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Scalp Is Itching, But Not Inflamed or Red

Doc,

I am 23 and for the past three years I have experienced an itchy scalp and hair loss. About a year ago I went to the doctor and he said to use anti-dandruff shampoo. However this has done nothing to cure the itchiness of the scalp, which seems to be associated with hairloss, with both becoming more intense over the last six months. It seems to be rapid thinning across the crown and top midline where prior it was a slow receeding hairline. My question is why the sudden change from a slow receeding hairline to rapid hairloss and why the itchiness that is associated with the hairloss, knowing that my scalp is not red or inflamed. Sometimes it feels like a crawling sensation across the scalp.Also, I am thinking of taking propecia to slow the hair loss. Is this wise? What should I know before starting?

Dry scalp tends to cause an itchy scalp. The more you scratch or think about your scalp, the more you will scratch your scalp. Excessive scratching can cause hair loss if it pulls the hair as you scratch (called trichotillomania). I am not certain if there is a true relationship between itchy scalp and hair loss. I believe taking Propecia would help with Male Pattern Baldness (MPB), but as I have said many times on this blog, you need to have a diagnosis first. Propecia could either regrow hair, stop the hair loss, or slow down the process of hair loss in someone with real male genetic hair loss.

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Scalp Flap Experience

I am a patient of yours and I read a previous blog question and response from you the other day where you worked the problem out with the patient. I came to you 13 years ago with a problem that others could not help me with. After I explained the problem to you (which you listened carefully) I went into my solution. Although I prefer you not to use my name, you might want to tell your audience my story. I have been forever in your debt and grateful.

I remember you very well. You came to me after having done two flap procedures where sections of your scalp were moved from the back and sides of your head to cover the front (like a banana peel). This was an operation invented by a man from Argentina (Jury Flap) that was popular amongst certain surgeons in the late 1980s. This left the patient with an unnatural hair line, hair lying in the wrong direction and a hair line that (on my particular patient in question) was located far too high. You had gaps in many areas of your frontal hairline and there was no hair behind the flaps, leaving you bald in the mid-head. The donor area was depleted of substantial amounts of good movable hair so the supply was very limited and you lost much of your native neck hair as a result of the stress of the procedure.

I remember our first conversation and what you told me. You said (out of context): “I have been thinking about this problem for a few years now. I have met with doctor after doctor and when I finally figured out a way to manage the problem, none of the doctors who I visited would do what I asked them to do.” You went on to explain that your hair had a very strong wave and character to it (Italian hair of medium weight) and that if some hair was placed in front of these flaps, far in front of the flaps, then you could style your hair with a comb-back and a pompadour (like Elvis but much more subtle) and an angled combing style would hide your problem. You told me that you used gels and blow drying to achieve your looks; and you were convinced that this solution could solve your problem if I could find enough hair to transplant. After the first surgery (which was experimental on my part) and the ensuing 12 months it took for the hair to grow out to a good styling length, the results were fantastic. Your creative styling did wonders for the 600 grafts we put into your frontal hairline area. The good news was that we performed four surgeries over the 8 years we worked on you and you got enough hair to address, not only the frontal defects, but also the balding in your neck hair, which was a complication of the flap procedure. Today, you still must spend a few minutes every morning styling your hair, but even my eye can not pick out any defect on you- you looked great when last we met for dinner at one of your restaurants! Thanks for allowing me to share your experience.

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Scalp Expansion

For FUT I know some people have tight scalps and it’s hard to do FUT on them without leaving a wide scar. So kind of a strange question, but I know and have seen some other people who had large burns scars on their scalp or large sections of scalp removed due to cancer. In order to remove the cancer/ scar, close it up properly and make sure there was hair coverage over the area, they put what looked like silicone implants under the scalp; over the course of a couple of months, they filled it with saline to pre-stretch the skin and then took it out so when it came time for the reconstructive surgery, they could stretch the hair covered scalp over to cover the removed area of the scalp without any issues and without leaving a big scar.
So someone with a big balding pattern who would better benefit from the larger graft count that FUT provides, if their scalp is tight, can they first get these silicone implants to stretch the skin before the the FUT strip is taken? Better yet, can a person with balding just get this done to stretch their hair bearing scalp over the bald area without even needing to get transplants?
Scalp expansion with balloon expanders is a procedure commonly performed for injuries of the scalp, burns and other such problems. The normal scalp can be stretched over time if a balloon is placed under the scalp and slowly expanded. The expansion process requires a surgical strategy that requires a special type of expertise. Rather than answer you directly here, I will refer you to other posts on Baldingblog show examples of some patients who came to me with problems requiring balloon expansion or other such cases I became aware of; see here: https://baldingblog.com/?s=balloon
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Scalp Exercises to Regrow Hair?

Dr.,

I came across this web site: https://www.hairloss-reversible.com/my_approach.htm

I’m curious as to your opinion on the possibility that these “scalp exercises” might possibly regrow hair in some individuals after 8 or so months of doing the exercises as a result of increased blood flow to the scalp. It seems like a bunch of unscientific, hocus pocus to me, but if you read the other info on his site, it appears to be very accurate and makes the author
sound very credible.

Thanks.

I visited the above referenced link. It is based on the authors’ personal assumptions on the mechanism of hair loss. He tries to come up with a novel method for treating baldness based on his observation of his bald family members. Although it is interesting to follow his thought process, it is not scientific. Today’s medicine has changed drastically in comparison to 200 years ago. Back then, doctors had their own individual methods of treating different diseases, which at times where completely different and even conflicting with the others.

We use evidence-based medicine to support most of our treatment plans. Although lack of blood and oxygen of the scalp was once thought to be the main cause of baldness, today we know that the scalp oxygen level and blood supply is the same in balding and non-balding people. Massage therapy to increase the blood circulation can not stop the balding process.

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Scalp Exercise Device?

As an innovator in the field and with many patents to your name I am curious as to whether you have ever given thought to inventing a “scalp exercise” device. Imagine a motorized device strapped around one’s head moving the scalp up and down to increase one’s laxity in preparation for a future transplant. It would basically work as a scalp massage.

For a couple hundred dollars I’m sure many transplant patients would invest in one to maximize their graft numbers. Doing these exercises with the hands can get quite exhausting just after a few minutes.

It’s a good idea, but there have been a few patients who have came up with their own scalp exercise ideas that they are pursuing. In the grand scheme of things, scalp exercises are not the rate limiting step, nor do the exercises have a drastic impact on the success or planning of a hair transplant procedure in most situations.

Believe it or not, if I were to create a device for scalp massages and claimed it could loosen the scalp, it would be a medical device from the FDA’s perspective. It would then have to be proven safe and effective, a tall and expensive undertaking I might say.


2012-06-10 10:59:16Scalp Exercise Device?

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Scalp DHT, Propecia, and Androcur

Dear Dr. Rassman,

Article at hairlosstalk.com includes the following statement of “Spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles. As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body.”

1. Is it sufficient just to block scalp DHT levels, or serum DHT reduction also necessary to combat MPB? If scalp DHT inhibition is sufficient for MPB, is serum DHT inhibition dangerous for the body as claimed by this doctor?

2. You’ve told in one of your comments that propecia is a anti-androgen, but the prospectus states that it does not have an anti-androgenic effect. Could you please clarify?

3. It’s mentioned that Androcur is the best against MPB. Is this the case?

Your reply will be much appreciated.

Finasteride needs to go through the blood stream to get to the hair follicles. When it gets to the hair follicle it then fixes to the tissue and blocks the DHT. Finasteride is not dangerous to the scalp.

Finasteride blocks DHT and when it does this, the testosterone levels often rise. If the body would not produce testosterone in response to a DHT block, then one would say it is anti-androgenic, but it is foolish talk like that because testosterone needs to be present to have DHT made by the body (DHT being a byproduct of testosterone).

Drugs like Androcur are good blockers of androgens and can produce major side effects on the male sex drive, something I would not recommend for patients with male patterned genetic balding.


2009-03-17 16:39:58Scalp DHT, Propecia, and Androcur

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Scalp Burn Treated with Balloon Expander, How is it Done?

let’s assume that the burn is in the front and top of the head. A balloon is then placed in the crown to expanded in the scalp over a couple of months. Each week, about two times, fluid is injected into a ‘port’ on the balloon. With each injection, the balloon expands until it is stretched enough with enough redundancy to cover the burned areas. Then the burned scar is removed and the new scalp is advanced forward. I have been involved in a number of these challenging cases and the results are very rewarding. I have seen fully half of the scalp burned and treated successfully this way, sometimes with added hair transplants for fine tuning the process.


2020-03-05 15:03:59Scalp Burn Treated with Balloon Expander, How is it Done?

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Scalp Biopsy Misdiagnosis?

Is it possible to have a misdiagnosis from a scalp biopsy?

It depends upon what the biopsy is for. If it is for classic male pattern balding, then the answer is yes. If it is for cancer or other real pathology, there are always human variables that relate to skills and specialization.


2007-08-30 08:34:52Scalp Biopsy Misdiagnosis?

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Scalp Aches After Laser Therapy

I am a 23 yr old male, suffering from thinning hair. I went to a Dr, and he gave minoxydil as part of the treatment, and laser therapy as the other. He uses a laser pen like device, and runs it through my scalp for about 15 min. Well my question is that: everytime he does the laser therapy, my scalp aches a bit. I told him about it, and he says that it is normal, but i need more reassurance.
Thank you

I am unfamiliar with this “laser pen” he is using, but if you think that the aching follows the use of the laser pen, then I would believe that the laser pen is the cause. Perhaps it would be helpful to read my past blog entries regarding the use of lasers in hair therapy, and more specifically, this blog entry about Low Laser Light Therapy. I’m sorry I couldn’t be more helpful, but if you could get me the actual name of the device, I might be able to research it further.


2005-12-28 13:03:26Scalp Aches After Laser Therapy

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Why are my scabs still on my scalp

What you have are not scabs but necrosis of the skin in the recipient area. This means that these black areas have skin that has died as a result of your hair transplant. You need so see your surgeon as this will require wound care and eventually you will be left with a scar in that area with no hair growth in the blackened area.


2019-01-14 13:48:29Why are my scabs still on my scalp