Sides And Back Thinning On Dutasteride (pics)

[MKP05]

I've just taken some additional photos to give you an impression of what is happening to my hair now. I don't have a professional camera with me now, an iPad fails to capture signs of empty hair follicles ('dots' indicating that I used to have hairs there) and differences in scalp colour and texture. I have no vision problems and every time during my experiments I clearly noticed changes to my scalp (during regression and regrowth phases). This is a very important predictor in my case.

Predictably, my current regression firstly affected my most deceased segment- my temples.
The first four photos - to give a general impression of my hairline now (different lighting). Obviously, it looks like sh*t now. Once again(.

Sorry to hear that you’re struggling. I guess it’s a constant battle even for someone who has a solid grasp on their condition, treatment and triggers. Your hair doesn’t look bad to me at all. Of course I know from experience that we are our own worst critics. I am still at the point where I can fool most people Inyo thinking I am simply receding when in actuality I have much more than that going on both on top and at the back. My struggle comes from knowing that I’ve yet to slow it down to an acceptable level and will very soon be exposed. it’s funny that for the whole 1.5 years I was on finasteride I could see the regression occurring but at least it was month by month. Now it is literally daily. That’s a harsh reality. I’d love to wake up tomorrow and say “well at least it looks as shitty as it did yesterday”. But there’s only been one day over the past 5 weeks where I’ve actually felt that I’ve held ground from the previous day. Every other day I’ve found at least one area where it’s gotten noticeably worse. I’m in total agreement with you that until I solve the chromic inflammation it’s not going to get any better.

I really hope you figure out what’s causing your current problem. You’ve been nothing but helpful to me in your advice and I do appreciate it. I’m confident that you will figure it out and get back on track.

 

[MKP05]

Everything is relative. To be fair, my hair now looks incomparably good than it was last summer. It was a total f*****g sh*t. Over the course of about 6-7 months of my regimen I have managed to get back about 3-4cm of my temples. It used to be a completely bald V-shaped spot that almost connected with a bald spot on my crown (a real lake in the forest'). I regret a lot that I have no photos of how my hair looked last summer. When I started I had no idea that I might find myself on a hair loss forum. Also, at that time I hardly cared about my hair. I had a forelock hairstyle that covered my hairline and had little idea that a have a considerable bald spoof my crown, I did not pay any attention. I started to address the issue only after some of my friends pointed it to me and giggled. Their point was that if I cannot take care of myself, then what should one expect of me in my professional etc field... I decided that I would address the challenge as throughly as I can.

The last photo: the cotton stick indicates where my temples ended last summer. In comparative terms, now I realise it was disgusting. Also, during treatment my overall hairline lowered by about 1-1,5cm (mid-forehead point)

Everything is relative. To be fair, my hair now looks incomparably good than it was last summer. It was a total f*****g sh*t. Over the course of about 6-7 months of my regimen I have managed to get back about 3-4cm of my temples. It used to be a completely bald V-shaped spot that almost connected with a bald spot on my crown (a real lake in the forest'). I regret a lot that I have no photos of how my hair looked last summer. When I started I had no idea that I might find myself on a hair loss forum. Also, at that time I hardly cared about my hair. I had a forelock hairstyle that covered my hairline and had little idea that a have a considerable bald spoof my crown, I did not pay any attention. I started to address the issue only after some of my friends pointed it to me and giggled. Their point was that if I cannot take care of myself, then what should one expect of me in my professional etc field... I decided that I would address the challenge as throughly as I can.

The last photo: the cotton stick indicates where my temples ended last summer. In comparative terms, now I realise it was disgusting. Also, during treatment my overall hairline lowered by about 1-1,5cm (mid-forehead point)

Wow. That’s incredible. I’m very happy for you. If I had to guess I’d say you are in the medical profession and quite possibly a dermatologist. You don’t have to confirm or deny since I’m sure thar could be a bit awkward a topic for a hair loss site. In any case I do appreciate your knowledge on these topics as well as your advice. It’s really been invaluable to me and I’d very likely be making compounding mistakes right now (ie clobetasol, corticosteroids, prednisone) if not for your warnings. At the very least you’ve given me great pause to ever consider these again although another areata outbreak would be difficult to treat otherwise. The bald spot on the back of my head is right where I got areata in 2018 (the one which grew to the size of a softball). This doesn’t seem like AA. There is some minuscule growth of hairs inside the oval and is not slick bald. Plus the hair pull test is not producing easily pulled hairs. This looks more like retrograde alopecia to me. It’s still just so suspicious to me that this occurred one week after switching medication. I actually thought it was improving two weeks ago but now seems to have gotten worse.

 

[Anatoly]

Just took another picture and you are absolutely right that I have major inflammation occurring at the back of my head and likely elsewhere. To the naked eye it is hard to detect but in pictures it seems quite clear. I’ve also started to get itchy red bumps again on my scalp again - something i haven’t had in probably 8 or 9 months. I know that this is another major sign of an underlying inflammatory issue.
------ It's good that you have your visit soon. So apparent inflammation means death for your hair. Reddish and ITCHY scalp is the worst thing, this means that a good number of hairs in these zones are already dead, be prepared for further shedding. Do not apply Rogaine on these zones.

In the past I was prescribed a topical solution of clindamycin for the bumps and it has worked but clearly this is not addressing the underlying issue. I’m afraid to use anything right now.

------- Topical clindamycin is popular. To my knowledge, you can use it safely without ruining your current experimental model. I warned you against oral antibiotics that affect your digestion system and absorption of nutrients essential for hair growth. With respect to lowering the risk of bacterial infections - ask your dermatologist about zinc supplements. Zinc (both topical and oral) is well-known as a treatment against bacterial infections and inflammation. It's of particular relevance to dermatological conditions. There is solid science behind zinc to improve one's hair. It also raises natural testosterone, which good: as a male ages, his T decreases, therefore his body converts more of the remaining T into DHT. Combating T, believing that this would also help against hair loss is a very weird idea, although some on this forum seem to take it very seriously. I take zinc sulphate 124mg twice daily (only after a good meal so as not to feel sick). Ask about a safe dose in your case and check for zinc deficiency.

what really aggravates me is that I have mentioned inflammation, the bumps, and general discoloration multiple times in office visits to different dermatologists and they have all sort of shrugged it off.
------- Those where bad dermatologists. I cannot imagine how they dared to fail to investigate further the causes and consider proper prevention measures. Maybe they thought this efforts was not worth salary paid to them.



I’ve sort of known since day 1 that inflammation was playing a large role here. Additionally I’ve noticed an increase in itchiness all over the last several days. Arms, legs. Face neck. Something is going on and it’s all connected.

------ DMSO has been used to address these conditions for decades. It's a reliable and safe (if used properly) drug.

I am interested to potentially try a Jak inhibitor and will discuss with my derm next week. Interesting about DMSO. I’ve seen a few others in this forum mention this but I think I’m a bit confused by your suggestions. How would I obtain DMSO in the safe concentrations you’re describing? I certainly don’t want to burn my scalp.

---- The thing is that you should strictly follow the rules and this drug will work for you. IF you fail to adhere to the rules, it will cause you a lot of damage:

Rules of DMSO use:
1) In European pharmacies it is usually sold as a concentrate: 100ml bottle of 99% DMSO. You also need a syringe dispenser, latex gloves (to protect your hands in case you occasionally spill it) and a mask (to protect your nose from disgusting smell). Never allow a direct contact between your skin and 99% solution - you'll immediately get a chemical burn. Additionally, you need an empty bottle etc with a cover for a solution you prepare.
2) Do not smell a 99% concentrate - it smells so disgusting that some may even develop a bronchospasm. Even a 3% solution smells disgusting - it's a garlic smell.
3) do your maths: You'd better start with the lowest possible solution = 3%. DMSO is completely water-soluble = it's a water-based solution you need. Take a distilled bottled water: if you take tap water - impurities and bacteria it may contain will be assisted by DMSO to penetrate your skin. A 3% solution means that you take 1 ml of DMSO 99% concentrate (using a syringe dispenser) and 30 ml of distilled water. You put 30ml of distilled water into an empty bottle (with a cover), then add 1ml of DMSO 99% concentrate. Then you cover the bottle and mix the solution throughly. The solution is ready for use.
4) Keep the bottle with the solution covered. If you leave it open, water will evaporate and therefore the concentration of DMSO will rise.
5) Before applying the solution on your scalp do an allergy test: put a few drops of the solution onto the interior side of your wrist or elbow skin - the skin there is thin and sensitive. If you feel and see nothing for an hour, things are ok. 3% is a very low concentration and cannot cause any allergy. It is just a precautionary measure.
6) Avoid contact with your eyes. Do not drink it (just in case...).
7) Use a cotton pad generously moistened with the solution.
8) Part your hair so as to reach your scalp better and gently rub your scalp using the pad. I don't apply it on my whole scalp, just the area of the top- from my crown to my hairline.
9) Make sure you apply the solution after you wash your hair. Do not apply it on dirty scalp. After that you can apply your minoxidil and massage a bit.
10) You can do the procedure daily, once in 2-3 days. You do not need to adhere strictly to a daily regimen.
5-7 days of regular application is enough for you to see a difference in your scalp quality and minoxidil absorption.
11) During the first 1-2 weeks of regular treatment you will see a more flaky scalp. It is not a fungal infection that cause dandruff and requires Nizoral. This is a good sign: your scalp is getting rid of dead skin cells and keratin build-ups, your hair shafts open up.
12) Do not try to accelerate the peeling phase by your nails etc. Just massage your scalp while shampooing. It should get rid of dead skin etc depositions naturally. You may use a face/hair scrub onto your scalp to accelerate the peeling effect. A week is enough for you to feel the difference with your fingers and see it with your eyes.

Give it a try for at least a week. You can always stop it without any withdrawal syndrome.

A 3% solution is powerful enough. You do not need to increase it to 5-7%, as is used more often. Take a safer side.

 

[TheHandsomeLurker]

I have never colored my hair. My hair has grayed severely since 2018. I have an identical twin brother. He’s also going gray at the same time but he doesn’t have any hair loss (aside from gradual aging). His hair condition looks like what mine used to look like.

How on earth can you have androgenic alopecia if your identical twin doesn't? And based on your pictures, I don't see anything that looks like androgenic alopecia.

 

[MKP05]

How on earth can you have androgenic alopecia if your identical twin doesn't? And based on your pictures, I don't see anything that looks like androgenic alopecia.

Tell that to the 3 dermatologists and GP who all said that I do despite telling them about my twin brother. I do have definite characteristics of Androgenetic Alopecia (drastic recession at temples). See picture.

But I also have a history of alopecia areata so I could have multiple things going on at once. All I know is that the hair loss I have had has DRASTICALLY accelerated both when I started finasteride and dutasteride.

 

[MKP05]

Rules of DMSO use:
1) In European pharmacies it is usually sold as a concentrate: 100ml bottle of 99% DMSO. You also need a syringe dispenser, latex gloves (to protect your hands in case you occasionally spill it) and a mask (to protect your nose from disgusting smell). Never allow a direct contact between your skin and 99% solution - you'll immediately get a chemical burn. Additionally, you need an empty bottle etc with a cover for a solution you prepare.
2) Do not smell a 99% concentrate - it smells so disgusting that some may even develop a bronchospasm. Even a 3% solution smells disgusting - it's a garlic smell.
3) do your maths: You'd better start with the lowest possible solution = 3%. DMSO is completely water-soluble = it's a water-based solution you need. Take a distilled bottled water: if you take tap water - impurities and bacteria it may contain will be assisted by DMSO to penetrate your skin. A 3% solution means that you take 1 ml of DMSO 99% concentrate (using a syringe dispenser) and 30 ml of distilled water. You put 30ml of distilled water into an empty bottle (with a cover), then add 1ml of DMSO 99% concentrate. Then you cover the bottle and mix the solution throughly. The solution is ready for use.
4) Keep the bottle with the solution covered. If you leave it open, water will evaporate and therefore the concentration of DMSO will rise.
5) Before applying the solution on your scalp do an allergy test: put a few drops of the solution onto the interior side of your wrist or elbow skin - the skin there is thin and sensitive. If you feel and see nothing for an hour, things are ok. 3% is a very low concentration and cannot cause any allergy. It is just a precautionary measure.
6) Avoid contact with your eyes. Do not drink it (just in case...).
7) Use a cotton pad generously moistened with the solution.
8) Part your hair so as to reach your scalp better and gently rub your scalp using the pad. I don't apply it on my whole scalp, just the area of the top- from my crown to my hairline.
9) Make sure you apply the solution after you wash your hair. Do not apply it on dirty scalp. After that you can apply your minoxidil and massage a bit.
10) You can do the procedure daily, once in 2-3 days. You do not need to adhere strictly to a daily regimen.
5-7 days of regular application is enough for you to see a difference in your scalp quality and minoxidil absorption.
11) During the first 1-2 weeks of regular treatment you will see a more flaky scalp. It is not a fungal infection that cause dandruff and requires Nizoral. This is a good sign: your scalp is getting rid of dead skin cells and keratin build-ups, your hair shafts open up.
12) Do not try to accelerate the peeling phase by your nails etc. Just massage your scalp while shampooing. It should get rid of dead skin etc depositions naturally. You may use a face/hair scrub onto your scalp to accelerate the peeling effect. A week is enough for you to feel the difference with your fingers and see it with your eyes.

Give it a try for at least a week. You can always stop it without any withdrawal syndrome.

A 3% solution is powerful enough. You do not need to increase it to 5-7%, as is used more often. Take a safer side.

Thanks Anatoly. I might try this. What do I have to lose at this point? Couple of questions.

Do you make multiple parts in your hair from back to front in order to reach the scalp? It would seem to take a long time to do this and get coverage on your whole scalp. I’m not opposed to doing this but since consistency is the key to a good regimen I just want to do this as quickly as possible.

Are there benefits to doing this without also applying minoxidil afterward? I ask because I’m still hesitant to apply minoxidil to the top of my head (only doing the hairline right now). Then again I’ve lost so much density on top that it might make sense to just go all in.

is it better to do this at night or in the morning? In other words does this dry quickly so that I can apply before bed? Applying before work might be tough.

 

[Anatoly]

Do you make multiple parts in your hair from back to front in order to reach the scalp?
------ Yes, multiple parts 2-3 cm each, advancing from my crown to my frontal hairline. Each part is about 10-20cm long. To cover each part I need about 4-5 touches with a cotton pad. The diameter of a cotton pad is about 5-6cm. I damp with the solution it generously.
I usually require 7-8 parts to reach my forehead. This takes me 2-3min now. When I started I needed to adjust, it took me much longer at first. Now my hand is well trained. My hair is 10-20cm long, it's much more difficult to deal with it. Your hair is shorter, it will save you extra time. You just need to train a bit. After DMSO I do the same procedure with Rogaine foam (I spread a tiny line of foam 7-8 times and massage it into my scalp. This takes me up to 10 minutes.


It would seem to take a long time to do this and get coverage on your whole scalp. I’m not opposed to doing this but since consistency is the key to a good regimen I just want to do this as quickly as possible.
----- You'll do it quickly, just need some time to train your hands.

Are there benefits to doing this without also applying minoxidil afterward?
----- DMSO will help your battle independently of minoxidil. It's an anti-inflammatory drug. An hour compress with 20-30% DMSO to e.g. your knee will eradicate pain in your joint there (never try it!). Its topical formulations are used to treat various inflammatory conditions - acne/rosacea/dermatitis/eczema.

I ask because I’m still hesitant to apply minoxidil to the top of my head (only doing the hairline right now). Then again I’ve lost so much density on top that it might make sense to just go all in.
----- If you don't want to apply minoxidil on your crown, don't do it - if it makes you less stressed. To my view, it simply does not matter: minoxidil that is applied to your temples anyway affects your entire scalp. It also gets into your blood and affect you systemically (e.g. increases your heart rate). Do not take the word 'topical' too literally. When I'm pressed for time to do this thorough parting, I simply apply the usual amount to more easily accessible areas (hairline, temples) - provided I'm on DMSO (=this amount will be well absorbed even on a smaller area) - this will give a comparable effect. Be sure, minoxidil you apply on your temples affects your back and crown with comparable intensity.
What you need to avoid: if your skin is itchy and inflamed/damaged etc - do not apply minoxidil there because it contains irritating substances (alcohol etc) and will exacerbate itchiness/ inflammation.

At the same time all things being equal, you'll get a slightly better result by applying equal amount of minoxidil to a larger area rather than trying to rub this amount into your temples exclusively.

is it better to do this at night or in the morning? In other words does this dry quickly so that I can apply before bed? Applying before work might be tough.
------- You should apply it after you wash your hair. It does not matter morning or night. Remember, it's a powerful conductor of both good and bad substances. If you apply it on dirty hair after a day in NYC, pollutions etc that may rest on your hair will absorb as well.
I wash my hair every morning. I use Rogaine in the morning and do not have time to wait until is soaks and dries up. DMSO helps to accelerate this and saves my time.

 

[Anatoly]

Whether a DMSO solution dries quickly? Well, it's mostly water.... If you take a cotton pad damped with water and rub along your forehead - it will dry in a few minutes. A DMSO water-based solution will get into your scalp quicker. I apply it when my hair is still wet after a wash. I only use a towel to get off extra water and then apply the solution. Never use a hairdryer on wet hair. It's very important for hair to dry naturally. It takes me 20-30min. During this time I brush my teeth, have breakfast, check news etc. I start my morning with hair procedures first.

 

[MKP05]

I didn’t know that minoxidil applied only at the hairline could impact ( positively for regrowth and negatively for withdrawal) hair outside of the applied area. I never considered it going systemic unless you were microneedling. Huh. That could certainly explain a lot of my past and recent problems.

 

[Anatoly]

As far as I know in the USA you require a prescription for a 5% solution. It's rather strange that none of your doctors mentioned some basic facts about how this drug works. Actually a lot of guys on this form complain about unwanted hair growth all over their bodies - one of the most common side effects. This is listed in prescription info btw - e.g. I have very hairy arms and legs, chest... now. It does not matter a lot where exactly you apply it on your scalp.

 

[Anatoly]

a funny thing: I certainly do not apply it on my eyes)), but my eyelashes have become so dense and long that I do not feel confident about it, now I've to cut them so as not to have too feminine eyes...

 

[MKP05]

As far as I know in the USA you require a prescription for a 5% solution. It's rather strange that none of your doctors mentioned some basic facts about how this drug works. Actually a lot of guys on this form complain about unwanted hair growth all over their bodies - one of the most common side effects. This is listed in prescription info btw - e.g. I have very hairy arms and legs, chest... now. It does not matter a lot where exactly you apply it on your scalp.

No prescription needed for 5% in US. It’s readily available OTC. The initial dermatologist who was treating me since 2018 for areata and then male pattern baldness was not very good. Just a local practice near where I live. I reasoned that my areata was always resolved with corticosteroids and they did help with both episodes I’ve had since 2018. But i suspect that they did a very poor job in connecting all of the dots when it came to my frontal hair loss.

Since December I’m now with a major NYC practice. It requires more travel but they are exceedingly more knowledgeable about hair loss. Had I known then what I do now I would’ve made the switch a year ago. I feel like I’m in better hands now (they are a leader in JAK research for example) and hopefully it’s not too late. My condition has degenerated 10 fold in the last 4-5 weeks so I’m really in dire straights right now. My next appointment is Tuesday.

 

[MKP05]

What else may be done:
1) do not apply Nizoral on visibly inflamed = reddish scalp zones; this makes things worse
2) in no case apply minoxidil on inflamed/reddish/itchy scalp- it contains very irritating (for skin) auxiliary agents (conductors incl. alcohol) and will make things much worse (exacerbating inflammation); apply minoxidil only on non-reddish zones - e.g. on adjacent areas with healthy scalp - minoxidil will anyway reach your follicles in reddish zones but without extra irritation of those visibly inflamed zones;
3) I strongly discourage you from using corticosteriods again, you'll ruin everything, although it's true a topical corticosteriod solution will eradicate this inflammation rapidly and effectively;

If you're unready to start a JAK inhibitor immediately, there is one more option that should work against this kind inflammation, and this would be of great help for you in any case besides its anti-inflammatory effect: DMSO (dimethyl sulfoxide).
1) it's very old drug, synthesised by a Russian chemist), in the first WW it was used to ease pain and for wound healing, in the USA they discovered its very powerful effect as a conductor (to help agents penetrate deeply into one's body - e.g. it's frequently used in various face creams, some steroid creams (to help topical corticosteriods reach your joints and ease pain), is is effective for 30+ various inflammatory conditions incl. eczema, prosiaris etc, against skin atrophy, or at very high concentrations it is used to get rid of super-glue))
The problem is that is it easily produced and very cheap, there is no point for a company invest to expensive trials (to meet FDA criteria).
2) risks: it is dangerous to take it orally, but some oral formulation has even been approved by FDA against cystitis. In Russia this medicine is sold via pharmacies as a 99% liquid solution. In the USA, I found, it is sold at e.g. Walmart.
There are numerous risks from chemical burns to eye damage etc. All these risks are about high concentrations of DMSO. e.g. it's very popular to ease joints pain as mono therapy - e.g. a topical 20-60% solution applied to ones' knee for an hour and it will work against pain thank to its anti-inflammatory effect, however, if one keeps a compress too long and does not wash one's knee with water after application, one will likely have a chemical burn.

The point is that it is unsafe if used at high concentrations.

DMSO is widely used in dermatology for various skin inflammatory conditions - rosacea/acne/dermatisis (as a safer non-hormonal alternative to e.g. corticosteriods) and for hair loss. It is less popular in the USA than in Europe. The concentrations for dermatological use are 10-20%. For me this is unsafe, I'm a very cautious person.

Avery low concentration is sufficient to produce good results. Concentrations below 6-7% cannot produce any side effects, higher concentrations applied topically will produce reddish skin for a few hours, higher concentrations will raise the probability of a burn. This is the main concert about this drug.
It has no irreversible effects, it does not cause dependency or affect hormone; system. No cancer risks (some use it against cancer, but there is no evidence that it's effective).

3) effects with respect to hair loss:
- peeling effect: at low concentrations it allows very gentle peeling effect - dead scalp skin peels off more effectively and rapidly + it activates healing mechanisms, it allows to get rid of keratinisation (whether it is black dots on your nose or clogged hair shafts) - actually excessive keratin build-ups are a very important factor that explains e.g. why topical minoxidil fails to produce much result or finasteride'dutasteride despite lowering DHT and inflammation may not be sufficient soo see proper regrowth (hairs simply cannot regrow through keratinised depositions in diseased zones)-
An expensive and more risky alternative is a professional chemical peel (glycoic/lactic/citric acids - AHA/BHA acids). I have tested 14 different hair peels for home use (e.g. Nioxin, Nook, Lebel, Kaaral KO5, Oribe and others) - all they failed (despite price tags and brand names) to produce necessary results and unclog my hair shafts, effects were very short-lasting and did not allow proper Rogaine absorption. I also tried two professional chemical peels (once AHA, once BHA) - this is a very complicated and risky thing: they require a neutraliser, it's very difficult to estimate proper concentrations and timing (before applying a neutraliser), the risk of excessive chemical burn is very high + one cannot use minoxidil and any other topical solutions for 2-7 days after such peeling (which will raise the probability of minoxidil withdrawal effect).

- anti-inflammatory effect: its quite strong - e.g. DMSO alone is used to treat even joints pain + a variety of skin inflammatory conditions, most importantly there is no dependency and/or discontinuation syndrome

- conductor: it's a very effective conductor to direct medicines deeply into skin, even high-strength minoxidil absorbs and soaks within 5-15 minutes (without DMSO my hair look extremely greasy even 7-10 hours after application, no signs of Rogaine application within 1-2 minutes), very convenient

So I’ve noticed since I started applying minoxidil again and cut back drastically on ketoconazole shampoo that the reemergence of red bumps on my scalp have returned as well as a general itchiness all over. The bumps are mostly sitting beneath the surface or slightly raised and they are sore to the touch. Clearly both the bumps and the itch are signs of inflammation and are very bad indicators. These last weeks have been very bad from a hair loss perspective. In addition to the DMSO to fight the inflammation is there any shampoo (zinc?) to help deal with the itchiness and the bumps? You suggested not using nizoral on inflamed zones so maybe there is an alternative. I clearly have a chronic inflammation issue which needs to be addressed. I know steroids (ie prednisone) would help but I’m aware from your previous comments that this should be avoided. Is a jak inhibitor my best bet after I’ve tried DMSO? I don’t really care about the cost. My only hesitation is the potential to compromise my immune system with flu and now coronavirus circulating. I also know there are risks to the liver.

 

[Anatoly]

So I’ve noticed since I started applying minoxidil again and cut back drastically on ketoconazole shampoo that the reemergence of red bumps on my scalp have returned as well as a general itchiness all over. The bumps are mostly sitting beneath the surface or slightly raised and they are sore to the touch.

-------- The underlying cause of these manifestations of inflammation is not so clear. Nizoral often exacerbates various inflammatory skin conditions. But it is also very helpful to combat a range of inflammatory conditions, esp. those caused by fungal infections. It is extremely difficult to judge whether you should temporary discontinue Nizoral at all or increase it and use it daily instead.
So, your observation is that these bumps have appeared right after you cut down on Nizoral? As far as I remember, I suggested cutting down Nizoral exactly because I saw an increase in inflammation on your back (some earlier photo). I suggest avoiding Nizoral till Tuesday, your dermatologist will make a more definite assessment - whether you should discontinue it at all or use it daily instead.
BTW, how long do you usually keep it on your scalp before washing it away?

Also, Rogaine is associated with itchy/inflamed scalp (mainly because of the auxiliary substances it contains). Usually this side effect manifests itself very early after your start treatment - within less that a week. Over time this side effects subside. How soon after you resumed minoxidil these inflammation emerged? You also used minoxidil in the past - what was during your past experience? As far as I know, Rogaine can cause itchy/reddish scalp at the very beginning of your treatment, but not the kind of bumps you're experiencing now. Also, you do not apply minoxidil on your back, do you? With respect to skin irritation the word 'topical' is important.

In addition to the DMSO to fight the inflammation is there any shampoo (zinc?) to help deal with the itchiness and the bumps? You suggested not using nizoral on inflamed zones so maybe there is an alternative.

-------- Zinc is very effective against a wide range of dermatological conditions caused by an infection. Sufficient dose is important: many shampoos for ordinary haircare contain very small amount of zinc, insufficient for treatment purposes. At the same time there is a range of shampoos (sold at pharmacies) that contain zinc as a main ingredient - specifically for intense inflammatory infection-caused conditions. There is also a wide range of zinc-based creams that are very effective. They are often prescribed in a combination with oral zinc. I would advise considering this option instead of a shampoo that may be too weak. You may ask your dermatologist about a zinc-based cream to address the issue before an antibiotics route (as a secondary option). Also check for zinc deficiency. DMSO alone should be well sufficient to get rid of this inflammation, but it does not address the underlying cause.

I know steroids (ie prednisone) would help but I’m aware from your previous comments that this should be avoided. Is a jak inhibitor my best bet after I’ve tried DMSO?
------ This is a reasonable route. In the end, DMSO and regular zinc supplements (at a working dose) is a much safer option before trying an immunosuppressant.

My only hesitation is the potential to compromise my immune system with flu and now coronavirus circulating. I also know there are risks to the liver.

------The safety profile of this particular immunosuppressant is very good in contrast to many others in this class of drugs. Your blood tests will show whether it causes your liver damage sufficient to discontinue the drug . The probability is low. An unhealthy diet is much more harmful to one's liver than many drugs, including this one. An endless number of drugs causes only temporary increase in one's liver enzymes, which subsides after one's body adjusts. The statistics (to date) with respect to its safety is impressive. Your dermatologist will certainly inform you about the safety profile. If if was not safe enough, it would not be considered at a treatment option for hair loss - just a cosmetic condition.

 

[stejames]

I take dutasteride twice a week (finasteride 5 days). When I take it on Sunday I dont have an itch the following days. when I take on Wed I usually have a head itch on friday.

 

[Anatoly]

I've surfed my 'database' of academic articles. There is a good probability that these bumps have been caused by an infection. But infections are of different origin. You used Nizoral consistently twice a week for a long time (before cutting down on it). Despite Nizoral, these bumps have appeared. Probably this is not a fungal infection, but a bacterial infection. Nizoral is not of particular effectiveness against a bacterial infection. It requires a different type of an antibiotic.
You also mentioned that formerly you experienced similar kind of bumps. Were you on your usual Nizoral regimen during that time? If so and given that it failed to prevent these bumps, it's quite plausible that they were not caused by a fungal infection, but a bacterial infection instead.

To address this indue you do not necessarily need to use such a heavy artillery as antibiotics - as a first-line treatment. Zinc solutions are very effective as well. If it fails, then one need to use a stronger (and more serious) option - e.g. clindamycin.

 

[Anatoly]

If an infection is confirmed by your dermatologist, you should be more cautious with respect to DMSO. Remember - it's a conductor of both good and bad things. In particular, DMSO may facilitate bacteria penetrating your scalp - assuming you're prone to getting infections.

To address this potential risk, you should consider the following:
1) your daily shampoo should contain zinc, zinc is a powerful anti-bacterial agent (I use a Vichy shampoo that contains a small amount of zinc as well)
2) a shampoo alone may be insufficient, a daily zinc supplement will additionally lower the risks (e.g. I regularly take zinc sulphate 124mg)
3) the reduce the risk of future fungal infections you may consider daily Nizoral use at a small dose:
Earlier I mentioned that I use Nizoral daily. This is exactly because I use DMSO as well.
In my morning routine I use a Vichy shampoo with the main purpose to get rid to dirt, sebum etc. After this shampoo I use just a few drops of Nizoral (very small amount), it foams perfectly to allow full coverage of my scalp. Then wash it away and apply a conditioner. Only after these measures I apply a DMSO solution.

I have never experienced any infections (bacterial or fungal) on my scalp during 7 months on this regimen. Although I suffered from skin infections quite often - during the time before I started to address my hair loss.

Do control these risks properly if you consider starting DMSO.

 

[Guru0007]

Sorry to hear that you’re struggling. I guess it’s a constant battle even for someone who has a solid grasp on their condition, treatment and triggers. Your hair doesn’t look bad to me at all. Of course I know from experience that we are our own worst critics. I am still at the point where I can fool most people Inyo thinking I am simply receding when in actuality I have much more than that going on both on top and at the back. My struggle comes from knowing that I’ve yet to slow it down to an acceptable level and will very soon be exposed. it’s funny that for the whole 1.5 years I was on finasteride I could see the regression occurring but at least it was month by month. Now it is literally daily. That’s a harsh reality. I’d love to wake up tomorrow and say “well at least it looks as shitty as it did yesterday”. But there’s only been one day over the past 5 weeks where I’ve actually felt that I’ve held ground from the previous day. Every other day I’ve found at least one area where it’s gotten noticeably worse. I’m in total agreement with you that until I solve the chromic inflammation it’s not going to get any better.

I really hope you figure out what’s causing your current problem. You’ve been nothing but helpful to me in your advice and I do appreciate it. I’m confident that you will figure it out and get back on track.

Dude how is ur hair now?

 

[bluecyclone]

Still losing 600+ hairs a day top sides and back on topical Dutasteride

 

[Guru0007]

Still losing 600+ hairs a day top sides and back on topical Dutasteride

Mostly Telogen Effluvium bro...