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Common Scalp conditions

Common Scalp Conditions + Pictures, Symptoms & Treatment

by Dr.Bahman Sotoodian

Scalp conditions can come in various forms and can cause severe symptoms. Most scalp conditions are not contagious and some are inherited, while others can be caused by malnutrition or infection. Accurate diagnosis and treatment depend on the specific cause of the scalp condition. Common symptoms of scalp conditions include itching, inflammation, and skin flaking. It is important to consult with a healthcare provider, such as a dermatologist, for a thorough examination and proper diagnosis in order to receive appropriate treatment.

This article will discuss common scalp conditions and treatment options.

Different types of Scalp conditions

Scalp Eczema (Dermatitis)

Seborrheic dermatitis is a common form of eczema that can affect the scalp and hairline. It can occur in babies, children, and adults and is characterized by red, scaly skin with dandruff and a rash that may vary in severity. The rash may also appear on other parts of the body, such as the eyebrows, eyelids, sides of the nose, and the creases of the knees and elbows.

Scalp Eczema
Different types of Scalp conditions: Scalp Eczema (Dermatitis)

Does scalp Eczema lead to hair loss?

While seborrheic dermatitis or scalp eczema itself may not directly cause hair loss, the act of scratching and itching the scalp can damage the scalp and hair follicles. This can lead to brittle hair, which can cause some hair loss.

Symptoms

  •     Blister-like, little bumps
  •     Scaly, thick skin
  •     Red skin
  •     Flaky skin
  •     Greasy or waxy skin
  •     Extremely itchy or burning sensation
  •     Lesions that ooze or are “weeping.”
  •     Changes in skin color after healing

Underlying Causes

  • Changes in hormones
  • Genetics
  • Illness
  • Stress
  • Detergents and soaps that contain harsh chemicals.
  • Alcohol-based lotions or excessive alcohol use
  • Certain medications, such as psoralen (for psoriasis), interferon, and lithium.
  • Excessive sweating
  • Being exposed to an allergen

Treatment

  • Moisturize the scalp with medical emollients such as Diprobase® lotion, Doublebase® gel, and Emollin® spray-on oil.
  • Preparation of salicylic acid and tar, Cocois® or Sebco®, for instance.
  • Topical steroids for the scalp, such as Elocon lotion®, Bettamousse®, or Synalar® gel, may be prescribed.
  • Topical steroids and salicylic acid, such as Diprosalic® scalp application, can be helpful if the scalp is scaly and inflamed.
  • It may be necessary to prescribe oral antibiotics if the scalp is infected.
  • Oral antifungal.

Prevention

  • Lower your stress levels.
  • Limit your exposure to allergens.
  • Steer clear of using hot water when washing your hair, as this can further dry out your scalp.
  • Use a gentle shampoo to remove sweat and dirt from your scalp, especially after working out.

Folliculitis

Folliculitis is a common skin condition characterized by inflammation of the hair follicles. It is often caused by a bacterial infection and may initially appear as small pimples around the hair follicles. Mild cases of folliculitis can typically be treated with self-care measures and will heal without scarring within a few days. However, more severe or recurrent infections may require prescription medication. If left untreated, severe infections can result in permanent hair loss and scarring.

Folliculitis on scalp
Different types of Scalp conditions: Folliculitis

Symptoms

  • Small bumps or pimples clustered around hair follicles
  • Blisters with pus that break open and crust over
  • Skin irritation and burning
  • Painful and tender skin
  • A swollen bump

Underlying Causes

  • Frequently brought on by bacterial infections in hair follicles, most frequently Staphylococcus aureus (Staph).
  • May also be brought on by other bacteria, parasites, fungi, drugs, or physical trauma.
  • In some cases, the cause is unknown.

Treatment

  • Antibacterial lotions, gels, or pills
  • Fungal infections can be treated with creams, shampoos, or pills.
  • Anti-inflammatory creams or pills. If you have mild eosinophilic folliculitis, your doctor may recommend using a steroid cream to relieve itching.
  • If you have a large boil or carbuncle, your doctor may make a small incision to drain the pus. This may alleviate pain, hasten recovery, and reduce the risk of scarring.
  • If the treatments haven’t helped, then your doctor may suggest laser hair removal.

Prevention

  • Wash your skin frequently. Always use a clean washcloth and towel, and never share your towels or washcloths.
  • Regularly wash your clothes.
  • Avoid applying pressure or friction to your skin.
  • If you can, avoid shaving. If you don’t need a clean-shaven face and have facial folliculitis, growing a beard might be a good option.
  • Shave carefully.
  • Try depilatories or other hair removal methods, or hair removal products. However, they too might cause skin irritation.

Is folliculitis a sexually transmitted disease?

Folliculitis is not a sexually transmitted infection, but it can be transmitted through close skin contact in some cases. The herpes simplex virus, on the other hand, is spread through sexual contact. This virus can cause folliculitis in rare cases.

Androgenetic Alopecia

Androgenetic alopecia is a common hair loss condition that affects both men and women. In fact, by the age of 50, the condition affects 30% to 50% of men. Androgenetic alopecia is also referred to as “male-pattern baldness.” The pattern of hair loss in women differs; thin hair is distributed over the entire head, and the hairline does not usually recede as it does in men.

Androgenetic Alopecia
Different types of Scalp conditions: Androgenetic Alopecia

Symptoms

  • Male bald spots and a receding hairline
  • Women with thinning hair at the top of their heads

Underlying Causes

  • Genetics
  • The effects of androgens, which are male sex hormones
  •  Androgenetic alopecia, in particular, is caused by a genetic sensitivity to the androgen DHT, or dihydrotestosterone.

Treatment

  • Topical minoxidil solution
  • Finasteride

Prevention

  • Androgenic alopecia is unpreventable.

Is it possible to regrow hair after androgenetic alopecia?

If you have androgenetic alopecia, you may experience hair regrowth, but the rate of regrowth varies from person to person. Although androgenetic alopecia cannot be prevented, there are numerous hair loss treatments available to slow the process or restore hair permanently.

Alopecia Areata

Alopecia areata is an autoimmune skin disease that causes hair loss on the scalp, face, and other body parts. The body’s immune system attacks the hair follicles, causing them to shrink and slow hair growth. There could be a cycle of hair loss that involves unpredictable regrowth and loss.

Alopecia Areata
Different types of Scalp conditions: Alopecia Areata

The three varieties of alopecia areata are as follows:

  • Alopecia areata: Small, coin-sized patches of hair loss appear on the scalp, around the beard area, on the eyelashes, in the armpits, and in the brows.
  • Alopecia totalis: This results in complete hair loss on the scalp.
  • Alopecia Universalis: This results in total hair loss throughout the body and scalp.

Symptoms

  • Sudden hair loss
  • Coin sized patches of hair loss

Underlying Causes

  • The immune system attacks hair follicles, resulting in inflammation.

Treatment

  • Both oral and injectable medications (including JAK inhibitor treatment)
  • Injections of steroids into the areas where the hair has fallen out

Prevention

  • Eat a protein- and vegetable-rich, wholesome, and balanced diet.
  • Preventing unnecessary scalp or hair trauma
  • Lowering stress

How is alopecia areata scalp condition treated?

Although there is no cure for alopecia areata, it can be treated and hair can regrow. There are several treatment options available for alopecia areata, including the use of corticosteroids, which are anti-inflammatory drugs used to treat autoimmune diseases. Other treatment options may also be used to manage alopecia areata.

Head Lice

Head lice are tiny insects that can cause itching and small red bumps on the neck, scalp, and shoulders. They are not visible to the naked eye, but their eggs, called nits, can be seen as small, round or oval-shaped globs of hair attached to the hair near the scalp. Nits may be mistaken for dandruff, but they are more difficult to remove. They can cause discomfort and may require treatment to eliminate the lice infestation.

Head lice
Different types of Scalp conditions: Head lice

Symptoms

  • Itching on the scalp, neck, and ears is the most common symptom of head lice. An allergic reaction to louse bites has occurred.
  • The lice may be visible, but they are often difficult to detect because they are small, avoid light, and move quickly.
  • Nits adhere to hair shafts and can be difficult to see due to their small size. They are most visible around the ears and the neck’s hairline. Empty nits may be easier to detect because they are lighter in color and located further away from the scalp.
  • Scalp, neck, and shoulder soreness, as scratching can cause small, red bumps that can become infected with bacteria.

Underlying Causes

  • The most common way to contract head lice is through direct contact with someone who is already infested.
  • Sharing personal items such as combs, brushes, and hats with another person infected with head lice

Treatment

  • To get rid of nits and lice, use a fine-toothed comb.
  • Shampoos, lotions, and creams that are available over the counter or by prescription such as:
  • Permethrin (Nix).
  • Spinosad (Natroba). Spinosad is suitable for adults and children aged 6 months and up. It kills lice and nits and does not usually require repeat treatment.
  • Malathion. Malathion is safe for adults and children over the age of two. Because of the high alcohol content, the drug should not be used with a hair dryer or near an open flame. If necessary, malathion can be reapplied 7 to 9 days after the initial treatment.
  • Ivermectin (Stromectol). In addition to the nonprescription lotion, ivermectin is available by prescription as a tablet to be taken orally.

Prevention

  • Combs, brushes, hats, and scarves should not be shared.
  • Avoid lying on furniture such as pillows, couches, or beds that have come into contact with someone who has head lice.

How long do head lice last?

Head lice will be completely eradicated after two to three weeks of effective treatment. The duration is determined by the number of lice that have made a home in your hair. To get rid of lice quickly, make sure you follow the directions on your medicated shampoo, lotion, or cream. If left untreated, lice can live on your head for up to 30 days or longer.

Lichen Planus

Lichen planus is an autoimmune disorder characterized by the development of itchy, small patches of hair loss on the scalp. It is also known as scarring alopecia, and is an inflammatory skin condition.

Lichen Planus
Different types of Scalp conditions: Lichen planus

Lichen planus is a condition that can often be managed at home for mild cases, but severe pain or itching may require prescription medication. It is important to note that lichen planus is not contagious. If you are experiencing severe symptoms, it is advisable to seek medical attention.

Symptoms

  • Purplish, flat bumps, usually on the inner forearm, wrist, or ankle, but also on the genitals.
  • Itching
  • Blisters that scab or crust over
  • Lacy white patches around the mouth, lips, or tongue
  • Painful sores
  • Hair loss
  • Color shift in the scalp
  • Damage or loss of nails

Underlying Causes

  • Lichen planus develops when your immune system attacks skin or mucous membrane cells.
  • Hepatitis C virus infection
  • Influenza vaccine
  • Specific dyes, chemicals, and metals
  • Ibuprofen (Advil, Motrin IB, and other pain relievers) and naproxen (Aleve, and others),
  • Certain heart disease, high blood pressure, and arthritis medications

Treatment

  • Prescribed cream or ointment containing corticosteroids.
  • Injectable or oral corticosteroids
  • Oral antibiotics
  • medications for immune responses
  • Antihistamines
  • Retinoids

Prevention

  • There is no way to avoid lichen planus.

Is Lichen Planus contagious?

Lichen planus cannot be transmitted from one person to another through skin-to-skin contact or unprotected sexual activity. It is not contagious and cannot be spread from person to person. It is important to note that lichen planus is a condition that affects the skin and is not caused by an infectious agent.

After Lichen Planus, can hair grow again?

Lichen planopilaris is a condition that cannot be cured, but it can be managed with treatment. Some approaches used to treat this condition are similar to those used for alopecia areata, such as the use of corticosteroids. These medications can help to reduce inflammation and improve symptoms. It is important to work with a healthcare provider to determine the most appropriate treatment plan for your specific needs.

Tinea Capitis (Ringworm)

Ringworm is a fungal infection that affects the outer layer of the scalp. It is characterized by the development of a rash with circular patches and raised, red edges. The rash tends to spread from the outside of the circle, leaving the inside unaffected, which gives it a ring-shaped appearance.

Tinea Capitis
Different types of Scalp conditions: Tinea Capitis (Ringworm)

Unlike many other scalp conditions, ringworm is contagious. It can be spread through direct contact with an infected person or animal, or by sharing personal items such as hats, combs, brushes, clothing, or towels. It is important to practice good hygiene and avoid sharing items to prevent the spread of this infection.

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Symptoms

  • Dandruff-like dry scaling
  • Smooth areas where hair has fallen out
  • A yellow crust
  • Hair that is matted
  • An inflamed mass resembling an abscess
  • Black spots where hair has fallen out

Underlying Causes

  • Tinea capitis is caused by mold-like fungi known as dermatophytes.
  • It can be contracted through contact with infected people, animals, or soil.

Treatment

  • Grisseofulvin (Grifulvin V, Gris-PEG), terbinafine, and itraconazole are examples of prescription drugs or antifungal shampoos that are effective.
  • Since ringworm is so contagious, antifungal shampoo must be used by everyone in the house.

Prevention

  • Maintain good hygiene practices
  • Keep distance from anyone who may be infected.
  • Items such as combs, towels, bedsheets, caps, and so on should not be shared.
  • Take the medications on a regular basis to avoid infection relapse.
  • Use medicated shampoos as recommended by your trichologist.
  • Keep infected pets and farm animals away from you.

Psoriasis

Psoriasis is a genetic autoimmune disorder that causes long-term inflammation and periods of remission and relapse. It affects the scalp in about half of all cases, and can range from mild, almost undetectable symptoms to severe, long-lasting sores that are thick and crusted. Scalp psoriasis can cause itching that can disrupt sleep and daily activities, and frequent scratching can lead to skin infections and hair loss. It is important to work with a healthcare provider to develop a treatment plan to manage the symptoms of this condition.

Different types of Scalp conditions: Psoriasis

Symptoms

  • Bumps that are scaly, red, or purple
  • Scales of silvery-white or gray
  • Flaking similar to dandruff
  • Scalp dryness
  • Itching
  • Pain or burning
  • Hair loss

Underlying Causes

  • Scalp psoriasis is inherited, and the causes are complex.
  • Environmental exposures may play a role in the development or exacerbation of this condition
  • skin injuries
  • sunburn
  • medications
  • stress and other autoimmune or inflammatory diseases.

Treatment

  • Medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. Some of these products are available over the counter, but others require a prescription.
  • Tar shampoo may be effective in mild cases.
  • Shampoo containing salicylic acid may assist in the breakdown of scales.
  • Corticosteroids applied to the skin may help reduce inflammation and itching.
  • If you have moderate to severe scalp psoriasis, your doctor may prescribe an oral medication:
  • Acitretin (Soriatane), a potent vitamin A derivative
  • Apremilast (Otezla) is a small molecule inhibitor that is taken twice daily.
  • Corticosteroids
  • Cyclosporine (Sandimmune) suppresses the immune system, which aids in the reduction of psoriasis inflammation.
  • Methotrexate (Rheumatrex) inhibits an enzyme that promotes the rapid growth of skin cells.
  • Tapinarof (Vtama) cream 1%
  • A once-daily dose of the Janus kinase inhibitor upacitinib (Rinvoq)

Prevention

  • Psoriasis symptoms may come and go, but there is no known treatment for the disease.
  • Avoid Skin trauma
  • Reduce your stress
  • Certain medications can disrupt the body’s immune response and cause inflammation, triggering psoriasis. Among these medications are:
  • Lithium
  • Antimalarial medications like chloroquine and hydroxychloroquine
  • inderal (Hemangeol), a blood pressure medication
  • Indocin (indomethacin) is a nonsteroidal anti-inflammatory medication used to treat arthritis.

What vitamin deficiency causes scalp psoriasis?

There is a link between psoriasis and vitamin D deficiency. Although a deficiency is not believed to be the direct cause of psoriasis, it may weaken the body’s ability to maintain healthy skin, which could increase the frequency of flare-ups. Adequate intake of vitamin D may help to improve symptoms of psoriasis. It is important to work with a healthcare provider to determine the appropriate levels of vitamin D for your individual needs.

Diagnosis of scalp conditions

During a history and physical examination, many scalp skin conditions can be diagnosed. A diagnostician can examine the scalp and gather information about the patient’s history of symptoms to make a diagnosis. However, the symptoms of many scalp disorders can overlap, and diagnostic tests may be necessary to differentiate between different possibilities. In some cases, a dermatologist may be consulted to assist with the diagnosis. Factors that may be considered in the diagnosis of a scalp condition include:

  • The appearance and location of any lesions or rashes
  • The patient’s medical history
  • Results of any diagnostic tests
  • The presence of any other symptoms. It is important to work with a healthcare provider to accurately diagnose and treat any scalp condition.
Diagnosis of scalp conditions
Diagnosis of scalp conditions

To accurately diagnose a scalp condition, a healthcare provider may conduct a thorough physical examination to evaluate visible symptoms on the scalp skin. They may also ask about the patient’s family medical history to determine if there are any hereditary scalp conditions, such as psoriasis, present. Other diagnostic tests that may be used to assess scalp conditions include:

  • A pull test to measure the extent of hair loss in people with alopecia
  • A scalp biopsy, in which a small sample of scalp tissue is removed and examined under a microscope to identify the type of scalp condition or the cause of hair loss
  • Cultures, in which a sample of tissue is examined under a microscope to check for a specific type of infection. These tests can help the healthcare provider to determine the underlying cause of the scalp condition and develop an appropriate treatment plan.

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Final Thoughts and outlook for patients with scalp conditions

There are various factors that can cause scalp skin conditions, and the appropriate treatment approach may depend on the specific condition. Some conditions may be managed with self-care strategies, while others may require medical treatment. If a certain treatment is not effectively reducing the severity of the condition, it is important to consult a healthcare provider for further evaluation and guidance.

Many people with scalp conditions can maintain a positive outlook, as medications that slow hair loss or promote hair regrowth can be somewhat effective. Additionally, research on the treatment of various scalp skin conditions is ongoing. Infection-related scalp conditions can often be treated and eliminated, while some other scalp conditions may not be curable but can still be managed with treatment to slow the progression of symptoms. It is important to work with a healthcare provider to determine the most appropriate treatment plan for your specific needs.

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4 comments

Hana March 5, 2023 - 5:09 pm

Great article, thank you! Can scalp eczema be caused by stress or anxiety?

Reply
Support March 9, 2023 - 4:28 am

Yes, scalp eczema (dermatitis) can be caused or worsened by stress or anxiety. Emotional stress can trigger or exacerbate many skin conditions, including scalp eczema. In fact, stress is often cited as a major contributing factor in eczema flare-ups.

Reply
billie March 11, 2023 - 4:01 pm

I didn’t know that folliculitis could be caused by using hair products, how can I avoid this?

Reply
Support March 13, 2023 - 4:55 pm

Yes, folliculitis can be caused by using hair products that irritate the hair follicles, such as gels, pomades, and hairsprays. To avoid folliculitis, it’s important to avoid using these types of products if possible. If you do use hair products, make sure to wash your hair and scalp thoroughly afterwards to remove any residue. You may also want to try using products that are specifically designed for sensitive skin.

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