Scalp Conditions and Problems

" There are many types of scalp conditions and related problems that can cause  symptoms such as itching, flaking and hair loss. There is no known cause and no cure, just methods for controlling symptoms. Scalp problems such as mild flaking are referred to as dandruff,  with yellowish scaly and greasy scaling or flaking referred to as seborrhea or seborrheic dermatitis.  In babies the condition is referred to as cradle cap. The primary cause of skin cell flaking is dry skin or excess sebum production from the sebaceous glands, which are found on the scalp, face and armpits. The substance secreted causes the flakes to clump on the skin, causing them to fall off in larger, more noticeable batches. It is not a reflection of poor personal hygiene, unless a person infrequently shampoos. Many cases of seborrheic dermatitis have the presence of a fungus called Pityrosporon ovale. Silver scales are a symptom of psoriasis, which is often mistaken for seborrhea. Seborrheic dermatitis results in the most intense itching and symptoms. In adults, treatment starts with over the counter dandruff shampoo. If the condition is unresponsive, a visit to the Doctor is necessary."   


The most common types of scalp conditions and symptoms are described below.  These include:


Itchy Scalp Conditions


An itchy scalp can be caused by any of the scalp conditions listed below.  In most cases it is caused by a yeast (pityrosporum) found naturally on the skin that is attracted to the dead skin cells on the scalp.

In most cases, itchy scalp conditions can be controlled with an anti-dandruff shampoo that contains ketoconazole.  Scalp itch and dandruff can be treated by washing the hair 2x during the morning shower.  The first lather and rinse is to remove dead skin and the second will help to kill any yeast buildup.  One recommended product is Nizoral A-D Anti dandruff shampoo.

Dandruff


A mild case of dandruff is the natural way the scalp eliminates dead skin cells.  For some unknown reason, in some people or in others at some particular time, the skin cells die off faster, causing dandruff.  When the sebaceous glands produce excess  sebum or oil, the flakes build up on the scalp before falling, and then fall off in a larger quantity. This creates the appearance of white flakes in the hair and shoulders, prompting treatment.   An oily scalp occurs when the body is producing too much oil due to a hormonal imbalance, such as during adolescence. 

In some people, Dandruff can be triggered by medications used to grow hair such as Rogainea (minoxidil).

How to cure dandruff


For mild dandruff, purchase an over the counter dandruff shampoo that either contains selenium oxide, zinc pyrithione tar or ketoconazole.

In babies, a natural product such as Cradle Clear Lotion can help soothe and moisturize dry skin.

Seborrhea


A more severe case of dandruff is referred to as seborrhea. When a scalp is oily, but not itching, crusty or inflamed, then the condition is called seborrhea. Seborrhea refers to the over production of sebum, an oily substance manufactured by the sebaceous glands.  When itching, crusting skin and inflammation are involved, then the scalp problem is referred to as seborrheic dermatitis of the scalp.

Seborrheic Dermatitis of the Scalp


Seborrheic scalp dermatitis refers to scales that form on the face and/or the scalp. It has no known cause, and tends to run in families.  The condition is seen more often in: 

  • adults age 30 to 71
  • men
  • during cold weather months
  • infants under 3 months of age (called cradle cap)

Seborrheic dermatitis scalp symptoms include flaking the dead skin cells on the scalp.  This can be when the scalp is dry or oily/greasy.  The skin scales or flakes will appear yellow in color and greasy in texture. Scalp itch is often intense and some patients experience hair loss. In chronic cases (severe), pimples red/yellow pimples can form in the following areas:

  • Hairline

    seborrheic dermatitis
    Seborrheic Dermatitis at the hairline on child
    Source: Principles of Pediatric Dermatology
  • Around the ears

    seborrheic scalp condition
    Seborrheic Dermatitis in Ear and "Dandruff" flakes in hair
    Source: Principles of Pediatric Dermatology
  • on the bridge of the nose
  • along the eyebrows and eyelids
  • chest  (sternum)
  • back 
  • armpit
  • legs
  • groin

Seborrheic dermatitis scalp treatment involves the use of Ketoconazole cream or dandruff shampoos that contain the ingredients:

  • selenium sulfide
  • salicylic acid
  • sulfur
  • tar

Like other scalp conditions, anti dandruff shampoos are used every other day and then 2x per week until the condition is eliminated.  Follow the manufacturers or your dermatologists directions.  

If your condition does not respond to over the counter treatment, be sure to see a doctor as it could indicate that a prescription product is needed, or that there is a systemic underlying cause such as diabetes.

Scalp Conditions that are Similar to Seborrheic Dermatitis

Seborrheic dermatitis scalp conditions appear similar to and should be differentiated from psoriasis (does not effect areas beyond the hairline), impetigo (skin lesions are in one area and related dandruff is not greasy), Pityrias rosea (have a distinct skin patch appearance that looks like a hub and spokes) and T. Cruris and corporis (not greasy, caused by a fungus that can be determined with tests..

Hair Lice


Hair lice is caused by insects (adults are 2-3mm in length) that feed on a person's blood. They are primarily found on the scalp. Lice and their eggs (nits) can also be seen on an infested person's clothes.  Lice are only spread by crawling from person to person after close contact (they do not fly or jump).  

lice_nymph
Picture of Lice in each life stage (egg, nymph or baby lice and adult)
Source: CDC

Lice can be seen with the naked eye but are difficult to find.  Use a fine-toothed comb combined with the help of a flashlight and magnifying glass.  

If lice are found, check everyone living in the same home as this is one of the scalp conditions that is contagious.   If you share a bed with another person, that person should be treated along with the person with the lice.  All items used by the infested person should be washed in hot water and then placed into the dryer (need temperatures of 123F to kill lice and Nits.

Lice can be treated with products that are available with and without a prescription (called pediculicides) .  Over the counter products available for removing hair lice include RID and Pronto (active ingredient piperonyl butoxide).  You can also use a chemical and pesticide free, non-toxic natural lice remedy such as Naughty Nits.  

Regardless of the scalp lice treatment selected, follow the manufacturers directions.  You can download these lice treatment instructions (PDF Download) developed by the  U.S. Centers for Disease Control.

Ringworm (Dermatophytes, Tinea)


Scalp ringworm is caused by a common scalp fungus. It causes symptoms such as bald patches/scalp hair loss, dark skin pigmentation, itch, redness, and scaling.  The same class of fungus can cause, athletes foot, jock itch, and rough toe and finger nails. The infection is spread from person to person or can be spread by pets.

Scalp ringworm appears 4 days to 2 weeks after exposure.  Treatment involves the use of a prescription medication or a natural product such as Naturasil that uses plant extracts.

No matter which of the scalp conditions is causing the problem,  be sure to see a Doctor if it does not respond to over the counter treatments.

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References for Scalp Conditions and Problems:

Mens Health - Stop Your Itchin

Principles of Pediatric Dermatology
Dr. Mahmoud Hijazy

 




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