Treating Scalp Scales
Question
My little girl is severely disabled and it is VERY difficult to get her hair washed. She requires 24 hour care by a LVN or myself. She is orally/nasally suctioned every 1-5 minutes for very large amount of continuous secretions. She can't swallow, gag, cough, see, hear, or move on her own. Because of her size, a dislocated hip from birth, and a recent knee fracture that never healed properly, her legs have to be kept completely supported. She gets daily bed baths, but giving her a tub bath is almost impossible. So, I would like to know how to go about clearing up a problem with her scalp. Because I am not able to wash her hair often, it has developed patches of an oily, yellowish substance. (This also shows up on her legs, forehead, and eyebrows.) This won't comb out. It isn't dry. Oil seem to make it stickier. She has very sensitive skin, so many things break her out, cause her tongue to swell and her body to become one big red blotch. I've heard of using Sebulex, but I'm afraid of what it might do. Any suggestions? Thanks so much.
Carrie C. - Northern, California
Dr. Greene's Answer
Dear Carrie, Thank you for writing. It is clear that you have little time for yourself. I am so impressed that you would take what little time you do have to use the Internet in order to find the answer to your question. I feel privileged that your search led to DrGreene.com and that you would pose your question to me.
Seborrhea Can Cause Scalp Scales
Based on your description, I am reminded of seborrhea or seborrheic dermatitis. Sometimes these scales are only of cosmetic concern, however they can be very itchy and uncomfortable, and can lead to infection. By watching your daughter you will be able to tell if they are bothersome to her. If they are not, you may want to allow them to stay, if removing them is too much of a hardship for you.
Treating Seborrhea
If you do determine that you would like to remove the scales, the oil that you spoke of using can be helpful. If you are going to use oil, I would recommend warm mineral oil, and leaving it on for a few hours to soften the scales. Tea tree oil (5%) may be helpful and appears to be well tolerated. Then, real scrubbing is often necessary to remove the thick adherent scales on the scalp.
You may need to use a more aggressive approach if the scales have become thick and crusty. A shampoo containing sulfur and salicylic acid generally works very well. Examples of this would be the Sebulex you mentioned or MG217 Medicated Tar-Free Shampoo, which are available over the counter. Just be sure to avoid her eyes as these shampoos are safe, but can sting the eyes. If this doesn’t work, a stronger treatment is indicated. The next line of attack is a phenol-saline solution, such as P&S Liquid, which is also available over the counter. This should be massaged into the scalp at night and then shampooed out the following morning.
Whichever of these agents you use, it is important for it to be left on for a sufficient amount of time to loosen the scales properly. The most common reasons for failure of any of these treatments are not allowing the agent to stay on for the recommended time, or inadequate scrubbing.
Using hydrocortisone cream, in addition to one or more of the above treatments, adds help to bring the problem under control.
Due to the sensitive nature of your daughter’s skin, I would try applying any treatment you use on just a little patch of skin before trying it on her whole scalp. Only proceed if she tolerates the patch well.
Even after you find one that works well for her, you may need to switch it after a few weeks. Many parents find that treatments seem to lose their effectiveness. Rotating your approach every few weeks will usually solve that problem.
If your daughter’s skin does not improve, I recommend consultation with a dermatologist (skin specialist).
Alan Greene MD
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