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Disorders Of The Scalp

Scaling conditions

The following information relates to scalp condition’s that have scaling as the main symptom. The conditions do have other symptoms but scaling is the usual sign sufferers notice first or find the most problematic.

Pityriasis simplex, commonly known as Dandruff.

This is a fairly widespread and common complaint. It is recognised by scaling or flaking on the scalp, in fact the condition is so common its thought that most people at some stage may experience the problem. Dandruff rarely affects people before adolescence due to the lack of oil secretions at this age. The small white flakes may be scattered over the hair and shoulders by scratching, brushing or combing. It begins as a simple dry scaly scalp condition with fine flakes appearing on the scalp and the condition can affect the entire scalp.

It is often difficult to determine the onset of dandruff because there is a natural flaking of the scalp so an increase in scaling might go unnoticed for a period.
In more severe cases the flaking increases and accumulated flakes can cause the flow of oil to become blocked which, in turn, may affect the overall condition of the hair. If the condition is neglected, the hair can become dry, brittle and may even become split, damaged and unmanageable.  

What causes it and what can I do about it?

In general, the cause is a combination of an increase in the shedding of skin cells, oil production and the presence of micro organisms. In some, and indeed, more severe cases it can be triggered by an allergic reaction to the normal scalp flakes that are shed.

                        The following treatment advice has been provided by
                                 Consultant Trichlogist Jane Mayhead MIT 

Treatments for Dandruff

Most mild cases of dandruff are easy to eradicate with regular washing using a suitable shampoo. More severe dandruff responds well to a regular course of treatment. Because there is more than one cause to the onset of dandruff, the success of treatment depends on the removal of all possible causes such as those listed below

• The first stage is the removal of present flakes and to inhibit the formation of further flakes. Initially this can be done by an increase in the number of weekly washes using a specific shampoo.
• A weekly or fortnightly pre-wash scalp application may also be required.
• If an allergic response is the cause then regular control is important, but in these cases, complete

It may also be helpful if diet and lifestyle is considered which can aid a healthy scalp. Below we have provided some suggestions on how to do this:

• Avoid dairy products such as milk, cream and cheese.
• Avoid alcohol and smoking.
• Improve your bacterial health of the gut.
• Address any anxiety and stress issues.
• Address any weight issues.

Ultra violet light therapy can also be beneficial in reducing micro organism proliferation. However, this must only be administered by a qualified Trichologist.

Psoriasis

Psoriasis is a skin disorder that can be recognised by plaques, often circular-deep?? red, brown, purple, and clearly different from surrounding skin. Sometimes these plaques are completely covered with silver/white scales. The condition can appear on the scalp, knees, elbows, and, in severe cases, all over the body. 

Associated signs can include thimble-like pitting on fingernails (so named as it can resemble a thimble). The condition can also be accompanied by painful, stiff swollen joints. It effect’s approximately 2% of people and has a tendency to run in families. It can first develop at any age but most commonly starts between the ages 15 and 25.

What causes it and what can I do about it?

The exact cause is not known. Skin is normally made up of layers of skin cells. The top layer of cells are gradually shed (they fall off). New cells are constantly being produced underneath to replace the shed top layer. It usually takes about 28 days for a bottom cell to reach the top, after which time it is shed. This process is termed the mitotic rate. People with Psoriasis have an increased turnover of skin cells compared to those without the condition and the rate can be increased by as much as five times the expected normal rate. As more skin cells are made this ultimately leads to a build up of cells on the top layer. It’s this build up of skin cells that form the flaky plaques or severe scaling on the skin. There is also a slight change in the blood supply to the skin. It is this that tends to cause some inflammation in the skin, explaining perhaps why the skin underneath a patch of psoriasis is usually red.

Aggravating factors

There is no apparent reason why most eruptions of psoriasis develop. However, in some cases psoriasis is more likely to flare-up in certain situations. These can include the following:

• Stress - It is very difficult to measure stress or prove that it can induce psoriasis. However, some people feel that stress does contribute on some occasions. This may be due to an alteration in blood circulation which can be anxiety driven.
• Infections - Psoriasis may flare-up if you have a feverish illness.
• Medication – Problems could occur due to medicines for such conditions as high blood pressure or anti-inflammatory pain killers or Lithium. In some instances eruptions may not develop until the medication has been taken for several weeks.
• Alcohol – This can sometimes be a trigger for Psoriasis.  

                       The following treatment advice has been provided by
                              Consultant Trichlogist Jane Mayhead MIT

 Treatments for Psoriasis 

 

 There is no cure for Psoriasis and that includes scalp Psoriasis. Treatment aims to clear the scaling and reduce the rash as much as possible. However, as the rash tends to recur you may need courses of treatment periodically throughout your life. The best way to deal with the scalp is to have a regime that is altered according to the fluctuations in the condition.

There are various creams and ointments that are used to treat psoriasis. However, there is no one treatment that fits all. The treatment advised by your doctor may depend on the severity and type of Psoriasis. In addition, one treatment may work well in one person but not on another. It is not unusual to try a different treatment if the first one does not work so well. The correct application of cream or ointment is crucial for best results, knowing exactly how to use whatever treatment has been prescribed is important. It can take several weeks of treatment to clear plaques of psoriasis. Generally long standing problems are more difficult to treat and therefore can take even longer.

Scalp moisturisers (emollients)

These are treatments that can help to soften hard skin plaques and they may help to reduce swelling and itching. A scalp emollient may be all that is needed to successfully treat very mild psoriasis.

Coal Tar preparations

These types of preparations have been used to treat psoriasis for many years but it is not clear how they work. It’s thought they may reduce the turnover of the skin cells, slowing the production of flakes. Whatever it is that dictates the success of this type of treatment it does seem to reduce some inflammation. However, the drawback of using them is in the application. It can be messy and can also give off a fairly unpleasant smell. Tar based shampoo is popular for scalp psoriasis. The main issues with following this course of treatment on the scalp is that they can be harsh on the hair and can leave a rather unpleasant lingering odour. Do not use Coal tar based products on any broken or sore skin and the products are not suitable for use on the face.

Salicylic Acid

This treatment is sometimes combined with other treatments such as coal tar or steroid sreams. It tends to loosen and lift the scales from the surface of the skin. Excessive use of these products is not recommended. However,it does seem to be one of the most effective in treating the condition.

 

Seborrhoeic Dermatitis also termed Seborrhoeic Eczema

What is Seborrhoeic Dermatitis/Eczema?

The words Dermatitis and Eczema in this case refer to the same condition. The term Dermatitis denotes an inflammation of the skin and seborrhoea refers to the fact that the condition appears in areas rich in sebaceous (oil) glands, such as the nasal folds, forehead and scalp.

Seborrhoeic Dermatitis is a fairly common scalp complaint. It’s thought to affect as many as 3% of people and does seem to be more common in men than women. Infants can develop a form of it but it usually clears up after a few months. It is common in young adults, generally peaks at the age of forty and although it can occur in older individuals it is much less common.

The signs and symptoms

Seborrhoeic Dermatitis can be recognised by a dullish red moist scalp, the underlying erythematic (reddening of the skin) can be embarrassing when it affects the face. The red areas are covered with greasy looking white or yellowish scales. Most commonly, the rash comes up on just one or two areas but it can sometimes be extensive. The scalp can produce scaling, dandruff like, flakes which can often get stuck and be difficult to remove.

Areas most commonly affected

• Scalp: The condition here ranges form a mild dandruff to a severe red scaly, weepy and even oozy rash that can extend out onto nearby parts of the fore head and ears. Cradle Cap in infants can be linked to this condition.
• Face: The creases beside the nose and adjacent parts of the cheeks. It can often affect the inner parts of the eyebrows which sometimes cause the eyelids to become red and irritable.
• Ears: Some suffers have inflammation inside the ear canal, in the ear or behind the ears. The skin can weep and ooze fluid. the ears may also become swollen.
• Body: The front of the chest, between the shoulder blades, armpits, groin and areas that are prone to sweating and retaining moisture. Skin folds are also prone, such as under breasts or the abdomen. Circular red patches that are sometimes scaly can be seen in these areas.

What causes it and what can I do about it?

Seborrhoeic Dermatitis can be controlled with treatments that attack the yeasts that live on the surface of everyone’s skin, Molassezia fur fur, also known as pityrosporum ovule. This suggests that these skin yeasts play a part in causing it. This yeast germ lives in the sebum (oil) of the human skin in most adults. For the majority of people it does no harm. However, some people seem to have a reaction to this germ which then causes inflammation. Androgen (a male hormone) production stimulates sebum secretions and the yeasts like to live in sebum, sweat, and skin scales, causing it to proliferate. Seborrhoeic Dermatitis is not transmitted from person to person.

Aggravating factors

There is no one cause of an eruption of seborrhea. However, in some cases it is more likely to erupt in certain situations, these can include the following:

• Stress: Nervous tension or anxiety can cause androgen over production and excessive perspiration, both of which can accelerate the problem.
• Fungal infections: An increase in the level of yeasts Medication, particularly those used for hormonal treatment.
• Diet: Avoid dairy products such in particular cow’s milk, cream and cheeses. Avoid alcohol and foods that contain yeasts.

 

                 The following treatment advice has been provided by
                                   Consultant Trichlogist Jane Mayhead MIT
                    PLEASE NOTE… The Trichology clinic advises for scalp treatment only.

Treatments For scalp Seborrhoeic Dermatitis

There is no cure. However, it can be controlled with possible long-term remissions. Treatment can often suppress the condition rather than cure it and unfortunately it frequently returns after treatment is stopped. Treatment therefore may have to be used long-term and, for this reason, the choice of treatment is crucial to ensure suitability for long-term use.

Salicylic Acid

This is often combined into a cream or lotion generally as a pre wash treatment or even in a shampoo. It is used to lift and loosen the flaking scales that build up on the skins surface. Excessive use of this product is not recommended.

Yeast inhibitors

Produced into a cream, lotion or shampoo. It is used to inhibit yeast production on the skin surface. Candida detox and good gut bacterial health may also be beneficial to help with excessive yeast production.

Steroid creams

Cream or lotion preparations containing a hydrocortisone often found in differing strengths. Applied to the skin, its benefits are to suppress the itching, inflammation and soreness. These preparations need to be used with caution and are not recommended for long-term use.

Cetrimide

An anti-fungal and anti-bacterial solution generally added to a shampoo or lotion preparation. A mild treatment ideal for regular use.

Cream

A pre-wash cream application of a ‘mild salicylic acid based product’ is used when chronic scaling covers the scalp. Removal of these flakes first is essential. This should then be followed by a shampoo specifically designed to treat the scalp without compromising the hair quality. Ideally this shampoo should contain a yeast inhibitor or cetrimide solution. A steroid cream can then be applied if the condition is particularly irritated. Lamp therapy, such as ultra violet light and infa red is also beneficial and can be a good alternative to steroid use for treating irritated skin. A combination of regular clinical treatment and a home based regime, which can be altered according to the severity of the condition, is often the best way to successfully keep the problem under control. For mild scaling treatment shampoo can be used regularly. When using the shampoo, leave the product on the scalp for 5 to 10 minutes before rinsing off. This is to ensure contact with the skin for an adequate period of time. For treating babies and young children olive oil is a good alternative to remove scalp flakes, however, its not recommended to leave the oil on the scalp for too long without washing, over night is sufficient.