[58F] With persistent scalp and skin issues

Patient Description

A 58-year-old female has been experiencing a suspected fungal infection in her hair follicles for six years. Despite trying various treatments, including antifungal sprays typically used for feet, there has been no improvement. The patient describes a persistent spot on her scalp and widespread skin depigmentation that has remained unchanged over time. The affected scalp area is characterized by black hairs, contrasting with her natural blonde hair, and the hair appears as if it has a perforated line. Additionally, she experiences the formation of tiny concave scabs on her hands, particularly when she brushes her hair over the affected scalp area. The patient has not seen a doctor in a long time, and previous consultations did not yield any significant findings.

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Arora's Assessment

What might be happening

Based on your description, there are a few potential conditions that could explain your symptoms:

  1. Fungal Infection: The persistent issue with your hair follicles and the change in hair color could be due to a fungal infection, such as tinea capitis. This type of infection can cause hair loss, changes in hair color, and scalp irritation. Antifungal treatments, either topical or oral, are typically used to treat this condition.

  2. Vitiligo or Other Pigmentation Disorders: The loss of pigmentation on your skin might be related to vitiligo, a condition where the skin loses its pigment cells, leading to discolored patches. This condition is usually diagnosed through a physical examination and sometimes a skin biopsy.

  3. Morgellons Disease: Although controversial, Morgellons disease is characterized by the sensation of crawling on or under the skin, and sometimes fibers or threads appearing from the skin. This could explain the sensation you described and the scabs forming on your hands.

  4. Dermatological Conditions: The scabs and changes in your skin could be related to a dermatological condition that might require a biopsy for accurate diagnosis.

What you can do

Fungal Infection:

  • Consider using antifungal shampoos or treatments specifically designed for the scalp.
  • Keep your scalp clean and dry to prevent further fungal growth.

Pigmentation Issues:

  • Protect your skin from the sun, as sun exposure can worsen pigmentation issues.
  • Consider seeing a dermatologist for a proper diagnosis and potential treatments, such as topical corticosteroids or light therapy.

General Skin Care:

  • Avoid scratching or picking at your skin to prevent further irritation or infection.
  • Use gentle, fragrance-free skin care products to avoid additional irritation.

Symptom Tracking:

  • Use MDandMe to journal your symptoms, track any changes, and share this information with a healthcare provider for a more comprehensive evaluation.

What you should look out for

  • If you notice any new or worsening symptoms, such as increased pain, spreading of the affected areas, or signs of infection (redness, swelling, pus), seek medical attention.
  • If you experience any systemic symptoms like fever, fatigue, or unexplained weight loss, it's important to consult a healthcare provider.
  • Given the complexity and duration of your symptoms, consider scheduling an appointment with a dermatologist or a healthcare provider for a thorough evaluation and appropriate testing.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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1 mo ago


People Also Ask


What are common symptoms of a fungal infection on the scalp?

Common symptoms of a fungal infection on the scalp, such as tinea capitis, include itchy, scaly patches, hair loss, and sometimes black dots where hair has broken off. The scalp may also become red and inflamed.


How is vitiligo diagnosed and treated?

Vitiligo is diagnosed through a physical examination and sometimes a skin biopsy. Treatment options include topical corticosteroids, light therapy, and depigmentation therapy, although results can vary.


What is Morgellons disease and how is it managed?

Morgellons disease is a controversial condition characterized by the sensation of crawling on or under the skin and sometimes fibers appearing from the skin. Management often involves addressing symptoms and may include dermatological and psychological support.


What should I do if over-the-counter treatments for a suspected fungal infection are not working?

If over-the-counter treatments for a suspected fungal infection are not effective, it is important to consult a healthcare provider. They may prescribe stronger antifungal medications or conduct tests to confirm the diagnosis and rule out other conditions.

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