Conditions that affect the scalp and hair are not unusual, but they can be very embarrassing because they’re not easily hidden. “Our hair is part of our identity,” says Marnie B. Nussbaum, MD, a dermatologist in New York City. “When we experience issues with it, it may alter our confidence.”
Knowing how to spot and distinguish between scalp or hair problems is the first step to getting the right treatment. Here are some common conditions, what causes them, and what can be done about them.
As our scalps shed dead skin cells, a little bit of flaking is not cause for concern. But if those tiny white flakes are chronically littering your hairline and shoulders, then you may have dandruff. Also known as seborrheic dermatitis, the condition causes itchiness and can make your scalp inflamed and sore.
Doctors aren't sure what causes dandruff, but a few suspected culprits are stress, genes, living in a cold or dry climate, your overall health, or an overabundance of the yeast that lives on your skin and feeds off the oil that your hair follicles make.
Over-the-counter shampoos can be effective for treating dandruff. Look for ones that contain zinc pyrithione, tar, salicylic acid, and ketoconazole. These ingredients fight the fungus that can cause dandruff, and help exfoliate your scalp to prevent flakes. But the American Academy of Dermatology cautions that shampoos containing coal tar can discolor light-colored hair and make your scalp more sensitive to sunlight.
What looks a lot like a bad case of dandruff may actually be scalp psoriasis. Psoriasis is an autoimmune disease that can affect the skin anywhere on the body, including the scalp. Like dandruff, it causes flaking and itching, but it's also marked by raised, red, often thick scaly patches, Dr. Nussbaum says. You may have a single patch, several, or your entire scalp can be affected. The patches may also pop up on your forehead, the back of your neck, or behind your ears.
The itching can get so intense that it wakes you up at night, Nussbaum says; and if you scratch it too much, it can lead to skin infections and hair loss. “It is absolutely essential for a psoriasis patient to be seen by a dermatologist for an individualized assessment and treatment plan,” she adds.
Scalp psoriasis can be treated in a variety of ways. Medicated shampoos with salicylic acid can help decrease flaking. Topical corticosteroids can decrease inflammation and resolve thick plaques. And other treatments for mild to moderate cases include light therapy and drugs known as immunomodulators that help regulate the immune system. With the right treatment, hair loss associated with scalp psoriasis is reversible.
While thinning hair is often associated with males of a certain age, it can affect both men and women for a number of reasons. “You may have a hormonal imbalance, an underlying thyroid disorder, an autoimmune condition, an iron imbalance, or genetic risk factors,” Nussbaum says. “It may be induced by medication or malnutrition, or you may be experiencing a stressful life event or physical stress, among other factors.”
To recommend the most appropriate treatment, a dermatologist needs to determine what’s causing your hair loss. He may want to run blood tests to check for thyroid conditions, iron deficiency, hormonal conditions, autoimmune conditions, or diabetes.
If your hair loss is sudden and occurs in round patches, you may have a condition called alopecia areata, an autoimmune disease in which the body destroys healthy hair follicles. A common treatment involves monthly corticosteroid injections to decrease inflammation and help regrowth, Nussbaum says. Prescription creams and the drug minoxidil may also help spur hair growth.
Hair habits can cause or worsen hair loss. “Over-shampooing with the wrong products can strip hair’s natural oils, drying and weakening hair cuticles, and lead to hair breakage,” Nussbaum explains. She recommends using a soap- and alkali-free scalp shampoo — such as Sebamed Scalp Activating Shampoo — to stabilize hair structure, boost scalp circulation, and treat sensitive and delicate scalp skin. She also recommends a gentle, 10-minute scalp massage in the shower two to three times a week. “This helps loosen and remove skin flakes, product residue, and natural oils, and increases blood flow to the scalp to help promote new hair growth.”
Diet is also important. Foods that are high in omega-3 fatty acids, iron, and protein are associated with good scalp and hair health.
Despite its name, ringworm has nothing to do with worms. It’s a fungal infection of the scalp, also called tinea, and is related to athlete’s foot and jock itch. It gets its name from its appearance: a ring with red, itchy, scaly borders. It’s highly contagious and can spread from sharing hats, pillows, and brushes, and can also be spread by house pets. It is most common in toddlers and school-age children.
Treatment for ringworm of the scalp includes oral medications to kill the fungi, as well as medicated shampoos that may lessen the infection’s spread.
Also known as an ingrown hair or razor bump, folliculitis is more common on parts of your body where friction occurs (like your underarm) or that you regularly shave. But it can also occur on your scalp. The inflammation of a hair follicle is often caused by a bacterial or fungal infection and results in a pimple-like or red, raised bump.
If you shave your head or often wear a helmet, hat, or sweatband — particularly when you exercise or play a sport — you’re increasing your chances for folliculitis. This can cause the sweat and bacteria to get trapped in a hair follicle, leading to the inflammation.
Fortunately, it’s typically easy to treat. Applying a warm compress to the infected area may help reduce inflammation. There are also creams, shampoos, and pills available to control infections. To reduce the risk of recurrence, avoid shaving, if possible, or use an electric razor. If you exercise with headwear, be sure to shower immediately afterward.