Scalp skin is unique on the body due to the bulk of hair follicles and high amount of sebum(oil) production. These features make it vulnerable to fungal conditions, parasitic infestation, and inflammatory conditions. Because these scalp conditions share similar signs and symptoms of scaling, inflammation, hair loss, and itching, getting the correct diagnosis is important. Let’s discuss the most common scalp conditions and the best methods for treatment.
1. Psoriasis: Pink plaques with silvery scales
Psoriasis is an autoimmune condition where the cells are in overdrive leading to a build up of skin cells creating scaly patches that can itch, hurt and even bleed. The treatment is about relieving symptoms as psoriasis is controllable not curable. The first line treatment is to start with steroids, while tougher situations may require injections called biologics that help to suppress what's causing the flare ups. But you should also take in account your hair care routine as many shampoos can improve the rash and heat treatments such as blow-drying can worsen your psoriasis.
2. Folliculitis: Scattered pus bumps
Folliculitis is an inflammation of the hair follicle. It can be caused by a bacteria infection, shaving, excessive sweating and tweezing. It will appear as small bumps scattered over the scalp like acne. They can cause soreness and itching. The treatment can vary depending on the cause of the rash. First line treatments include a topical (liquid) or oral antibiotic followed by a steroid cream to help if the inflammation persists.
3. Seborrheic Dermatitis: Greasy scale and dandruff
Seborrhea is one of the most common scalp conditions. Cradle cap in babies turns into itchy patches with greasy scale or dandruff in an adult. It isn't contagious but can be embarrassing. Unfortunately, it often comes and goes with triggers such as stress and seasonal changes (winter and early spring). Aside from the scalp, the face, ears, and chest can also be affected. Although no definitive cause has been identified, a yeast (fungus) called malassezia that is in the oil secretion on the skin, seems to be the most likely culprit. Some predisposing factors include Parkinson's, depression, diabetes, a weakened immune system, and obesity. We recommend treating early and aggressively to avoid complications such as hair loss. Often a prescription strength anti-yeast shampoo called ketoconazole will help in addition to a topical steroid if itching persists.
4. Alopecia: Hair loss
Hair loss can be due to several factors, including medications, genetics, inflammation and hormone issues. If you notice hair breaking/shedding or bald spots on your scalp, it is important to get evaluated by a medical professional. After an in-depth discussion, it is helpful to run blood work to evaluate for anemia, vitamin deficiency, thyroid abnormalities, hormone levels, and autoimmune markers.
If blood tests are all normal, other sources of stress such as the death, pregnancy and surgery can cause some shedding months after the incident. However, most of the time, it’s due to the aging process and hormone levels. Woman’s estrogen levels decrease, and often, so does our hair. It also may be the toll of years of bleaching, dyeing, straightening, perming, and wearing tight pony tails.
The treatment is geared to correcting any medical abnormalities if they present themselves. Underlying scalp conditions such as seborrheic dermatitis or psoriasis should be addressed. In the case of hormonal thinning, there are treatments such a Rogaine, a solution that thickens existing hair can help. Eating a well-balanced diet, filled with vitamins such as B12, folate, and biotin are also useful when experiencing hair shedding. Lastly, taking a break from over-processing your hair is encouraged. In extreme cases, hair transplant or PRP is an effective option.
5. Ringworm: Scaly rash and bald spots
Also called tinea capitis, its most common in children but occasionally occurs in adults. The most common ways we contract the fungus is: Human to human, animal to human (cats are a common source), and object to human (clothing, towels, bedding/ linens, combs, and brushes). The resulting rash is usually painful and scaly. It also can cause bald spots, broken hairs, and black dots. The most effective treatment is taking an antifungal pill. Treating or discarding infected sources can help to prevent re-infection.