BlackSheep's story (21 y.o. persistent dandruff and hair loss)

[BlackSheep]

Hello all,

Every story needs a beginning.

I am a 21 year old college student. Exactly one year ago, while staying up doing some coursework, my scalp became intensely itchy. I've never had a problem with dandruff before in my life. At 17, I did have a problem of having a mildly itchy scalp with sebum collecting under my fingernails.

My first remedy was a mixture of olive oil, honey and vinegar. This seemed to keep the dandruff at bay on and off for 2 months. The itching scalp returned with a vengeance later. Saw a doctor, stopped using hair products, and he prescribed me some Nizoral. It seemed to work, but I immediately noted the vertex scalp hairs became permanently drier ever since. The itch then returned.

Then I resorted to coal tar. Temporary help, but itch returned. I'd itch so much the little raised bumps on my scalp would bleed.

It wasn't until half a year later, following a very stressful life experience, I got another short haircut and noticed how thinned out my vertex region was.

A year on, I have noticed the itch and dandruff become worse in the winter, when I stay up late, or if I've eaten a lot of sugary foods.

I've seen several doctors over the past year. The verdict is unanimous; there is no scarring, some scaling, and sometimes inflammation.

At present, most of my hair loss is diffuse around the vertex region still, with a continuous persisting itch all along this region. The raised bumps are still there. Vinegar now makes the itch worse. I feel sandy lumps of (presumably) sebum over my scalp occasionally. My hair line has not receded at all. There is some evidence I believe of new hair growth. When I part my hair (now roughly 7 inches long), I see numerous small hairs protruding, and they're as thick as the others. However, I do see random small bald spots. I'm currently on a cycle of Nizoral, Alepecin (that caffeine stuff) and coal tar.

It's obviously not traditional male pattern baldness, isn't tinnea capitis (no scarring)... I don't know what's going on. I read online that scalp itch may precede androgenetic alopecia.

Am visiting a GP once more tomorrow and demanding a referral for biopsy. Until then, I'd appreciate any thoughts anyone here may have. I've attached a recent picture. Thank you.

​

AS OF 21-03-2013, following the self-analysis below, I'm keeping a diary of my progress in improving my diffuse hair loss. Will update this original post whenever I feel is necessary until this June to see what effect a proper sleep pattern (at least 8 hours daily, before 10pm) has on my body, mind and hair.

26-03-2013 - Sleep pattern disrupted from travel, but feeling good in myself now I am sleeping more. Believe I have seen a couple of stubble-like thick terminal hairs here and there. Am now going for regular walks on top of my weightlifting and will soon return to swimming. Will also be trying out a combo I've been devising the past few days to tackle persistent itching/mild folliculitis - Coal tar shampoo >5 mins + some form of medicated shampoo (salicylates, Selsun, Nizoral) >5 mins. My reasoning is this is a follicle-deep persistent infection so stripping away one layer of scalp cells and then using a medicated shampoo will be much more effective. We'll see the result in the next few days!

02-04-2013 - Have used the above system and it is helping with the itching somewhat. Twice a week I use coal tar 5 mins, then nizoral 5 mins. On other days I use Selsun if I do wash my hair. Read the post below on the same day regarding other developments.

03-04-2013 - Had my buzzcut. As expected I have slight diffuse hair loss all round the sides and back. At the top, however, while the barber was buzzing away, I noticed streaked bands of sparse hairs. Had it evened out by the barber and you wouldn't even think I have a hair loss issue.

11-04-2013 - Scalp remains largely itch-free. However, there have been a few random flare-ups since the last message. Most of them followed my sleep-deprived transit abroad. It has since settled down, especially after starting cardio once more. Hair has grown back surprisingly quickly and feels thick and strong once more, as it did before all this started 16 months ago. Planning to tone down the nizoral-coal tar combo to just 2x a week in a fortnight.

29-04-2013 - Hair has grown a lot back. The itch has almost completely disappeared. Through staying up randomly some nights and observing patterns it seems spicy food, sleep deprivation and a lot of sugar aggravates it. Dairy and caffeine have absolutely no effect. Will post some more pictures possibly.

 

[BlackSheep]

Small update.

After some reading around it is clear the hair loss topic focus on this board is male pattern baldness via androgenetic alopecia rather than other forms of hair loss, which is why I'm yet to receive a single comment on this thread. I'm continuing to post here for the information of lurkers who may be suffering from the same problem as me.

Saw the FIFTH doctor regarding my hair loss and itching over the past year last Thursday. He agreed that the other doctors have not paid as much attention to my history and were over-zealous in diagnosing me with male pattern baldness. He stated that (in order of decreasing likelihood) seborrhoeic dermatitis, folliculitis and an allergic reaction were responsible for all the suffering I've gone through.

I thank the good Lord he paid attention to the logic of my disease process (scalp itch -> hair loss) and has referred me to a dermatologist. I should be seeing them in 2-3 weeks.

The doctor asked me to stop using ALL traditional treatments for scalp itch or hair loss (nizoral, coal tar, head and shoulders in my case), so the dermatologist can see the true extent of my problem. I have not used them for four days and the uniform dandruff has returned, sure enough. For the remaining time I will have to shower twice a day to combat any visible flakes.

I have been using the Alepecin caffeine shampoo twice a day in the meantime. It hasn't helped with the dandruff. My hair has definitely become thicker and less erratically positioned (a couple of months into my sudden onset of scalp itch I noticed individual hairs on my vertex poking in odd directions, that'd never happened before).

I don't know whether the alepecin shampoo is responsible for this or if it's just me being less stressed and more at peace with finally getting the medical attention I wanted. Or, for that matter, me rubbing my scalp less. I think the scalp rubbing hasn't done mine any good. After a year of this, I feel the more one fiddles with their scalp, the more problems are worsened.

Regardless, things are stabilising.

 

[BlackSheep]

Quick and necessary update.

On the fourth/fifth day into my recommended abstinence from seborrhoeic dermatitis treatment by my doctor, I could no longer take the itching scalp and resorted to using the Selsun Blue I'd ordered some time back online. I was up at 1am last night doing some work when the intense burning and desire to itch overcame me.

I noticed my hair was becoming thinner in that timeframe, which amazed me to be quite honest. Never would've thought decreased perfusion of my scalp follicles by the causative fungus would, if unchecked, lead to such a quick result. After that single wash with Selsun Blue (left it in for 5-6 mins) my hair feels less itchy already and I believe it does look thicker as well.

I'm now going against my doctor's recommendation and cycling on Selsun-Coal-Nizoral in that order for first-time washes and using Alepecin if I need a second wash that day. I'll just stop using the shampoos two days before my dermatology appointment comes in. I feel this is the perfect trade-off between me keeping my scalp well-perfused and hairs I still have intact whilst giving the dermatologist a good indication of what's going on up top.

From all this, it appears my disease process is exacerbated by some form of physiological stress and I readily relapse into itching bouts without the treatments. Until I see the dermatologist I'm also going to try and control this stress by sleeping better, learning good sleep hygiene and avoiding too much sugary food.

For those who may be reading this and also suspecting they have seb. dermatitis, for me at least, I don't think allergies have anything to do with it. I've been on a trial of Loratidine (antihistamine) and it hasn't done anything for the itch. Nor has staying away from dairy (I'm lactose tolerant but do have cow milk intolerance, as I'm just fine with goat's milk).

 

[BlackSheep]

Still waiting for the NHS to send me my referral note. This process is incredibly slow. I've phoned my surgery and asked why it's taken so long. Expectedly, so "administrative" problem is the cause. I wouldn't be surprised if they sidelined the referral as "non-essential" or "cosmetic", or some other asinine reasoning.

I've also discovered that, contrary to what I've always believed, my hair loss has been diffuse and not solely on the vertex and crown. When separating layers of hair on the sides, I see the parting has become noticeably wider than two years ago (the last time my hair grew long).

So, at present, I believe I have mild diffuse pan-head hair loss. I have attempted to correct my sleep pattern and my scalp does generally feel less itchy. Also, I've only been using the Alepecin shampoo in the past 4 days (no conditioner, no keto or anything else) and my hair feels stronger and fuller.

 

[BlackSheep]

Sleep pattern correction has not worked. I've succumbed to the natural tendency I have to over-achieve and that's ended up in me regularly staying awake till 4am. I had an incredibly stressful day recently and noticed the day after more hair than usual was falling out.

I immediately went to my doctor, presented my case of poor sleep for the past few years with sleep hygiene attempts failing, and they've given me melatonin for 2 weeks to help reset my circadian rhythmn.

At this point I am convinced my seborrheic dermatitis is secondary to constant physiological stress. It has been years since I was able to sleep consistently for at least five days. The reasons shifted (idle boredom to student partying to overworking) but the end effect remained the same.

I suspect, based on this history (very poor sleep pattern and stress for past few years) and presentation (diffuse hair loss across scalp with no receding of hairline), I have chronic telogen effluvium with secondary seborrheic dermatitis.

I will be seeing the dermatologist in two weeks time. No more updates until then. Will post afterwards regarding the outcome of this and if the two weeks of improved sleep has had any effect on my hair. Fingers crossed for me guys!

 

[BlackSheep]

Will try and keep these briefer from now on.

Dermatology department and the useless referrals system here meant that I'll be seeing a dermatologist in SIX WEEKS TIME. This is despite first being referred at the beginning of November 2012! I would have waited for 4.5 months just to be seen!

My sleep pattern has been fixed and the itching has subsided a small bit but that is irrelevant, frankly.

By sheer luck, I felt some itching on the front of my scalp today. As a medic student, I inspected it then noticed there were several pimples there. Burst one and there was blood and pus.

This is folliculitis. Without a doubt. This whole time I've had folliculitis and the f***ing incompetent doctors I've seen one after the other failed to properly inspect my scalp for any bumps.

I have done some provisional reading online and see a lot of people with folliculitis have had success with tea trea oil shampoo. I need some stronger treatment than this and will try and hassle a doctor on Friday to give me something for it.

There you have it people; if you have a persistent itchy scalp, with occasional bumps/scabs, diffuse hair loss all over with no hairline receding and no proper relief with the standard anti-inflammatory type shampoos for seborrheic dermatitis, you have folliculitis.

From now on, I am approaching this entire topic as if I have folliculitis.

 

[BlackSheep]

From my battle with hair loss I have learned one important lesson.

Don't succumb to hairline/vertex obsession.

After lurking these boards for months and viewing all these charts I became fixated by the categories and the changes I was going through in my own vertex. I can safely say a very large chunk of people here also have the same fixation (all this "Norwood grade" talk). Pretty frightening if you ask me; desperate men latch onto the anecdotal subculture here and begin actively seeking propecia etc. even though their causes of hair loss might not be androgenetic alopecia.

Since the dust settled after noticing I have diffuse hair loss, I've been carefully examining my hair. There's actually more hair loss around the sideburns and sides than the vertex; I'd completely missed this for months!

It has given me some peace of mind in a strange way knowing the true cause of my hair loss. Taking into consideration my poor sleep pattern for the past few years (regularly missing an entire night's sleep), I'm convinced the hair loss is actually chronic telogen effluvium with a secondary mild folliculitis. Fixing my sleep pattern is of paramount importance. If I see new hairs in the next couple of weeks, then, I'll have my answer and solution. Will keep everyone posted and will give a detailed guide of exactly what I've done, presuming/hoping it works. Best wishes all.

 

[talmoode]

I haven't been able to sleep well for the past 6 to 7 years and whether or not it has contributed to my hair loss, I would love to do something about it and have a good night sleep!!!!

 

[desparado]

Hi blacksheep,

After a very long time, its great to see a person who feels exactly the same way. I have the same time of hairloss,diffuse dandruff and itchy scalp.. I have been given male pattern baldness diagonsis which is clearly not the case for us. when ever the dandruff is reduced the hair loss is less. i use selenium di sulfide shampoo and reduces dandruff to some extent compared to other shampoo. even my bro has same kind of hairloss.. it might be even enviromental, hard water cuz when i changed my location , my hair loss started. but it could be of various reasons. and i'm trying to figure wats the trigger is but couldn't able to find out. i dont have a single clue, wats causing my dandruff or could i control it . everyday is a mess man to be honest. and i'm 24 yr old. diffuse hairloss from 17.

cheers mate.

 

[BlackSheep]

I can relate with both you guys. I am convinced it is a physiological response to stress of some sort. The body is "shutting off" the supply to the hair via adrenal activation (cortisol).

talmode, getting sleep fixed is the best thing you can do. I'm sleeping more regularly (more or less) than before (in bed by 1am at the latest). For the past three years I've regularly been staying up till 5am.

I noticed that, the more frequently I've done this over the years, the more problematic my mood is, the less gains I've seen in the gym, and since Nov 2011, the diffuse hair loss and dandruff issue.

Work on sleep hygiene (Google it, you'll see all kinds of directions for it), and if that doesn't work, speak to a doctor and they'll give you some short term sleeping tablets to help reset things. I only needed melatonin for 3-4 days for my pattern to be corrected somewhat. It's just a matter of sleeping earlier and more now.

desparado, I completely agree. I've also noticed more hair loss when there's itching, or if I haven't slept properly. Can't be a coincidence. Would you say your sleep, diet and exercise patterns are healthy? It's quite likely one of those is at fault here if the both of us have the exact same problem. I'm an allergic person, but they're kept in check by avoiding the problem foods. Sleep is my biggest problem.

 

[BlackSheep]

What I've laid out in this thread has resulted in some new thick terminal hairs; I can see them clearly when I pull my long hair back and view what's poking out near my front hairline.

Unfortunately, I'd say 40% of my hair is still missing and the number of long hairs is decreasing by the day. It looks rather unsightly.

I'm getting a buzzcut tomorrow and will continue my system regardless until I see the dermatologist this month to get a third person medical confirmation what I'm doing is right.

 

[BlackSheep]

Very important information for those who are in the same boat as me.

Cut your hair as short as possible ASAP and then begin the shampoo regimens!

This is day two of my newfound buzzcut. I've been carrying on with the regimen laid out previously (5 min coal tar 5 min nizoral every 3 days, selsun/salicylate/head and shoulders in between) and my scalp has not been itchy at all! I've concisely checked for any new hairs and absolutely nothing is falling out anymore! My dandruff and sebum plug problem has also completely disappeared overnight!

I have a feeling my very long hair and my habit of wearing caps has always worsened the problem since it trapped moisture and heat, presumably making it an ideal breeding ground for the bloody scalp bugs.

So, from my very early preliminary experience, cutting your hair as short as possible (ask barber to style if patchy like mine) and then applying the system I figured out will almost immediately fix things up.

 

[Korean Wave]

You seem to be doing very well battling your hair loss according to the information you're providing. Thanks for the advice you've sneaked in as well. Just a few questions?

A buzz-cut would not suit me at all, so I have to keep my hair at a reasonable length. I slightly disagree with what you said about the shampoos being more effective on short cut hair. One problem, included in the hair loss, which I've been fighting against, is the over productive sebum. My hair seems to get greasy CONSTANTLY. My diet is oil, fat, sugar free and I was my hair with sebum fighting shampoos. What would you recommend?

 

[BlackSheep]

You seem to be doing very well battling your hair loss according to the information you're providing. Thanks for the advice you've sneaked in as well. Just a few questions?

A buzz-cut would not suit me at all, so I have to keep my hair at a reasonable length. I slightly disagree with what you said about the shampoos being more effective on short cut hair. One problem, included in the hair loss, which I've been fighting against, is the over productive sebum. My hair seems to get greasy CONSTANTLY. My diet is oil, fat, sugar free and I was my hair with sebum fighting shampoos. What would you recommend?

The experiences shared in this thread are entirely anecdotal and apply to me only. Whatever the reason might be (combination of no hat wearing, less hair to absorb the shampoos etc.), I haven't had to itch my scalp for even a nanosecond since I got the buzzcut. It might not apply with others but it certainly does with me.

The buzz-cut doesn't suit me very well, either; I have all sorts of nicks and scars on my scalp from my younger days for starters. I did it as a necessary evil because of the inconsistency in sporadic hair regrowth on my scalp. I had no idea prior to the trim it'd actually work as a solution to my scalp itching, dandruff and hair loss.

I've been fighting an overactive sebum issue just like you this whole time. Whenever I scratched my scalp, the sebum would even collect under my nails like a pungent glue.

Perhaps try my approach (entirely at your own discretion) regarding the shampoo system (5 min coal tar 5 min nizoral every 3 days and a filler shampoo afterwards) plus a shorter haircut and see if that addresses the problem? My scalp is no longer "oily" but isn't dry anymore despite the heavy shampooing, so it's under control as well.

I don't know your own hair loss story so can't say much else. I understand people with male pattern baldness (as opposed to my problem) generally have sebum over-production anyway, so the other people on this forum are the right ones to ask if you're in the male pattern baldness boat.

 

[lifewithouthair]

Hmmm.. I have A similar bald spot like you at the back and even the dandruff and itching etc, I wonder if it's not my male pattern baldness but some inflammation related hair loss, that would explain so many things :/ weird...
Btw has your shampooing and haircut helped? Did you get any pain in your scalp like when moving your hair around? I seem to have got horrible pain inthe areas where I'm loosing my hair.

 

[Quantum Cat]

Blacksheep, do you use melatonin to help you sleep? Or to help you stay awake?

I've been thinking about trying melatonin myself as my sleep patterns and moods are all over the place. I think in the UK you can't buy it legally though

 

[BlackSheep]

Hmmm.. I have A similar bald spot like you at the back and even the dandruff and itching etc, I wonder if it's not my male pattern baldness but some inflammation related hair loss, that would explain so many things :/ weird...
Btw has your shampooing and haircut helped? Did you get any pain in your scalp like when moving your hair around? I seem to have got horrible pain inthe areas where I'm loosing my hair.

Sounds like the bands of semi-baldness I have all across the top of my scalp. It was most apparent when the barber did the first round of trimming. I remarked to my father how I looked like a mangy stray cat. My very long hair masked it the whole time.

If you suspect inflammation (redness, itching, heat, pustules, crusting, bleeding), and it's localised, like mine was (usually around the top of the scalp but extended elsewhere), then that's presumably the cause.

From my reading, if there's none of that and it's still localised, it might just be an autoimmune issue (alopecia areata) or something more sinister (tinea capitis).

It's now been over four straight days since I had my buzzcut and continued with my shampooing regimen. I haven't itched my scalp once, I haven't felt a single pimple on my scalp, and I haven't seen a single sign of redness. I'm in no pain whatsoever, my scalp actually feels "warm" and nourished again, there's absolutely no dryness or oil now despite the fairly heavy shampooing assault. Most importantly of all for me, I've only counted ONE head hair falling out over the past few days in the shower.

It's honestly been a miracle. Aside from slight thinning, you'd think there was absolutely nothing wrong with me.

I wish I had the wherewithal to have done this a year ago. So much suffering would have been avoided then.

Blacksheep, do you use melatonin to help you sleep? Or to help you stay awake?

I've been thinking about trying melatonin myself as my sleep patterns and moods are all over the place. I think in the UK you can't buy it legally though

I've succumbed to melatonin and it's definitely helping me. One thing to consider is that melatonin is identical to the form produced in the body (it's the hormone that controls your circadian rhythm). If one carries on staying up late habitually and consuming caffeine, then it won't do squat.

Do what I did; visit your GP, explain your pattern's been messed up for a while, and that you've tried every possible thing relating to sleep hygiene but it doesn't help. They'll give you a prescription for melatonin.

 

[BlackSheep]

Photo of my scalp taken today. Will be having two more buzzcuts over the next month to give you guys (and myself) and objective idea of how my hair regrowth is shaping up. Looking forward to the day this thread sits in the "Success Stories" section.

Compare it with the picture in the first post. There does appear to be slightly more hair density since early January around the crown region. I can also report my hair feels much thicker than it was back then.

I believe this is an example of uniform diffuse hair loss across the entire scalp with absolutely no receding of the hairline (you can barely even see my hairline here, that's how "regular" it is for someone of my age). Other thoughts/opinions are welcomed.

(P.S. the white diagonal line near my crown on the LHS isn't scarring alopecia, it's an actual scar from childhood)

 

[BlackSheep]

Been a while since I last posted with updates:

- Since the above, saw several more doctors, and finally a consensus in opinion. They deemed it to be some sort of transient allergic seborrheic dermatitis which then led onto secondary folliculitis. All of them predicted I was a frequent headwear user for years. I used to wear stuff on my head while sweating intensely during workouts because it kept my (formerly) long hair in check.

- In early July one doctor prescribed me with fusidic acid and steroid creams for twice daily application plus antihistamine to prevent any allergies factoring in. My scalp was completely itch and dandruff free for the entire two weeks I was on them. However, one week after the course finished, the itching and dandruff came back. I've also had a very dysfunctional sleep pattern lately so I think it re-triggered the issue (note from my first post this is what kickstarted the whole thing in December 2011).

- I've booked an appointment to see a doctor and see what they'll give/say. Clearly for me sleep is a crucial factor in my scalp condition.

 

[BlackSheep]

Hi all,

I've returned with some good news regarding my hair loss.

Following on from the above, I finally saw a dermatologist, who determined my hair loss has been due to either moderate persisting seborrheic dermatitis or some sort of type 3 hypersensitivity reaction affecting my scalp. I have a lot of other allergy symptoms, and she even noted the urticaria/hives on my forearms as we spoke. I had a punch biopsy done 4 weeks ago and awaiting results for that which I'll share here soon.

The breakthrough news, however, is I finally have regrowth! I listened stringently to my GP and dermatologist. All I've done in the past month is use my betnovate steroid drops twice a day without fail, used an antihistamine (hydroxyzine) once a day, used Nizoral every other day, washed my hair at least once a day, and fixed my life pattern up (sleeping earlier and longer, reduced stress etc). In addition, I've kept my hair extremely short. Shaved it all off a couple weeks back even.

As far as the diet goes, I've learned over the past two years that dairy and sugar elimination had absolutely no effect if I was eating fine to begin with. I've ensured getting no less than 5 fruit and veg a day, as well as more cardio.

A note on external scalp applications; warmed coconut oil, olive oil, honey etc. did provide some temporary relief, but were nowhere near as effective as the steroid-antihistamine-short hair combo.

As a result of the above, I was pleased to see small dark dots on my scalp, indicating the follicles are finally pumping out new hairs once more. I've also seen a big reduction in the number of vellous-type hairs. My head is still sporadically itchy every so often, but it's tolerable now.

At present, my hair's about as dense as the picture in post 18, which is an improvement, since I lost more hairs after that point.

So, just thought I'd share this with everyone. Living healthier and stringently following doctor advice has been far more effective than any of the random alternative suggestions sometimes offered online. Also, the steroid drops clearly aren't irritating my scalp or causing more hair loss if newer thick ones are returning, which is what the doctors suggested.

Will post again after my biopsy results have come back.