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Real members of MyPrurigoTeam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

Scalp PN

A MyPrurigoTeam Member asked a question 💭
Wheeling, WV

I have PN on my scalp. Everything I read and see about it doesn't show or tell the many ways it presents. Like spiky things and nodules creating a skin like substance that encases the hair and layers and layers of trapped hair. Most of the bald spots have hair trapped underneath.

August 31
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A MyPrurigoTeam Member

Hi Pamela! What treatments are you using on your scalp? I have PN on my scalp as well. Some of the lesions are quite painful and large. My current treatment plan involves prescription Derma Smooth at bedtime, N-Acetyl-Cysteine (NAC 600 mg twice per day) supplement for itching, and Head and Shoulders Bare shampoo. This plan has pretty much kept my scalp under control.

September 1
A MyPrurigoTeam Member

I have found that prescription Derma Smooth has really helped me. My dermatologist injected the nodules with steroid medication which also helps the nodule to dissolve. I have liquid Clobetesol on hand, but I think that Derma Smooth works better.

September 6
A MyPrurigoTeam Member

I also have PN on my scalp. I also use Head & Shoulders shampoo. I like to take hot Epsom Salt Baths because it helps to break down the nodules & soften them on my scalp.

September 6
MyPrurigoTeam

What you're describing — spiky nodules, a skin-like substance encasing the hair, layered buildup, and trapped hair beneath bald spots — sounds like a really complex and frustrating presentation of scalp PN. You're absolutely right that most resources don't capture the full picture of how differently it can show up.

What's Show Full Answer

What you're describing — spiky nodules, a skin-like substance encasing the hair, layered buildup, and trapped hair beneath bald spots — sounds like a really complex and frustrating presentation of scalp PN. You're absolutely right that most resources don't capture the full picture of how differently it can show up.

What's likely happening involves a few things working together: - Hyperkeratinization — PN causes an excess buildup of keratin, the protein that makes up skin and hair. This can create thick, layered, crusty material that traps hair underneath.
- Nodule formation — Repeated scratching causes nodules to form and harden, which can feel spiky or rough to the touch.
- Hair follicle damage — Scratching and rubbing can damage follicles, leading to hair loss and bald patches. The trapped hair you're noticing beneath those spots is consistent with this kind of follicle disruption.
- Itch-scratch cycle — The more the area is scratched, the more the skin thickens and the cycle continues. A MyPrurigoTeam member described their scalp PN experience this way: "My hair is so thin, I call it see-thru hair 😄" — so you're definitely not alone in dealing with significant hair-related changes.

It would be really worth describing these specific presentations in detail to a dermatologist, as the buildup and trapped hair may benefit from targeted treatments like medicated shampoos with a pH between 4.5 and 6.0, topical corticosteroids, or other scalp-specific approaches.

August 31

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