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I have a friend who has some dark, bumpy, crusty, itchy splotches on his scalp. He is fair skinned and short haired, and these spots are dark brown, about the size of a quarter, and include some scabs from excessive scratching. His dermatologist first thought it was seborrheic dermatitis, and treated with some cortisone salves (clobetasol propionate); then decided it was folliculitis, and put him on antibiotics; then decided it was fungal, and put him on an antifungal for a week (does any fungal infection clear in one week? and don't you have to select the appropriate antifungal?). He already alternates all of the scalp treatment shampoos on a daily basis, and has for years (zinc, ketoconazole, salycilate, pine tar, herbal), but is getting no relief whatsoever. This week the doctor gave him cortisone injections on his scalp, but, again, it has brought no relief whatsoever.
I was wondering if anyone diagnosed with DH (dermatitis herpetiformis; Duhring's Disease; Skin Celiac Disease) thinks that this description could in fact be of DH. I don't think it usually confines to the scalp, but I guess that is part of what can make some things hard to diagnose (especially when you don't take any scrapings or biopsies, or anything). Any suggestions welcome, especially regarding whether this fits the description, and the best method for diagnosis. It is my understanding that DH can be diagnosed by a scraping next to a lesion, but that this requires skill on the part of the doctor and the lab, so any reference to the usefulness of a Celiac panel in the diagnosis of DH would be much appreciated (I have read that all DH have CD, albeit possibly subclinical, and 5% of CD patients have DH, so it would seem to me that the Celiac Panel would be diagnostic for the DH as well, but I have not actually read that anywhere; of course he could have CD and a fungus on his scalp, too!). I have also tried to do an image search on google, and found many photos of DH, none on the scalp though.
Thanks.
Hilary
p.s. This might be a clue: he does have one splotch on the top of one foot which a different doctor diagnosed as ring worm a few weeks ago, but it did not respond to two weeks of OTC creams or to the cortisone injection. On the foot it is about the size of a dime, and it is cherry red, with many little bumps in it. It is slightly darker at the outer edge, but has not cleared in the center as would be expected if it were ringworm. That doctor looked at his scalp and said nothing (don't you just love these guys?).

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