or suspects something else wrong with my scalp. But I still want another derm to give me a second opinion on my issues as well as address my concerns about steroids. Will keep you posted. Please let me know what your derm says as well.

    Thank you again for all your understanding and support.
  5. pilar

    pilar Member

    I wouldn't be surprised if he's saying it's not the steroids that caused the inflammation because then it would point to his negligence causing this. I don't know. You know, during this TE nightmare, I've seen so many doctors and it's so hard to talk to one that actually cares. I feel like a lot of them are very careless. So props to you for being a smart girl! :)

    You're right, 2 weeks was probably not enough to cause scalp thinning. But if long term steroid use can cause scalp thinning, then using it for 2 weeks can have some effect. That's why my Derm didn't want to prescribe Clobestol because she said it has an ingredient that can aggravate the scalp, especially if you're prone to Seb Derm.

    I think it would be a good idea to get a second opinion. I saw 2 derms in a 2 week period because I wanted to see what each of them thought. Luckily, both said the same thing. But the first one did give me samples of Clobestol shampoo (which I didn't use until I got a second opinion) even though she also didn't think I needed it at the time.
  6. pilar

    pilar Member

    That's awesome!

    I think a second opinion will give you better insight on your situation.

    Is this the new derm you're seeing male or female?
  7. Little Star

    Little Star New Member

    Yea, I bet your derm is right and the inactive ingredient caused me some additional irritation. The steroid definitely did not do what it was supposed to. It did the opposite, if anything.

    And I completely agree with you, I doubt he would admit that a medication he prescribed caused further issues. I do agree that many doctors seem very flippant and careless when handing out prescriptions. I understand that they see a lot of patients and that it probably is hard to give everyone the time and attention they deserve. But I feel like doctors look at you for two seconds then prescribe meds to get you out of their hair. They rarely discuss side effects or what to expect. I would have NEVER used the steroids had I known how potent they were before hand. The first time he prescribed them my hair was still falling out a lot, and I actually refused to use them because I was too scared to put anything on my head. I didn't begin using them until he used fear tactics on me i.e. "you need to use them or your hair will start falling out again". My scalp had mild dermatitis, nothing severe. I think it's just stupid that he said that to me.

    My new doctor is male also. I wish I could find a female, but the ones I called were booked months out.

    Pilar, do you work? If so, how did you manage to stay focused on your job when all of your issues were going on? I am having a really hard time at work right now. My boss even mentioned I seem distracted.
  8. pilar

    pilar Member

    That's something BOTH derms told me - that a steroid wasn't necessary for mild inflammation. Shame on him for scaring your into using it.

    Yes, I do work. I work in purchasing and when this ordeal began, I had to take 2 weeks off. I was a wreck, couldn't sleep, eat, it completely consumed me. During the 10 months of TE I also coudln't focus on my work 100% and honestly I don't know how I made it through the 10 months without getting fired. I remember contantly going online and looking for "success stories" or happy endings to this nightmare. It was hard to find stories like that, but I did find some. I think it's those few positive stories that got me through it. I also met a very nice lady on this forum (DinDin) and we continue to email each other every day. I honestly don't think I would of made it through this without her support.
  9. Little Star

    Little Star New Member

    I feel the same way. I took a week off about a month ago, but I feel like I'm going to need more time off again. I'm also not sure how I haven't been fired. My boss continues to be very understanding. But you see how often I am on this forum, so I am definitely not focusing or being as productive as I should be.

    Would you mind if we exchanged email addresses so we could communicate that way?
  10. pilar

    pilar Member

    Here's one of my email addresses

    I don't use this one too often, but send me an email here and then I'll reply from the email I use daily. I just don't want to make my regular email public.
  11. NYCGirlie

    NYCGirlie New Member

    Has anyone ever used Fluocinonide (topical solution)? My derma said I have TE (cause is still unknown). He prescribed Fluocinonide for me to help with the itchy/burning/tingling sensations that come and go. Its mostly in front and crown (where its thinned most) and sometimes side and back. He said this solution would soothe that and also treat imflammation "if I had that". I dont have any flaking but have this "sensations" that come and go. I dont want to be an experiment...any info on Fluocinonide??
  12. pilar

    pilar Member

    Hi NYCGirlie:

    Fluocinonide is a topical steriod. It's similar to what Little Star and I were prescribed. Little Star used Clobestol and I used Diprolene. Steroids are usually prescribed for inflammation, pain, itching and burning of the scalp. When I first saw my derm in September, even though I had some inflammation and itching, she didn't find it necessary to use a steroid. It wasn't until a few weeks after that I used 4 medicated shampoos and dyed my hair, ALL in 3-4 days that caused MAJOR inflammation. This is when she prescribed the Diprolene. I used it for 8 days (once a day) and it helped with the scalp pain (it was sore to the touch) and burning. The redness continues to decrease and even though I still get a little itching here and there, it's A LOT better than it was before the steroids.

    I would be very careful with steroids as they should not be used unless you REALLY need them.

    How often did your doctor say to use it?

  13. NYCGirlie

    NYCGirlie New Member

    After reading this, I am definitely going to a female dermatologist for a second opinion! At first my derma said he had no clue why my scalp had these sensations. Then at my followup (with bloodwork results ready), I mentioned the sensations again and he prescribed Fluocinonide. He said if the hairloss is caused by an inflammation in the scalp, this would cure that. He said to only use it when I feel the tingling/itch/burning. But odd thing is he didnt even examine my scalp before prescribing it! I have no redness or flaking or anything on my scalp. After googling it and finding out it was a steroid, I refuse to use it unless I absolutely need it. I am going to another female dermatologist soon for a second opinion
  14. pradap

    pradap New Member

    I was starting to think I was crazy. Not that I wish this torture on anyone, but it is good to know that someone else has experienced this. I have tried numerous anti-dandruff shampoos including Nizoral, T Gel and now Head & Shoulders. I was on the steroid meds for about a month. I was on Clobetasol, which is very potent, and I am worried I may have irritated my scalp with its use. My dermatologist did not tell me that it is one of the most potent topical steroids nor did he tell me that I should not use it for more than two weeks at a time. My dandruff cleared up on its own but I know my scalp must still be inflamed if it's hurting like this.:):(:D

    Last edited by a moderator: Nov 30, 2010
  15. Little Star

    Little Star New Member


    I have the same sensations you describe, mostly on the top of my scalp. It's very sensitive. My telogen effluvium ended about a month and a half ago though. These sensations started two weeks ago. I have been to two derms and both said they cannot see nor feel inflammation.

    I used Clobetasol for about two maybe three weeks tops, twice a day. I stopped treatment about two weeks before all these weird scalp sensations began. I thought the steroid caused them, but both derms have said that is unlikely. They're not sure what the cause of the pain is. I'm supposed to go back in two months for a follow up to see if anything has changed. My derm keeps telling me it's going to be fine, but in the meantime it's driving me bonkers.

    If you do decide to use the steroid, I would use it very sparingly at first to see if it does anything. If you don't notice a difference after a few days I would stop use. I personally think the inactive ingredient in my steroid as well as all the medicated shampoos I was using are what caused the soreness on my scalp. It could also just be sensitivity from the TE as a lot of people report strange, painful scalp sensations before, during and after hair loss. It's called trichodynia, and no one seems to know what causes it.
  16. Little Star

    Little Star New Member


    My sensations are also mostly on the top and crown. When you come the ends of your hair, does it hurt the top of your scalp in the areas where you are feeling these sensations? What about moving the hair around in those areas? My top, crown and sides have also thinned the most, by the way.
  17. Little Star

    Little Star New Member

    Here's a study that ties trichodynia to hair loss. Apparently, it's more common in people with TE and seems to be associated with anxiety, depression and other psychological disorders as well:

    The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia.


    BACKGROUND: Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity. Although androgenetic alopecia (AGA) and telogen effluvium (TE) are different entities in terms of pathogenesis, etiology, and clinical picture, both may be influenced by psychologic stress and may be the cause of secondary stress.
    AIMS: To investigate the presence of trichodynia in patients with TE and AGA and to evaluate psychologic comorbidity in patients with trichodynia.
    MATERIALS AND METHODS: A total of 248 patients (153 females, 95 males), presenting with hair loss due to either TE or AGA, were enrolled in this study. The prevalence of trichodynia in these two groups was compared with that in controls (n = 184). In addition, psychiatric evaluation was performed in 25 patients with trichodynia (13 females, 12 males) and in 25 controls (16 females, nine males) without alopecia and trichodynia by a psychiatrist; Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria were used for the assessment.
    RESULTS: Trichodynia was found in 72 patients (29%) with hair loss and in six controls (3.3%; P < 0.0001); 25 of the 72 patients with trichodynia underwent psychiatric evaluation and 19 of the 25 patients were found to have psychopathologic signs (76%). In the control group, only five patients had psychopathologic signs (20%; P = 0.0004). Of those with hair loss, trichodynia was more frequent in the TE group than in the AGA group (P < 0.0071).
    CONCLUSIONS: Trichodynia is a common symptom in patients with TE and AGA, and often coexists with psychopathologic findings, including depression, obsessive personality disorder, and anxiety.
    Last edited by a moderator: Dec 3, 2010