Dear Readers,

Peaches is a 57-year-old lady from Kingston 6. She works at a university. Her problem is persistent, patchy hair loss for many years that is so bad that she has to wear a wig as her own hair only grows in small patches.

Peaches tells Lifeline that years ago, she visited England and was treated by a doctor for a scalp fungal infection. Peaches related that she used all the treatment and the infection "kind of" went away, but since then, her hair easily breaks in patches. Over the years, she has used many steroid ointments and lotions for hair loss, but the problem has persisted to the point that she has given up because some areas of her scalp don't look normal anymore. Peaches asks Lifeline for advice on what to do again to try to solve her scalp hair-loss problem.

Without a doubt, it is way past time for Peaches to have sought the help of a dermatologist. There are several disorders that cause hair loss and scarring of the scalp. Two such conditions that come readily to mind are scalp fungus (Tinea Capitis) and scalp psoriasis.

Scalp psoriasis is a skin disorder that produces a raised, red, itchy, and scaly rash on the scalp that can appear in multiple patches over the entire scalp and even spread to the forehead and back of the neck. It is often associated with thick, silvery scales and flaking of the scalp and hair loss. It is not contagious, but results from an abnormality of the immune system, which causes overgrowth of the scalp cells, which build up in patches. It is often found within families and can be inherited. It is often exacerbated by stress. Associated scarring is not usually permanent and hair grows back with successful treatment.

Treatment includes:

Salicylic acid topical preparations;

Coal tar applications and shampoos;

Topical steroids;

Vitamin A and D topical applications;

This must be applied directly to the scalp.

Seemingly of more relevance to Peaches is the fact that she was treated, perhaps unsuccessfully, for Tinea Capitis (scalp fungus) some years ago. The scalp infection may well have persisted these long years and become quite chronic, the course and progress of the infection having been influenced by numerous topical applications and shampoos over the years!

Peaches mentions that she has always used ointments, lotions, and shampoos for the problem. She does not mention oral therapy, yet Tinea Capitis is really difficult to treat without the use of oral (internal) medication as the hair root itself is infected! The hair tends to just keep growing out with the infection as the topical applications do not deeply penetrate the scalp to the roots.

Tinea Capitis is ringworm of the scalp and can be caused by two fungi: Microsporum and Trichophyton. The fungus is easily caught from infected children, pets (cats), combs, and hair brushes, or hats and clothing worn or used by another person infected with the fungus. Unclean barber shears are another source of contracting this infection. Tinea Capitis may infect some or even the entire scalp, depending on how long the infection remains untreated.

Infected areas may have minimal hair loss or may appear bald with small, black dots due to hair that has broken off. There is almost always scalp itching, and this disorder, in its chronic form, can cause not only hair loss, but lasting scars. After many years of infection, hair loss can be permanent.

Treatment requires oral medications such as Terbinafine (Lamisil), Itraconazole (Sporonox), Ketoconazole (Nizoral), or Griseofulcin taken for at least four-six weeks and up to an additional two weeks after all infection seems to have disappeared.

All combs and brushes in use should be soaked for an hour each day for three days in a mixture of half bleach and half water. Towels, pillows, combs, and brushes should not be shared with other family members. The washing of the scalp with Ketoconazole shampoo twice a week in addition to oral therapy may help diminish spread of the infection.

When infection with a scalp fungus seems to persist, it should be determined if the following situations exist:

Poor compliance with treatment;

Reinfection with the scalp fungus;

Inadequate treatment;

Sharing of hair combs, brushes, and hats;

Lifeline advises Peaches to schedule a visit with a dermatologist as soon as she can and get this scalp condition sorted out.

Write to: Lifeline, PO Box 1731, KGN 8

AJM