Dr Freeman shares the scoop on common scalp problems and the best treatments, hair & scalp products to use
Has many causes, from simply a dry scalp to diseases like psoriasis and seborrhoeic dermatitis. For simple dryness, which can occasionally generate a mild itch, try shampooing the hair less often and with a cooler water stream. Shampoo traps oils, so if you do it too frequently, you may dry your hair out, leaving it prone to breakage. Even washing the hair with conditioner only can work for some. When the flaking is more noticeable and often the itch is more of a feature, the dandruff is being generated by mild seborrhoeic dermatitis. When you were an infant and had cradle cap (see below) that was an early sign of seborrheic dermatitis. If this is the case then try using an anti-dandruff shampoo daily. Leave shampoo on for five minutes, then rinse well. You may need to try several dandruff shampoos to find one that works best for you. If one stops working, try another. In general the Imidazole-based shampoos (eg Nizoral) available from the chemist works best, but when that doesn’t help, call your doctor.
If the dandruff flakes you see are greasy and yellow, you may have more aggressive form of seborrheic dermatitis. It’s an inflammatory skin condition that can occur where there are lots of oil glands, like the scalp and face. Though seborrheic dermatitis is related to hormones, normal fungus, and even some neurological problems like Parkinson’s Disease, they are treated the same as dandruff; with anti-dandruff shampoos. Severe cases may need a prescription steroid or oral antifungal medicine. For the face, the BLOC Red serum can be quite successful.
This form of seborrheic dermatitis affects infants, typically in the first six months. It causes greasy, yellowish scales or crusts on the scalp. Although it may frighten parents, cradle cap is not a sign of a more serious infection, and it will usually clear up by the baby’s first birthday.
For treatment, try soaking your baby’s scalp softly with baby or coconut oil to loosen the scales. After a few minutes, wash your baby’s hair with a gentle baby shampoo. Then brush the scalp very gently with a soft brush to loosen the flakes. If a regular shampoo isn’t working, ask your doctor about a medicated option.
At least half of all the people who have psoriasis have it on their scalp. Scalp psoriasis can be very mild, with slight, fine scaling. It can also be very severe with thick, crusted plaques covering the entire scalp. Psoriasis can extend beyond the hairline onto the forehead, the back of the neck and around the ears.
When psoriasis appears on the scalp, you may notice:
● Reddish patches on the scalp. Some patches are barely noticeable. Patches also can be very noticeable, thick, and inflamed.
● Dandruff-like flaking and silvery-white scale. Scalp psoriasis can look a lot like dandruff. Many people who have scalp psoriasis see flaking. But there are differences between scalp psoriasis and dandruff. Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp.
● Dry scalp. The scalp may be so dry that the skin cracks and bleeds.
● Itching. This is one of the most common symptoms. For some the itch is mild; others have intense itching that can interfere with everyday life and cause sleepless nights.
● Bleeding. Because scalp psoriasis can be very itchy, almost everyone scratches. Scratching can make the scalp bleed. Scratching also tends to worsen the psoriasis. Scratching can make the patches larger and thicker. This is why dermatologists tell their patients, “Try not to scratch your scalp.”
● Burning sensation or soreness. The scalp can burn. It can feel extremely sore.
● Temporary hair loss. Scratching the scalp or using force to remove the scale can cause hair loss. Once the scalp psoriasis clears, hair usually regrows.
Treating scalp psoriasis
Treatments are often combined and rotated because a person’s psoriasis may become less responsive to medications after repeated use. Systemic treatments are not commonly used just for scalp psoriasis but may be used if psoriasis is present elsewhere on the body and/or the psoriasis is moderate to severe.
Mild scalp psoriasis
Tar products and salicylic acid generally work for very mild scalp psoriasis.
There are many coal tar and non-coal tar medicated shampoos for treating scalp lesions on the market. Remember, medicated shampoos are designed for the scalp, not the hair. So leave it on the scalp before washing it out. Suitable brands include Neutrogena T Gel shampoo.
Moderate to severe scalp psoriasis
If you have a more severe case of scalp psoriasis, you may need to try different treatment plans before you find the one that works for you. The doctor might need to be consulted for a compounded cream to use overnight containing coal tar and salicylic acid. There is a recently subsidised shampoo for severe psoriasis called Clobex, which is a prescription item. This powerful cortisone shampoo is often very effective at thinning out the psoriasis and relieving the itch.
For those where this is still not enough, Dermatologists have access to oral retinoid capsules that can be very helpful along with other physical therapies especially for localised psoriasis.
Allergy to preservatives and hair dye can lead to severe discomfort and a red itching scalp. In general it is best to avoid the preservative Methylisothiazolinone (MI) as this is often the cause of the preservative allergies. Hair dye allergies are due to the permanent hair dye PPD. It is simple to check – if you get a rash after exposure you are very likely to be allergic. The Dermatologist can confirm this with a patch allergy test. If it’s confirmed, you will need to change to “PPD free” hairs dyes, which are generally much more temporary.
Lastly, for those who have been losing hair from the top of the head and not wearing a hat at every moment. Let’s face it, this is mostly the men. Now you have all those sunspots on the top of the head. While they may just feel rough, they are a marker of very significant sun damage. They can lead on to different forms of skin cancer that if allowed to progress, could become life threatening. There are a number of different treatments available from your doctor. Best to start the day with Actinica sunscreen. All sunscreens only last a maximum four hours in the sun so top it up regularly. Hats are better but not always practical. There is a vitamin supplement that reduces sun spots and skin cancers. The supplement Insolar from Blackmores taken twice a day will make a significant difference. As for putting the hair back on, that is another story but best attempted as soon as hair loss is detected.