The Scalp

Filed under: 2.1 - Seborrheic Dermatitis

The Scalp.-If local treatment is to do any good, the hair must be cut as short as possible.

A. The Dry Type With Small Scales: First thickly apply the follow­ing salve for three days. Rub it in well, and cover the head with a cheap cotton cap.

Ac. salicylic gr. xx Petroleum jelly J iv

On the fourth day scrape out with a fine comb as much of the scale as pos­sible. Shampoo with pHisoHex or a mild soap. Then apply Pragmatar ointment.* This consists of coal tar, sulfur, and salicylic acid. It is a fairly strong ointment, but most scalps tol­erate it. Use this for three days, shampoo again, then leave the scalp alone for three days. Repeat the treat­ment, and keep up this schedule as long as necessary.

B. Crusted Type: Here there is a foul, piled-up accumulation of yellow crusts and scales, with the hair matted down in it, and underneath all this an inflamed scalp. It is necessary to do away with this corruption and get down to bedrock before any good can be done. It is not possible to do a good job of hair cutting until the whole mess has been softened up. The best way to do it is with continual dressings of thick gauze packs wet with normal saline solution, kept on by a tightly fitting cap. After about two days of this treatment the hair can be cut, and the scalp gently scraped and washed with pHisoHex.

Fig.  5.-Seborrheic   dermatitis.      Local   treatment:     tar   paste   or   sulfur   and   salicylic   acid  ointment.

This usually leaves a pretty much reddened, inflamed sur­face. If there are oozy places the oozing must be stopped. If there are not many and they are small, wet dressings of 14 per cent silver nitrate solution can be used. If the whole head is involved it is best to use Burow’s solution (1 tablespoonful to 1 glass of water). Then boric or zinc oxide ointment is applied for a few days, and when the inflammation has calmed down somewhat, proceed with the Pragmatar ointment as in the dry type. If there is pustulation, neomycin, bacitracin, or erythromycin ointment should be used, plus an anti­biotic internally.

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