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Other topics covered here - Dermovate, Nizoral Conditioning Shampoo, Minoxidil "burn"

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Some people called it scalp inflammation, others called it "minoxidil burn". In any case, this is some kind of scalp conditions characterized by severe itch, redness, excessive flakes and crust etc. This condition is commonly reported by people using Rogaine or topical minoxidil, that's why some people called it "minoxidil burn". It appears that people who are using 5% minoxidil are suffering more from scalp inflammation than those using 2%. Some doctors say that it is the alcohol in Rogaine that is causing the problem whereas others, eg: Dr. Proctor, a hair specialist in the U.S says that it is propylene glycol in Rogaine that is causing the problem. It is unclear why this condition is more prevalent among people who are using 5% topical minoxidil than 2%.

Please note that scalp inflammation can happen even if you are not using Rogaine or topical minoxidil. In fact, there is no scientific study which shows that topical minoxidil is the cause of scalp inflammation. Some people are simply more prone to certain scalp conditions than others. Besides topical minoxidil, Retin-A is also known to be associated with scalp inflammation. Specifically, scalp treated with Retin-A will become vulnerable to sunlight and may develop an inflammatory reactions due to sun's exposure. In addition, some suggested that inflammation may be related to bacterial activity on the scalp. Researchers Young et al. proposed that inflammation is a direct cause of bacteria that inhibits in the hair follicles. 

According to Dr. Razack, another hair specialist in the U.S and author of the book "Conquering Hair Loss", many researchers have suggested that scalp inflammation is closely related to hair loss. There was a clinical study   conducted by Young et al in 1991 showing that 96% of the participants in the study who have androgenic alopecia have also demostrated some kind of inflammatory response on their scalps. In another study conducted by Abell et al., inflammation was present in over 75% of the scalp biopsies obtained from close to 700 patients with androgenic alopecia.  

Personally, I believe that the crustings and flakes on the scalp are the major culprit in scalp inflammation related hair loss. Although both the crustings and flakes are simply dead skin on your scalp, they are responsible for physically pulling my hair off as they are breaking loose from the scalp.

For more in-depth analysis on inflammation and hair loss, a good reference would be the book "Conquering Hair Loss". However, we are not going to get into the technicalities here since what I really want is to talk about the treatments available for scalp inflammation.

Neutrogen T-Gel
I think the first thing that everyone should try is Neutrogen T-Gel. It is the least expensive of all treatments, about US $8 a bottle and virtually any drug store sells it as an over-the-counter shampoo. No prescription is required. Although it doesn't work for everyone, some have repoted good results without having to turn to other more expensive alternatives. So I would definitely give T-Gel a try before anything else. However, not everyone responds to T-Gel. In fact, some, like myself, really dislike the shampoo. It dries up my hair and leaves stains on my scalp.

Nizoral Shampoo
If T-Gel fails, the next thing that I recommend is Nizoral shampoo. It is more expensive than T-Gel and a prescription is required for U.S residents. Nizoral costs well over US $30 for one bottle in New York City and I guarantee you can find a much better deal ordering over the internet.  The active ingredient in Nizoral is 2% ketoconazole which in addition to being an anti-fungal agent, is also an antiandrogen and immunosupressant. All these attributes are beneficial to hair growth. Nizoral is intended to be used only once or twice a week. So it is important that you alternate Nizoral with another shampoo for hair loss.

Nizoral Conditioning Shampoo
Many people complain that while Nizoral shampoo works for them, it also makes their hair and scalp dry. In fact, even people who have oily hair and scalp, including myself, complain that Nizoral is too drying for the hair. Good news: Nizoral Conditioning Shampoo is now available. However, it is not widely available in every country at this point (not even in the U.S - to my knowledge) and your best bet is to shop for it on the internet. This is a great shampoo, it works just as well as regular Nizoral shampoo, has the same active ingredient - 2% ketoconazole and does not leave your hair and scalp dry. This one is now on my favorite list. It is slightly more expensive than regular Nizoral shampoo.

If both T-Gel and Nizoral fail, then your last resort is Dermovate, or sometimes called Temovate in North America. It is a topical scalp lotion that is available by prescription only for U.S residents. Dermovate is not cheap. A 50ml bottle costs over US $60 in New York City. However, you are supposed to place only a few drops on affected areas and a 50ml bottle should last you more than two months. The active ingredient in Dermovate is Clobetasol 17-propionate 0.05%, which is a kind of cortisone. Dermovate is extremely effective and it works almost instantaneoulsy. Depending on the severity of your conditions, continuous application for  up to six weeks may be required before your scalp is clear of all flakes and crust. Once your conditions have been stablizied, then you use Dermovate only when needed. For those who use Rogaine or topical minoxidil, Dermovate should be applied shortly after you put on Rogaine. Also, for best results, it is highly recommended that you include both Nizoral shampoo and Dermovate in your regimen.

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