HEALTH
   

 

 

Common Scalp Problems

 

Ezy Health @ GS Tamilan

 

  Introduction about scalp problems

Dandruff

Dandruff is a mild form of seborrhoeic dermatitis. Skin flakes are continuously shed from the scalp as part of the normal skin repair and renewal process. However, in the case of dandruff, the flakes are larger and the scaling is heavier than normal and is usually accompanied by redness, itching and soreness. The intense itching is most distressing to the patient as it is relieved only by scratching, which consequently causes more itching.

 

Seborrhoeic dermatitis

Seborrhoeic dermatitis has more severe symptoms compared to dandruff as it affects a larger area besides the scalp e.g. eyebrows, nose, cheeks and ears. It can even occur on the chest and around the groin. Because of the extensiveness of the condition, those afflicted tend to find it both discomforting and disruptive as it can restrict their normal activities.
 

What causes dandruff and seborrhoeic dermatitis?

These two conditions are thought to be associated with the presence of tiny yeast called pityrosporum found in small quantities in everyone. For people with dandruff and seborrhoeic dermatitis, they seem to have larger amounts of this yeast. It is found that when the amount produced is reduced, the condition often improves.

 

What you can do?

For cases of mild dandruff, use a dry scalp shampoo to remove flakes by shampooing more frequently and moisturising the scalp.


In the case of severe dandruff conditions, use medicated shampoos containing an active ingredient like zinc pyrithione, selenium sulphide or an antiseptic. For patients with scaly scalps, coal tar shampoos will help to control the yeast and in turn the flaking. In the beginning, it may be necessary to use the medicated shampoo more frequently to bring the condition under control. One must also avoid scratching the scalp when shampooing the hair. Instead, they should gently massage the scalp. Itchiness can also be alleviated by using warm water instead of hot water, by gently drying the hair and avoiding over-hot air from the hair dryer.


For severe seborrhoeic dermatitis cases, referral to a doctor is recommended as scalp lotions and topical steroid treatment may be necessary to help soften the scales and reduce severe inflammation and irritation.

 

Cradle cap

Very often in the first few months of life, a form of seborrhoeic dermatitis (cradle cap) affects the scalp of babies. It appears as a yellowish crust, mainly on the scalp but sometimes also on other areas like eyebrows and ears. The yellowish crusts are hard to remove. Olive oil can be applied to the patches and left overnight to soften the scales and then shampooing it out with a baby shampoo.

 

 

   Psoriasis

 

Like seborrhoeic dermatitis, psoriasis is due to an increased turnover of skin cells. Normally the skin's repair and renewal process takes about 30 days, but in patients with psoriasis the process is accelerated to about 7 times than normal. This results in thick patches of skin as the skin cells do not have enough time to mature and shed.

Areas affected are usually the scalp, elbows, knees and feet although it can be anywhere in the body. Psoriatic plaques appear as thick red patches with dry silvery scales and are often itchy. On the scalp, the lesions appear as a thick mat of dandruff accompanied by hair loss. This hair loss usually corrects itself once the condition is brought under control.

Psoriasis is not contagious but appears to be hereditary. It affects both men and women in equal numbers and can appear at any age, usually between 15 and 40. Although not proven, certain trigger factors appear to precipitate a flare-up, e.g. stress, alcohol intake, infections, drugs and cigarette smoking. Some experience worsening effects on exposure to sunlight whilst most seem to improve from the exposure.

Psoriasis is very unpredictable as it is a long-term condition with varying degrees in severity. Some patients may have only one attack while others may have frequent exacerbations and remissions. There is no known cure but with early detection and the availability of new treatment, longer periods of remission are possible.

 

 

Treatment

Special shampoos containing tar can be used to control mild psoriasis. If the condition is difficult to control and the psoriasis is also present in other parts of the body besides the scalp, referral to a doctor is recommended. For the more severe cases, it is usually required to soften the scales before medication is applied so as to maximize its effect thereby bringing the condition under control. Olive oil can be used to soften the scales. Products containing salicylic acid and sulphur are also used for this purpose. It is important to note that, for these softening agents to work properly, application must be thorough and there must be sufficient contact time. The olive oil, for example, must be massaged into the scalp. Medication in the form of lotions or ointments must be applied thoroughly to cover the whole scalp. They are then left in place for at least an hour. Get help from a family member to ensure thorough application and also when combing out the scales.

Apart from treatment, there are a few things that one must take note :

  • avoid use of strong perfumed or antiseptic soap
  • avoid scratching the scales or trying to remove them as this can worsen the condition
  • wear loose, comfortable cotton clothes
  •  

 

 

   Ringworm

 

Scalp ringworm is a fungal infection which is common in children. It is usually caught from animals like cats and other pets and sometimes people. The ringworm initially appears as a round lesion with scales at the edge and clear at the center accompanied by a bald patch. Eventually the fungus penetrate deeper to infect the hair shaft weakening hair and causing them to break off below the surface of the skin. These broken stumps of hair follicles create the characteristic 'black dots'.

 

Tratment

The flaking caused by the ringworm is sometimes mistaken for dandruff. For the right treatment to be given, it is best to ensure that the diagnosis is accurate.

Because of the deep-seated nature of the infection, treatment is usually systemic. Response with topical therapy is poor. Those with suspected ringworm must be referred to a doctor for proper treatment.
 

 

 

    Hair Loss

Hair has been associated with fashion and image. Hair has no biological function. However, studies have demonstrated that hair loss may have a serious psychological impact. This may be assoaciated with :

  • Low self-esteem / Depression
  • Introversion
  • Feeling of unattractiveness
  • Less Likable
  • Less successful

Hair is a living tissue, although the visible portion is technically dead. It grows in a particular distinct cycle, consisting of the anagen (growth), catagen (transitory) and telogen (resting) phases. The shedding of hair occurs when a new hair in the anagen phase pushes out the telogen hair.

The average number of hairs on the human scalp is between 100,000 to 150,000. Normally, each hair on the scalp will grow continuously for 2 to 4 years. It will subsequently stop growing for 2 - 4 weeks and will reach a resting phase where the hair eventually falls out. In its place a new healthy hair begins to grow, and this cycle is repeated. The hair on our scalp is always going through different stages of this hair cycle, so it is normal to shed between 50 - 100 hairs a day.

Hair loss is a natural occurrence in both men and women. It usually starts in adulthood and continues throughout life resulting in visible thinning. For some people, this happens prematurely. This could be due to :

  • Anaemia / dietary imbalance - our hair is nourished by blood. Deficiencies of iron, protein and carbohydrates in our diet can affect the growth of the hair.
  • Hypothyroidism
  • Medical treatment e.g. cancer therapy
  • Hereditary
  • Scalp problems - some scalp disorders like psoriasis, fungal infections and alopecia areata can eventually lead to hair loss
  • Hormonal changes in women - scalp hair differ from other body hairs, in that its growth is influenced by androgens. This is a male hormone, but found also in smaller quantities in women and is responsible or the common baldness in men. In women, there appears to be an increase in the levels of androgens in certain conditions like ovarian cysts and hirsutism (excess body and facial hair, thereby causing hair loss. Hormonal changes also occur after childbirth and menopause).
  • Stress - In women stress build up may be responsible for increasing the level of androgen, thereby causing hair loss
  • Excessive use of styling aids and hair treatment that damage the hair e.g. perming or dyeing


The most prevalent hair loss in men and women is Androgenetic Alopecia or also known as Male / Female Pattern Hair Loss. It is estimated that 95% of men suffering from hair loss is due to Androgenetic Alopecia.


Androgenetic Alopecia

 This is the most common kind of hair loss affecting both men and women. Contributory factors stem from a combination of ageing, biochemistry and genetics. Androgenetic Alopecia affects about 25% of men by age 25 and 40% of men by age 40. In women, it occurs a decade later, 30% of women by age 40.

Androgenetic Alopecia or Male Pattern Hair Loss is generally influenced by hereditary. Hence, a man can inherit this trait from his family. A man who suffers from Male Pattern Hair Loss has increased level of a hormone called DHT (a male hormone called dihydrotestosterone) in the scalp. DHT contributes to the shortening and thinning of the hair. As a result, the normal hair cycle is disrupted and men shed more than the average number of hair per day.

Male Pattern Hair Loss can start as early as late teens. This is characterized by the receding hairline at the forehead and is also commonly seen with the thinning at the top. This is followed by the baldness on the front and top portion of the head. All that remains is a border of hair around the side and back of the head. In some cases there is complete baldness.

The extent of hair loss in females with normal hormonal level is much more limited than in males. Premature hair loss in women causes hair thinning particularly at the top of the head but this rarely leads to complete baldness., Women with this condition tends to notice a thinning of their hair from their mid 30's onwards. Women with Male Pattern Hair Loss must undergo a thorough check to ensure there is sufficient protein / carbohydrate in their diet and the absence of thyroid, hormonal and anaemic conditions. Recent pregnancy can be another cause for hair loss in women.

Other types of hair loss that may occur include the following (but not limited to) :

Alopecia areata - This is a form of patchy alopecia that affects both men and women. This can cause loss of scalp hair in a period of just a few days in extreme cases.

 Scarring alopecia - Such alopecia are caused by trauma, burns and fungal infections although sometimes the cause is 'unknown'. There is localized permanent damage to the hair follicles

 Traction alopecia - This hair loss is due to styling of hair, which is too tight causing prolonged traction.

 Anagen effluvium - This refers to acute hair loss usually caused by chemotherapy or radiation.

 Diffuse thinning - It is often not known what causes this kind of hair loss although some illness can cause diffuse thinning.

 Profuse hair fall - Referral to a doctor is necessary to establish the cause because if such hair-fall becomes chronic, an overall loss of hair density usually becomes apparent
 

 

Treatment

TMale Pattern Hair Loss is a progressive condition and may worsen if one does not seek treatment. Selecting a hair loss treatment can be a costly decision as the market is flooded with many remedies.

Before any treatment can be prescribed, sufficient examination is required to establish the cause of hair loss. Otherwise, treatment may not be successful. Sometimes the change in hair growth is one of the first symptoms of an underlying disease e.g. anaemia. This must be attended to before the treatment for hair can proceed.

The goal of treatment is to restore a full head of hair or to prevent further hair loss in milder cases. Treatment can consist of stimulant lotions, scalp massages, oral tablets, surgery and vitamin/mineral supplementation. In many cases the rate of hair loss can be slowed down and the regrowth of loss hair achieved with the use of finasteride and minoxidil, both approved by the Malaysian Ministry of Health and the US FDA.

Important note :

As it is vital to establish the cause of hair loss before looking for a prescribed treatment, do seek appropriate advice or consultation from a qualified doctor or dermatologist beforehand.

 

Launched on June 2004
 Last Updated on 15 September 2004

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 © Gunasegaran Kulanthy Velu

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