Persistent Red Scalp After Use of Topical Minoxidil

Why is my scalp red after minoxidil?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the use of topical minoxidil.

Question

I used topical Rogaine and now have a red scalp! I used to use a tar based shampoo in the past and really liked using it… but now I can’t because my scalp is so sore.
What should I do?

Answer

Be sure to see a dermatologist to help figure this out. Either you have an 1) irritant contact dermatitis to Rogaine or 2) true allergic contact dermatitis to Rogaine or 3) the minoxidil has flared underlying seborrheic dermatitis or 4) the red scalp is due to something completely different and the Rogaine is just a coincidence.

If you want to read more about the possible causes of a red scalp, be sure to check out the link below.” You and your doctors can slowly sleuth this all out.  Sometimes a biopsy is needed to figure out what causes a red scalp. Sometimes patch testing is needed. But in every single case - a really good history and really good examination is needed.

Regardless of the exact cause, you’ll likely need some topical steroids for a few days (or weeks) to reset things and get back on track. Topical steroids are very safe when used for short periods of time and under supervision from someone who understands how to prescribe them.

I’m not worried about the tar shampoo discomfort right now. Any shampoo will often hurt when applied to a scalp that is really inflamed. A tar shampoo will likely be fine again once you sort things out as to what’s causing the current issue. You may need a new formulation of minoxidil if you are irritated by it or a good dandruff shampoo if the reason for the redness is a flare of seborrheic dermatitis. If you are truly allergic to minoxidil, you’ll possibly need some patch testing to prove it and you’ll need to stop using it all together if you are truly allergic to the minoxidil compound. Rogaine is not the only option for treating hair loss so get some good advice and see where it takes you.

If the cause of the red scalp is felt to be a scarring alopecia, such as lichen planopilaris or folliculitis decalvans you may need a biopsy. Be sure to see a dermatologist for a detailed evaluation of all the possible causes.

What treatment is possible for a red scalp?

The treatment all depends on the cause. We can’t talk about treatments until we determine exactly the cause. If the cause is related to a scalp disease that has now flared, treatment of the particular scalp condition may be needed and you may be able to continue Rogaine. If the cause of the scalp redness is a true allergic contact dermatitis, you’ll need to stop Rogaine. However, many patients with topical minoxidil allergies can still tolerate oral minoxidil. Other treatments for androgenetic alopecia can also be considered such as topical antiandrogens, oral antiandrogens, laser, PRP.

Good luck.