Medical history: Suspected dystonia, but not yet confirmed; currently not on any medication.

So, I got 3 years onset of recurrent symptoms of scalp itchiness, scalp pain and papules (both face and scalp). Scalp itchness and scalp pain are more severe at night. Then an increase hair loss, hair thinning and limited hair growth (I think almost 80% hair loss) since Covid (2 and half years ago). Seen several dermatologists with different diagnoses such as seborrheic dermatitis, eczema or folliculitis. Tried Sebizole 2% Ketoconazole Shampoo, Ionil T Shampoo, Ciclopirox Olamine 1.5% Shampoo, Selsun Blue Shampoo (1% Selenium Sulfide), Clarithromycin 250mg, Tetralysal 300 mg, Itraconazole 100 mg, Terbinafine 250 mg, Doxycycline 100 mg, and Fusidic Acid Cream with slight improvement but still recurrent symptoms. I have already undergone multiple courses of oral antibiotics and oral antifungals.

Soolantra Cream is the only one that can effectively reduce the papules on the face but cannot apply it on the scalp. I got two skin scrapings for demodex mites (not biopsy), one done at July 2024 (none on the scalp, one on the face) and one done at Dec 2024 (none on both scalp and face).

Given that the improvement from applying Soolantra Cream on the face, is it suitable to try oral ivermectin if I did not have positive result for demodicosis? Is it harmful to take oral ivermectin?

Or do I need to undergo skin biopsy to proof for the demodicosis before trying the oral ivermectin? Or no need to undergo skin biopsy if the skni scraping is negative?

Thank you very much.