Disorders of the Scalp
The following information relates to scalp conditions that have inflammation as the main symptom. The conditions do have other symptoms but inflammation is the usual the sign that sufferers notice first or find the most problematic.
Folliculitis
What is folliculitis?
Folliculitis is the term used to describe inflammation of hair follicles. This inflammation can be brought about by a number of causes and can occur on any part of the body that has hair but it is most commonly found on the face and scalp. Most cases are mild and easy to treat but more severe cases, however, can be extremely challenging. Folliculitis is widely used as a descriptive term often with a prefix or suffix such as ‘pustular’ folliculitis (inflammation of the follicles with the presence of pus). Or as in folliculitis ‘barbae’ (inflammation of the follicles of the beard). There are several types of folliculitis that can affect the scalp, however, the most common forms are superficial folliculitis also known as folliculitis simplex and deep recurring folliculitis, the latter being a more severe form.
The signs and symptoms of folliculitis affecting the scalp
The condition looks very much like acne with small round inflamed circles surrounding the opening of a hair follicle. Folliculitis causes a sensitive red pimple, often pustular. The area can become very swollen and painful if the inflammation is severe. With deep recurring folliculitis scarring may also be a problem.
What causes it and what can I do about it?
Most causes are due to an infection with a bacteria especially the type known as Staphylococcus Aureus. The affected hair follicles enlarge into pus-filled pimples. Other cases, however, can be caused by fungal presence such as yeasts that are found on the skin. Often folliculitis develops because damage has occurred to the affected hair follicles. When follicles are injured or when they're damaged they are more likely to become infected. They may be invaded by viruses, bacteria or fungi, leading to an infection. Shaving or even clothing that rubs on the skin irritating the hair follicles can cause such damage. The Hair follicles can also become blocked or irritated by substances such as sweat, oils, or even make-up. Some hairdressing practices can also be a cause, particularly those that cause tension and trauma to the hair and scalp, such as extensions, braiding and a tightly pulled ‘up-do’. Often regular sufferers find an eruption can occur after periods of illness or stress. Pre-existing scalp problems such as eczema may also contribute to the cause. Treatment will differ depending on the initial cause and severity of the condition.
What is the treatment?
The following Treatment advice has been provided by
Consultant Trichologist Jane Mayhead MIT
Treatment for superficial folliculitis can be relatively simple and can often be achieved by removing the causing factor, if it is known. If the cause is not known then advice may need to be sort. If the cause is bacterial then keeping the scalp clean is very important, the use of an antibacterial shampoo may also be beneficial. If the cause is fungal then the scalp will need to be treated with antifungal preparations.
Treatment of deep recurring folliculitis can be far more challenging. The first necessary step is to find the cause; in most cases the cause is bacterial. It may be necessary for a sample to be tested in order to establish the type of bacteria or, indeed, whether the cause is fungal. This will then ensure the correct medication is given. The doctor or dermatologist will perform these tests. It is important to seek medical advice as more severe forms of folliculitis can sometimes lead to complications such as destruction of the hair follicle and scarring or, in even more serious cases, bacterial infections. Trichologist advice on appropriate hair and scalp care is also advisable.
Contact dermatitis
What is contact dermatitis?
Contact dermatitis is the term used to describe an inflammatory, often itchy, response to a reaction of the skin by an external irritant. This can occur on any part of the skin and can also be termed irritant dermatitis. The following information is related to contact dermatitis that affects the scalp. The condition is experienced by an extraordinarily high number of people and nearly anything can be an irritant. It is usually divided into two related but separate types; ‘irritant’ contact dermatitis and ‘allergic’ contact dermatitis.
The signs and symptoms of Contact dermatitis
Irritant and allergic contact dermatitis manifest in the same way and are often differentiated by the causative agent rather than the manifestation. The condition is characterised as an inflammatory, often itchy, skin condition with possible burning sensations soon after contact with an irritant. The skin may appear red and dry. The dryness can result in cracking of the skin particularly if acute and persistent inflammation occurs. This may result in temporary or even permanent hair loss. Flaking of the scalp can also occur if the skin becomes extremely dry or if the skin weeps from continual scratching. Chronic dermatitis can be the result of a persistent contact dermatitis. Allergic contact dermatitis can develop after continual allergen exposure.
What causes it and what can I do about it?
Contact dermatitis usually appears immediately or soon after contact with an irritant agent. These agents can range from products such as soaps, personal care products, perfume, hair-care products - such as hair dyes, straightening creams and permanent wave solutions, etc. These are the external agents most frequently responsible for irritant contact dermatitis of the scalp. It’s thought this occurs from the alkalinity of these products removing the moisture or moisture retentive properties from the skin. An allergic response usually requires sensitisation by initial contact with the irritant. Once encountering the agent that previously came into contact with the skin, contact dermatitis typically appears. More often than not, once the irritant is withdrawn, the condition will recover over time. Persistent or chronic reactions should be treated by a medical professional.
Allergic contact dermatitis normally develops from an allergic response to irritants repeatedly applied to the skin. Eventually these irritants cause an allergy whereas with irritant contact dermatitis the skin has an immediate reaction to something that causes direct irritation. Allergic contact dermatitis can develop from hair care products, in particular, hair dyes. These allergic responses have been the subject of much debate in the media prompting manufacturers to promote warnings and skin testing on the products available from shops. Hair salons also have to follow guidelines to ensure safe use of hair colorant products. In some rare cases allergic responses have been severe, even leading to anaphylaxis. While manufacturers continue to eliminate potential allergens from their products individuals that have experienced even mild reactions to hair dyes should avoid using them altogether. It is possible to have allergy tests performed to ascertain which chemical is the allergen.
Atopic Eczema
What is Atopic Eczema?
Atopic Eczema is an inflammatory skin disorder that may also be termed as dermatitis, which means 'inflammation of the skin'. Atopic Eczema is the most common form of eczema but there are many different types of eczema. Atopic eczema has a typical pattern of skin inflammation to the upper layer of the skin which causes the symptoms listed below. The condition usually starts in infancy and is most common in children. However, for some it can continue into adulthood affecting both sexes equally. In some cases it can develop for the first time in adulthood. It can occur anywhere on the body although the following information relates to the affects it has on the scalp.
The signs and symptoms of Atopic Eczema
This inflammatory skin condition is characterised by changes in the upper layer of the skin that include inflammation, itching and flaking. These are the most significant symptoms of the condition. The skin will appear red, dry and can become flaky. The constant itching can lead to continued scratching often resulting in blistering, oozing, crusting, scaling, thickening and in some instances hair loss.
What causes it and what can I do about it?
A predisposition to Atopic conditions is often part of your genetic make-up as it so often runs in families. Common conditions that the family may have is eczema, asthma or hay fever. It is likely that one or more of these conditions are apparent. In the case of Atopic eczema the causes can be numerous and widespread so determining the source can be very difficult. This is the same for the scalp as it is for other areas of the skin. In Atopic eczema of the scalp the breakdown of the skin often leads to the normal function of the skin, as a protective barrier, being impaired, meaning that it does not perform well. This results in allergy-inducing substances or irritants possibly entering the skin. It is this that causes inflammation and dryness which then leads to itching. Constant scratching tends to induce more itching, causing what is termed as the ’itch-scratch’ syndrome which can be a difficult cycle to break. Stopping the scratching is key to controlling the problem as the scratching is what leads to further skin damage, thus more problems.
Allergy testing in some cases can be useful. There is no cure but the condition can be controlled often with long periods of remission.
What is the treatment?
The following Treatment advice has been provided by
Consultant Trichologist Jane Mayhead MIT
Because the skin from eczema, during a so called ‘flare-up’, is often dry, red and flaky, using a scalp cream will be of benefit. Due to the scalp being covered with hair treating scalp eczema can be quite a challenge. The best regime is a pre-wash cream treatment. This is to remove the flakes and soothe the irritation. It should then be followed by a shampoo designed to do the same thing. An emollient cream can then be applied to moisturise the skin after the washing. In areas that are repeatedly scratched the skin may thicken up. This is sometimes referred to as lichenification and steroid cream may then need to be used to heal the skin. This should be under the guidance of your Doctor.
Emollients or Moisturisers
The dryer your skin, the more regularly you should apply a moisturiser. Daily at least, but you may require applications several times a day and particularly at night. As scalp application can be difficult it is sometimes best to apply a moisturiser at night as then the hair can be washed in the morning.
Steroid Creams or Ointments
These treatments are usually only available on prescription and their use should be monitored. They come in different strengths and may cause side effects when they are applied topically. However, mild hydrocortisone creams can be purchased over the counter at pharmacists. Steroids are useful in treating the inflammation and itching of eczema.
Ultraviolet Light Therapy
This has proved to be successful at treating eczema but does, of course, need to be used with caution and therefore should only be applied by a professional at a specialist clinic for scalp treatment by a qualified dermatologist or trichologist.