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Is topical clobetasol safe for the scalp?

On the Safety of Topical Clobetasol 

I've often asked if applying topical clobetsol steroid cream, lotion, foam or shampoo to the scalp is safe. Before we answer that, it's important to understand what clobetasol is and why it's used. 


Clobetasol is a class I steroid. Hydrocortisone is Class 7.

There are seven classes of steroid strengths. Class 1 steroids are the strongest and class 7 are the weakest. Clobetasol is a class 1 steroid and requires a prescription (in most countries). Hydrocortisone is a class 7 steroid that can often be bought 'over the counter' at the local drug store.  In simple terms, clobetasol is about 600 times stronger than hydrocortisone.  That does not simply equate to dangerous. It simply equates to stronger. A common steroid potency chart is found in the list below



Frequency, Duration, Amount

When someone tells me they are are using clobetasol, the first thing I want to know is how much are they using and how often are they using it? It comes as a surprise to some that how much steroid a patient is using is usually more important to me that the how often.  A patient who used clobetasol every day but it takes them 5 months to use up their bottle has a very different safety risk profile than someone who is using clobeetasol every day but goes through a bottle every two weeks.  Similarly, a patient who uses clobetsol twice per week could be using more than a patient using it everyday. The amount matters!


On the Fear of Topical steroids

There is quite a bit of inappropriate and misguided fear about topical steroids. I'm not saying topical steroids don't deserve respect, because they do. However, the fear that permeates society mainly comes form poor knowledge and also from the misuse of these products among the general population. Sadly, sometimes this misdirected fear comes from unethical practice and misguided motives. It's tough to change that but I can give at least 1000 examples from my own practice over the years of these situations:

A clinic wanting to sell product A for a child advising a parent "Oh you wouldn't want to put a steroid on your child would you?"

A clinic wanting to sell treatment B to there patient saying "Steroids are not safe. This treatment I am recommending is drug-free and natural."

A clinic wanting to establish 'trust' with a client and advises them "You need to stay away from that other clinic recommending you that steroid treatment. What was recommended is very unsafe. I can't believe they wanted to give you that. They should be reported."


It's difficult in the short term to change how hair medicine gets practiced throughout the world and it's difficult to regulate clinics and practitioners that prey on the vulnerability of their clients and patients. However, we can first and foremost recognize these patterns and spread accurate information as a starting point. I can assure you it's not always a popular view. Topical steroids can be quite safe when used appropriately.  Of course, they are unsafe when used inappropriately.


Logic, Practicality and other Forgotten Issues

When it comes to topical steroids, we need to be logical and practical.  Practical thinking does us good as humans, and we should not forget these principles:

A. It's safe to walk to your across the parking lot to your car on a blazing hot summer day, but it would not be appropriate to walk for hours across the entire city on the same hot day.

B. It's safe to add a bit of hot chili pepper to dish that one is preparing for dinner, but adding the entire chili pepper bottle would just not make sense.

C. It's safe to add a dab of toothpaste to one's toothbrush, but squeezing out the whole tube onto the brush would just be bizarre. 

D. It's generally safe to use a bit of topical steroid for short periods of time to calm down an inflammatory scalp disorder that is causing a patient extreme discomfort, itching and burning. 

E. It's generally safe to use a bit of topical steroid for short periods of time to reduce scalp inflammation that is preventing hair growth.


Safety Monitoring

Anyone using topical steroids needs to be monitored by an expert who knows how to use these prescriptions and what side effects they carry.  

First, patients using the steroid must understand how much to use and for how long. They should carefully record the amount of steroid they are using on a monthly basis and carefully record how long it takes them to go through their tube or bottle. 

Excessive use of topical steroids does lead to thinning of the skin, and even side effects from absorption into the body. These side effects are relatively uncommon with proper doses. 


Use of Topical Clobetasol in Hair Loss

In hair dermatology, we use topical steroids for many reasons. Topical clobetsol is commonly used to treat alopecia areata, and scarring alopecias such as lichen planopilaris (LPP). When used, these should be used for a short of time as needed and always under supervision. Frequent breaks from the steroid use ("steroid holidays")  are frequently helpful. For children with inflammatory scalp conditions that require topical steroids, we often prescribe topical steroids for 4-6 weeks straight and then give a 2-4 week steroid-free holiday period. This cycle is often repeated.



Topical steroids can be both safe and effective when used appropriately. Of course, the don't help everyone and may not be enough of an immunosuppressive type treatment for certain kinds of hair loss. For example, some patients with alopecia areata and some patients with lichen planopilaris find that topical steroids help but not enough and hair loss still occurs despite using them.  In such as case the physician needs to decide whether to continue the topical steroid and add other immunosuppressive treatments or whether to stop the topical steroids altogether in place of the new immunosuppressive treatments. 




Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Smelly Scalp (Hair) Syndrome

Diagnosing and Treating an Unpleasant Scalp Smell

Every now and then, a patient reports that they have a problem with scalp odour. The story typically goes that their scalp smells bad and no matter what they do, they just can’t get rid of the smell.  The specific issue goes by a variety of names, although the most common names are smelly scalp syndrome (SSS) and smelly hair syndrome (SHS).


What causes SSS?

There is no one cause of smelly hair syndrome. There are many causes. The first thing that I tell my patients is that I need to use my eyes and ears to help determine the cause - use of my nose actually plays little role. 


Step 1: Hear the Story

To start with, I need to hear their story. I need to understand when the odor started and what things in the patient’s life changed around this time. I also need to understand several other issues including:

Were any new medications started?

Were any new hair products started?

Any new hair dyes started?

Were any new shampoos started?

How often does the patient shampoo?

What shampoos are used?

Did a child in the house start school?

Is their a new pet in the house?

Were any new hobbies started?

Is it just the scalp odor or does odour come from the body (armpits/groin?)

Has their been any changes in the patients health?

Are their any dental concerns?

Does the scalp itch?

Is their burning in the scalp?

Is the scalp tender?

Is their hair loss accompanying the odor ... or just odor?

Does the patient wake up with blood or secretions on the pillow?

Has the patient’s level of fatigue changed?

What is the patient’s stress level?

Has the patient travelled?

Has the patient’s diet changed?

Does the patient report any skin rashes?

Is their any concerns regarding sexually transmitted diseases?


Step 2: See the Scalp

After getting a sense about the patient’s story, I need to see the scalp, eyebrows, eyelashes and body hair. I also need to see the nails and may even examine parts of the skin.

The scalp examination is important to determine if there are any abnormalities in the skin of the scalp and/or the hair follicles themselves. It is important to determine if there is redness, scale, pustules (pimples), openings in the skin, sores, breakdown. Of course, determining whether or not the smell is actually associated with hair loss is critically important.


Causes of SSS

There are many potential cause of SSS. The most common causes include:

  1. Seborrheic dermatitis 
  2. Psoriasis
  3. Fungal Infections
  4. Allergic contact dermatitis 
  5. Irritant contact dermatitis
  6. Scarring Alopecias
  7. Apocrine/Eccrine Gland Overactivity
  8. Metabolic Disturbances
  9. Infections
  10. Skin Cancers
  11. Hormonal disorders
  12. Infrequent Washing 


Tests for SSS

For individuals with smelly scalp, there are no specific tests per se. However, a number of tests may be performed including:


1. Dermoscopy

Dermoscopy is a technique that involves examination of the hair and scalp with a specialized instrument known as a dermatoscope. Dermoscopy can help physicians identify special features that point to a specific disease including seborrheic dermatitis, psoriasis, tinea capitis, scarring alopecias, folliculitis.

2. Swabs of Pustules

Any pustules on the scalp need to be swabbed. The presence of yellow pustules does not necessarily mean their is an infection in the follicle, but careful assessment is needed. A swab will help not only to identify bacteria that might be present on the scalp but also to determine the precise antibiotics that kill those bacteria. This information is helpful if a decision is made at any point to treat.

3. Skin scrapings

Skin scrapings are important if a diagnosis of tinea capitis (scalp ringworm) is being considered. The scrapings can be examined under the microscope using a standard KOH preparation or sent off to a laboratory for analysis.

4. Examination of Hairs

Hairs themselves should be analyzed. A gentle pull of hairs may reveal secretions and crusts attached to hairs. These should be examined for bacteria and fungi as in the paragraph above.

5. Scalp Punch Biopsy

A scalp biopsy is rarely needed for patients with smelly scalp syndrome but should always be considered. Patients with scalp odor who have concerns about severe burning or pain or who have concerns about bleeding, weeping or oozing are most likely to benefit from a biopsy.

6. Blood Tests

Blood tests are usually normal in patients with scalp odor. However there are situations where I will consider blood tests for blood sugars, thyroid disease and hormone abnormalities.

7. Patch Testing

Patch testing is a method of determining whether a patient has a true allergy. It’s a very involved test and not appropriate for everyone but may be appropriate for a minority of patients with SSS who have marked scalp itching and tenderness especially those with rashes elsewhere on the body.



Treating SSS

The best treatment for SSS is to treat the underlying cause - if it can be identified. If the odor is coming from a scarring alopecia (like dissecting cellulitis) treatment for this condition is what is needed. If the smell is coming from a weeping skin cancer, the only definitive way to get rid of the smell is to treat that cancer. In other words, treatment for scalp odor is first and foremost centred around trying to lock in a diagnosis.

One needs to keep in mind that a cause is not always readily apparent. In such cases a variety of approaches can be taken. 


Treatments to Consider When No Cause Can be Found. 

In cases where the precise cause can not be identified, my general approach is to target scalp fungi, bacteria and inflammation. As I often say to physicians who visit with me in my clinic a helpful “memory tool” to treat scalp smell is to remember that dealing with challenging cases of scalp smell requires us to call in “smelly undercover FBI agents on a daily basis to deal with the slippery cover up.” 

This 'memory tool' reminds us we need to

a) uncover any scale

b) kill bacteria (letter B in FBI)

c) kill fungi (letter F in FBI)

d) reduce inflammation (letter I in FBI)

e) shampoo daily

f) slippery (reduce oils)

f) cover up any smell


The three letter FBI acronym stands for agents that target fungi (letter F), bacteria (letter B) and inflammation (letter I)

A variety of approaches are possible and there is no one treatment approach that fixed everything. But with a logical approach we can often combat challenging cases of scalp smell.

I generally start patients with a once daily to twice daily shampooing regimen which includes antibacterial cleansers alternating with ketoconazole shampoos and alternating with a sulphur shampoo containing salicylic acid. These are done in 3 day cycles (see below) amd are left on the scalp for three minutes each application. Depending on the specific situation, the patient may use a topical clindamycin/corticosteroid solution at night for a few weeks.


Initial Starting Routine:

Day 1 morning: Antibacterial cleanser 3 min

After morning shampoo: apply 3 drops peppermint oil in jojoba to scalp

Day 1 evening: Clindamycin/steroid solution 


Day 2 morning: Ketoconazole shampoo 3 min

After morning shampoo: apply 3 drops peppermint oil in jojoba to scalp

After morning shampoo: apply 3 drops peppermint oil in jojoba to scalp

Day 2 evening: Clindamycin/steroid solution 


Day 3 morning: Sulphur/SA shampoo

After morning shampoo: apply 3 drops peppermint oil in jojoba to scalp

Day 3 evening: Clindamycin/steroid solution 


Repeat cycle...


Let’s look at each of these steps in a bit more detail.


1. Uncover

In many of these smelly scalp syndromes, it is important to get rid of any scale or crust that might be harbouring bacteria. For this reason, I frequently recommend use of a shampoo containing salicylic acid. Salicylic acid helps remove scale. There are many ways to bring salicylic acid into a treatment program but shampoos are frequently the easiest. Neutrogena T sal is a common sulphur based shampoo which contains salicylic acid. Many patients with SHS like both components, but particularly the sulphur component.


2. Fungi

Yeast are a common culprit in scalp smell for many patients. Yeast known as Malassezia are thought to be the key underlying cause of seborrheic dermatitis. Any patient with scalp smell needs to eradicate yeast as a fundamental step in treatment. Ketoconazole is a good first step in eradicating yeast in patients with SSS. However other options can be considered including

a) zinc pyrithione shampoo 

b) ciclopirox shampoo

c) selenium sulphide

d) oral itraconazole

e) tea tree oil shampoo 

f) 1 teaspoon tea tree oil in 1 cup water


3. Bacteria

Bacterial load on the scalp should be reduced as part of a basic regimen to stop scalp smell. Antibacterial soaps containing triclosan were common antibacterial agents we used in the past. These are less commonly used given the ban on triclosan in many countries. However, I am a fan of  antibacterial washes for smelly scalp syndrome  -including harsh ones. Normally, we don't use soaps on the scalp as they tend to be harsh and tend to leave a residue. In many patients with SSS/SHS, this actually proves beneficial.

The use of antibacterial agents should be left on for 3 minutes.

Depending on the patient, bacterial load can also be controlled with

a) Topical clindamycin

b) Topical or oral metronidazole (Flagyl)

c) Oral doxycycline

d) Benzoyl peroxide body washes (10%) used as scalp cleanser

e) topical chlorhexidine 2-4 % applied with wash cloth (must be kept out of eyes and ears)

e) topical triclosan and phisohex - no longer used.


4. Inflammation

Inflammation in the skin of the scalp can change the types of oils that are produced and the types of free fatty acids that are released. In the early weeks of treating scalp smell, I recommend use of a mid potency topical steroid such as topical betamethasone valerate to help reduce inflammation. This can be used nightly with topical clindamycin compounded into it.


5. Reducing oils

A variety of options are available if it is discovered that the patient is producing too much oil. One can first see if shampoos like ketoconazole shampoo discussed above can help dry things out. The other option is to use various dry shampoos throughout the day. These can be washed out at night with one of the shampoos discussed above so that the clindamycin/betamethasone can be applied.

In rare cases, scalp smell can be improved by drastically and dramatically affecting the size of the oil glands with oral medications such as isotretinoin. In patients with bacterial scalp issues, reduction in oil glands makes bacteria less likely to remain on the scalp - a second benefit.


6. Cover up

There are a variety of other options to cover up smell. Use of essential oils such as peppermint oil, rosemary or lavender can be applied to the scalp. 3 drops of peppermint oil for every teaspoon of jojoba oil is a great start. This can be applied after the morning shampoo.

Rinses with baking soda help some. 1 teaspoon of baking soda is added to 1 cup of water along with a few drops rosemary. This is allowed to sit on the scalp 20 minutes.

For others, mixing 1/4 cup apple cider vinegar 3/4 cup water with 10 drops rosemary essential oil and 1/8 cup lemon juice forms a tonic than can be left on the scalp 30-40 minutes before rinsing off



Managing scalp door can be challenging. Too often it is forgotten that the fundamental step in treating scalp door is to treat the underlying cause of the door. That may require an examination by a dermatologist to determine that.  The use of suphur based shampoos with salicylic acid together with various antibacterial washes and anti-seborrheic shampoos is a good starting point. More advanced options should be discussed with a dermatologist including use of isotretinoin or metronidazole.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Focal Atrichia in AGA

Focal atrichia: What does it mean? 

Focal atrichia refers to small circular areas on the scalp that are devoid of hair. These areas are typically slightly larger than a pencil eraser. 


Focal atrichia is seen in both male and female androgenetic alopecia and more common in more advanced stages. They may contain a few tiny vellus hairs if one looks closely but eventually these tiny hairs disappear over time. Hair regrowth does not occur in these areas.

Studies by Olsen and Whiting (see references below) showed that focal atrichia was present in 44% of women with female pattern hair loss, including 67% of late onset vs 15% of early onset, compared to 3/146 (2%) of those with other hair disorders. Hu and colleagues showed that focal atrichia in men with balding was associated with more advanced stages.


Olsen EA, et al. Focal Atrichia: A Diagnostic Clue in Female Pattern Hair Loss. J Am Acad Dermatol. 2017.

Hu R, et al. Trichoscopic findings of androgenetic alopecia and their association with disease severity. J Dermatol. 2015.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Anti-tumour necrosis factor (TNF) agents such as adalimumab and infliximab have been shown to have benefit in inflammatory bowel disease (IBD). It is now recognized that cutaneous reactions such as new onset psoriasis or psoriasiform-like reactions are among the most common adverse reactions. 

Researchers from Australia retrospectively reviewed cases of anti-TNF-induced psoriasis or psoriasiform manifestations in IBD patients. A total of 10 (six females) of 270 (3.7%). IBD patients treated with anti-TNF therapy developed drug-induced psoriatic or psoriasiform-like reactions: five patients were treated with infliximab and five with adalimumab; nine had Crohn disease. The duration from start of anti-TNF agent to onset of rash was about 8 months on average. The scalp was the most frequent distribution (7/10). Three patients discontinued anti-TNF treatment with resolution of the rash. Topical treatment of the lesions allowed continued use of biological agent in the majority. 


Peer FC et al. Paradoxical psoriasiform reactions of anti-tumour necrosis factor therapy in inflammatory bowel disease patients. Intern Med J. 2017.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Can drugs cause or exacerbate seborrheic dermatitis?

Can drugs cause or exacerbate seborrheic dermatitis? 

Seborrheic dermatitis is red, scaly and sometimes itchy scalp and skin condition that closely resembles dandruff. The condition is extremely common and affects 5 % or more of the population.

There are a variety of well known factors that increase the risk of seborrheic dermatitis including depression, neurological conditions, alcoholism, stress, HIV/AIDS, organ transplantation and advanced age (over 60). 

Drugs are also potential causes of either worsening or inducing seborrheic dermatitis. The anti-cancer drugs are well known causes of seborrheic dermatitis like eruptions. Examples include dasatinib, gefitinib, sorafenib, sunitinib, vemurafenib, 5-FU, Erlotinib, cetuximab, IL-2, and interferon-α. I often advise a scalp biopsy in many of these cancer drug associated seborrheic dermatitis-like presentations as many are actually forms of scarring alopecia (ie EGFR inhibitors). 

Other drugs causing a seborrheic dermatitis-like eruption include griseofulvin, cimetidine, lithium, buspirone, haloperidol, lithium, methyldopa, gold, ethionamide, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol, and thiothixene.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Loss at the Nape of the Neck: What are the main causes?

Losing Hair at the Nape: What are the main Causes?

Hair loss can either be localized (meaning one area of the scalp) or diffuse (meaning all over the scalp). There are many causes of hair loss at nape of the neck and the back of the scalp. 


1. Traction alopecia

Screen Shot 2017-11-08 at 11.14.48 PM.png

Traction alopecia refers to a type of hair loss due to the tight pulling of hair. The back of the scalp is particularly susceptible to loss of hair.  Hair styling practices can frequently lead to traction including braids and weaves and pony tail.  If traction alopecia is of recent onset, hair regrowth can occur even without treatment. If traction is longer standing, the hair loss can often be permanent.  Some women with hair loss that looks like traction actually have a scarring alopecia known as cicatricial marginal alopecia. 



2. Alopecia Areata

Screen Shot 2017-11-08 at 11.12.14 PM.png

Alopecia areata is an autoimmune disease that affects about 2 % of the world. Hair loss can occur anywhere. Alopecia areata can frequently cause hair loss specifically at the nape in some patients. The particular form that causes loss at a the back of the scalp is the 'ophiasis' form. The ophiasis form is frequently resistant to standard treatments although topical steroids, steroid injections and diphencyprone are typically first line. 



3. Androgenetic Alopecia


Androgenetic alopecia (male and female thinning) typically causes hair loss at the top of the scalp. In men, the temples and crown are most often affected. In women, the mid-scalp region is generally affect first. The back of the scalp can also be affected although this is not typically thought of. Hair thinking along the nape is not uncommon in advancing balding in men and women. 



4. Frontal Fibrosing Alopecia


Frontal fibrosing alopecia (FFA) is a type of scarring alopecia. FFA typically affects women between 45-70. Most often hair is lost along the frontal hairline and eyebrow. However the back of the scalp (at the nape) and frequently be affected. The hair loss in the nape typically starts at the sides (left side and right side) just behind the ears. Treatments for FFA include topical steroids steroid injections, topical calcineurin inhibitors. Oral drugs include finasteride, doxycycline and hydroxychloroquine at the top of the list.


5.  Heat and Chemicals

Heat and chemical treatments can lead to hair shaft damage and hair loss at the nape. Frequently, heat and chemical overuse leads to an increased tendency to develop traction alopecia which si discussed above. 


6. Acne keloidalis nuchae

Acne keloidalis nuchae (AKN) is a condition that can affect both men and women. Small papule or bumps develop along the posterior scalp and are accompanied by hair loss in the region as well.  The hair loss in AKN is often permanent and can lead to thicken and thicker scars some of which are disfiguring. 


7. Hair shaft disorders

Some individuals are born with abnormalities in how the hair shaft is produced. This frequently leads to hair breakage. Monilethrix is one of the hair shaft disorders that frequently leads to hair loss along the nape. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Psoriasis + Seborrheic Dermatitis


Sebopsoriasis is a scaly scalp condition with features of both psoriasis and seborrheic dermatitis.

Many patients with psoriasis have overgrowth of Malassezia yeast which are known to play a role in seborrheic dermatitis. Some evidence suggests that Malassazia yeast may even be involved in the pathogenesis of psoriasis. Patients with sebopsoriasis often have a family history of psoriasis or seborrheic dermatitis. Lesions are less silvery white than classic psoriasis bit more defined and deeply red than classic seborrheic dermatitis. Scale is often thicker in areas than seborrheic dermatitis.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Scalp Elasticity: The Mayer Paul Formula

The flexibility or "elasticity" of the scalp is an important consideration for hair transplant surgeons performing follicular unit strip surgery (FUSS also called FUT). In general terms, the more elastic an individual's scalp is, the greater the number of grafts that can be taken ...  and the better the final hair density that can be created for the patient undergoing surgery.


A number of formulas and methods have been proposed to help surgeons calculate elasticity. There are even a number of commercial available instruments and tools that can also be bought to help calculate scalp elasticity.


The Mayer Paul Formula

The Mayer - Paul Formula is a well established method for calculating the elasticity of the scalp. To calculate elasticity on the scalp, two lines are initially drawn 5 cm (50 mm) apart. Then the two lines are compressed together (ideally with the two thumbs). Then, one records how far apart the two lines are after being squished together.

Scalp Elasticity is calculated as

[(50 mm - new position in mm)/50] multiplied by 100 %



In this video example, the lines have been squeezed from 5 cm apart to 2.5 cm apart (X = 2.5 for the formula in this example). The elasticity is calculated as 50 %. According to the Mayer Paul formula elasticity of 30 % or more means that a strip of at least 2.2 cm can be taken (if needed) on a first FUT surgery. In contrast, 10 % elasticity means that the strip should be kept less that 1 cm in width

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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The Nevus Sebaceous.

Nevus sebaceous

This is an uncommon scalp growth that is noticed at birth. The affected newborn has a hairless patch and the area remains devoid of hair for life.

The area is typically slightly yellow, orange or pinkish color. The area can change in appearance over time, especially at puberty. At puberty, the nevus sebaceous becomes much more bumpy.

Additional Changes in the NS

A number of benign and malignant tumors may occur in the nevus sebaceous. The most common benign tumors are the trichiblastoma and syringocystadenoma papilliferum. In fact, about 10-30 % of nevus sebaceous develop these benign tumors.

Surgical excision: Should these be removed?

Years ago, most individuals with a nevus sebaceous of the scalp were booked for surgery to have it removed out of concern for malignant transformation. The approach is different nowadays. Now the rate of transformation is understood to be very low (less than 1 %) and routine monitoring (rather than excision) is more common.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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What causes a red, itchy and bleeding scalp?

Redness, Itching and Bleeding

There are quite a few causes of a red, itchy and bleeding scalp. Anyone with such a trio best see a dermatologist to guide them.


Common conditions

Conditions such as psoriasis and seborrheic dermatitis are common in the population and must be placed at the top of the list of possibilities. Other causes include folliculitis decalvans and other scarring alopecias, infections, bites, infestations, allergy and irritation. 

Pinpoint bleeding in this photo tells me right away that the patient I am examining may be quite itchy. As it turned out, they were! 

I often prescribe a topical steroid to help reduce itching.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Does scalp psoriasis cause hair loss?

Scalp psoriasis and hair loss

Psoriasis is an inflammatory condition affecting about 3 % of the world. The skin, hair, nails and joints are affected. We are also now learning that individuals may also have increased risks of cardiovascular disease. About 50 % of patients with psoriasis have scalp involvement so psoriasis is a common issue in the hair clinic. For the majority of those with scalp psoriasis, psoriasis does not cause hair loss. 


When does hair loss occur?

Even though most individuals with scalp psoriasis do not experience hair loss as a direct result of their psoriasis, severe psoriasis can cause shedding (telogen effluvium) and rarely even a scarring type of hair loss. Some individuals with psoriasis have scalp itching - and repeated itching can cause hair breakage and subsequent hair loss.

The photo to the right shows the typical white powdery scale of psoriasis. It is easily mistaken for the scale of seborrheic dermatitis. The scale of seborrheic dermatitis, however, tends to be more yellow and greasy rather than white and powdery.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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What is "pityriasis amiantacea"?

Pityriasis amiantacea

Pityriasis amiantacea is not a diagnosis. Rather it is a phenomenon that sometimes happens to the skin and hairs during the process of inflammation. 

The finding of pityriasis amiantacea is often seen in patients with psoriasis, seborrheic dermatitis and various eczemas. 

The photo to the right is a magnified photo of the scalp of a patient with "pityriasis amiantacea" from psoriasis.

Treatment includes identifying the root cause. Treatment such as topical steroids, steroid injections, anti dandruff shampoos, salicylic acid, tar all play a role in treatment. 

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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