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I’m 23 this year, male. Have been having real bad hair fall since age 20-21 years old. Red patches of the scalp can be seen, scalp itch from time to time. Hair/Scalp smells sour/bad easily after bath. Tried out different shampoo including hairloss shampoo from Silkpro and Klorane but nothing worked. Went to seek help at NSC, was told to have Genetic hair loss. Was given Minoxidil 2% to try out and given Minoxidil 5% on a later date. Yet, condition did not improve at all. Have stop using minoxidil for about 1 year now, as it does no effect/changes. Hair still falling, scalp still having red patches, still itch from time to time, still does smell sour/bad easily after bath. what could my condition be? Is it really Genetic hair loss?
Thanks in advance.
I agree with Ethan that there may be 2 separate problems here. Genetic hairloss (androgenetic alopecia) is a gradual thinning of the hair over the frontal and vertex area. The scalp in androgenetic is not usually red.
If there is redness of the scalp, this may be due to seborrheic eczema or psoriasis, but there are a number of other conditions that can also cause scalp redness.
There are also some rarer causes of hairloss which can have both redness of the scalp and hairloss. Some of these conditions can cause scarring alopecia.
I would suggest that you revisit your dermatologist for reassessment to confirm the diagnosis and for further management of your problem.
Dr Colin Theng
Thanks for your question. I see two issues at hand:
- You are now having red patches on your scalp that are itchy
- You have noticed hair loss for some time, for which minoxidil did not work.
The problem is I don’t know the timeline of both, and whether the 2 issues are linked since it’s already been 1 year since you’ve visited the NSC.
Eg. It may be that when you were seen at the NSC, the red patches were not present and you had a hair loss pattern typical of genetic hair loss (or male pattern hair loss).
Is it really genetic hair loss?
Yes it still could be, but it’s more important to have a doctor assess you for the cause of your red itchy patches right now as it could be contributing to the cause of your hair loss.
Once that’s treated you may find that you lose less hair.
What could my condition be?
There are a number of conditions that could be the cause of red, itchy patches on your head.
Some possible causes include (in order of likelihood):
1. Seborrheic dermatitis
It’s a condition that I saw very frequently when I was at the NSC, amongst males in your age group.
Seborrheic dermatitis is an inflammatory condition of the scalp, affecting more males than females. It causes red, flaky skin that can be itchy, just as you’ve described.
Psoriasis is immune disease which can affect your skin, nails and joint. Scalp psoriasis occurs in about 50% of patients with psoriasis.
Patients with scalp psoriasis experience scalp redness, itching, flaking and scaling. Patients may also have bothersome itching.
Although the redness and flaking often cause embarrassment, scalp psoriasis does not usually cause hair loss.
3. Scarring alopecias
Less commonly, there are a group of conditions known as scarring alopecias that may also be associated with redness of the scalp and itching, and also cause permanent hair loss.
A dermatologist will be able to identify these conditions, and perform a skin biopsy to confirm the condition.
4. Allergic reaction/irritation of the scalp due to topical products
Some treatments for hair loss can also be associated with itchiness and redness, including minoxidil.
Other products that you use on your scalp can also cause allergic reactions/irritation, including hair gel, hair dyes, soap and shampoo.
If this is a case, you may notice itchiness and redness not just on your scalp, but also a rash present on your neck, ears or back, whereever the product comes into contact with your skin.
Infections are a possible causes of redness. Bacterial, viral and fungal infections may cause redness in the scalp.
Your doctor will have to take a history, do a thorough scalp examination, and sometimes submit a swab for further tests.
Scalp folliculitis is quite commonly seen in Singapore too, and can account for itchy red patches and pustules. It’s caused by your body mounting an inflammatory response to components in your hair follicles as a result of microorganisms.
I offered you up all these possible causes not for you to diagnose yourself, but to understand why you need to revisit your doctor to confirm the diagnosis, and to start you on the right treatment.
My recommendation would be to get a polyclinic letter and go back to the NSC as they will have medical records from the previous time they saw you.
Otherwise, you could also visit a private dermatologist.
Once the red patches are resolved, you can start to seek treatment for your hair loss. You can read more about hair loss treatment in Singapore here.