Hair and Scalp Problems
Common problems affecting the hair
and scalp include hair loss, infections, and disorders causing itching and
scaling.
Scalp Psoriasis
Scalp psoriasis a common skin ailment
that makes thick, reddish, often scaly patches on your scalp that can pop up as
a single patch or several. Severe scalp psoriasis happens if it affects your
entire scalp, your forehead, the back of your neck, or behind even your ears.
Scalp psoriasis is not contagious.
As with other types, we don’t know what causes it. Doctors believe it comes
from having a deficient immune system that causes skin cells to grow too
quickly and build up into patches. It can be hereditary. You may be more likely
to get scalp psoriasis if it runs in your family.
About half of the estimated 7.5
million people with psoriasis – which can affect any skin surface – have it on
their scalp.
Sometimes the scalp is the only
place they have it, but that’s uncommon. Scalp psoriasis can be mild and almost
unnoticeable. Those with severe cases have it last for a long time, and have it
cause thick, crusted sores. Although it’s technically harmless, scalp psoriasis
is definitely a bother. Intense itching can affect your sleep and everyday
life, and scratching a lot can lead to skin infections and even hair loss.
Symptoms
Symptoms of mild scalp psoriasis
may include only slight, fine scaling. Symptoms of moderate to severe scalp
psoriasis include: scaly, red, bumpy patches, silvery-white scales,
dandruff-like flaking, dry scalp, itching, burning or soreness, or hair loss.
Scalp psoriasis itself doesn’t
cause hair loss, but scratching a lot, picking at the scaly spots, harsh
treatments, and even the stress and frustration that a person acquires because
of the condition can lead to temporary hair loss. But the bright side is, hair
eventually grows back after your skin clears.
If a person is said to have these
symptoms, encourage them to see a doctor or dermatologist. The earlier scalp
psoriasis is treated the better.
Remedies
Technically, there is no cure for
scalp psoriasis, but many treatments can help symptoms, control flare-ups, and
prevent it from coming back. People who follow their treatment plan rarely have
to endure severe scalp psoriasis for long.
Psoriasis support groups can also offer valuable tips to
help medical treatments work better and ease the stress and sadness that this
common condition can cause.
Topical Treatments:
The first line of defense is
treatment you use directly on your skin: medicated shampoos, creams, gels,
oils, ointments, and soaps. You can get some of these products over the
counter, but stronger ones require a prescription.
Over-the-counter products often
contain one of two medications approved by the FDA for psoriasis are salicylic
acid and coal tar.
Office Treatments:
If you have mild scalp psoriasis on
a few areas, your doctor or dermatologist may consider injecting steroids
directly into those areas.
If your symptoms don’t respond to
topical treatments, phototherapy with a laser or non-laser light source may
help. For example, the excimer laser focuses high-intensity light on affected
areas and avoids the surrounding healthy skin. Ultraviolet (UV) light --
sometimes delivered with a hand-held device called a UV comb -- can be used to
treat the entire scalp. If you have very thin hair, or a shaved head, your
doctor may recommend that you go out in natural sunlight for brief periods.
Severe Scalp Psoriasis
If you have moderate to severe
scalp psoriasis, your doctor may prescribe a drug you take by mouth or one
that's injected or pumped through a needle into a vein. Oral medications
include: corticosteroids, cyclosporine, methotrexate, a strong form of vitamin
A called a derivative, and vitamin D derivative.
Since these medications can cause
serious side effects, including liver damage, they require a doctor’s close
eye. It's also important to know that oral vitamin derivatives are different
from -- and more powerful than – vitamin supplements bought over the counter.
Ordinary vitamin A and D supplements do not help.
The latest class of FDA-approved
medications are called biologics. These drugs, which you get by injection or
IV, may keep your skin from making too many cells. According to the American
Academy of Dermatology, five biologics may work:
• alefacept
(Amevive)
• efalizumab
(Raptiva)
• etanercept
(Enbrel)
• inflicimab
(Remicade)
• ustekinumab
(Stelara)
Alopecia
Hair loss (alopecia) is a frequent
concern for both men and women. Although it is normal to shed some hair each
day, people who experience more than normal hair loss may have the inherited
tendency to "common baldness." Male pattern baldness is the most
common cause of hair loss in men, with a receding hair line and baldness on the
top of the head. Women may develop female pattern baldness in which the hair
becomes thin over the entire scalp. Sudden and temporary loss of a large amount
of hair may be related to the stress of an illness or recent delivery of a baby
(telogen effluvium).
Alopecia areata is an autoimmune
condition resulting in hair loss. The immune system of the body mistakenly
stops hair growth for unknown reasons. Hair loss may be patchy or sparse and
may involve the rest of the body in addition to the scalp. Hair in most people
spontaneously regrows, though recurrences of the condition are also typical.
Genetic and environmental factors play a role in hair loss; the condition may
be seasonal as well.
Hair loss can occur in people of
all ages. The most frequent association is with thyroid disease, although hair
loss can be found in those with the following conditions:
• Lupus
• Lichen
planus
• Vitiligo
• Down
syndrome
Symptoms
Hair loss most commonly occurs on
the scalp, but it can also affect the eyebrows, eyelashes, beard, and other
body sites. Symptoms may include the following:
• Round,
patchy areas of non-scarring hair loss, ranging from mild to severe
• Mild: 1–5
scattered areas of hair loss on the scalp and beard
• Moderate:
More than 5 scattered areas of hair loss on the scalp and beard
• Severe:
loss of all of the hair on the scalp and body
• Scalp
burning (without redness), accompanying lesions
• Pitting
and ridging of the fingernails
Hairs that do grow back often lack
color, or may be either temporarily or permanently white.
Treatment
Those experiencing areas of patchy
hair loss are encourage to get evaluation from a primary a doctor or
dermatologist.
Both topical and systemic
medications may be prescribed, as well as injections. Treatments include:
• Localized
steroid injections (to help speed regrowth)
• Clobetasol
propionate gel or solution, a potent topical steroid
• Anthralin
cream, a topical irritant
• Light
therapy
• Topical
steroids plus minoxidil (Rogaine®)
• Systemic
steroids, such as prednisone, though they have no long-term benefit and are not
recommended for use beyond the short-term
Cradle cap
Cradle cap (also known as crusta
lactea, milk crust, honeycomb disease) is a yellowish, patchy, greasy, scaly
and crusty skin rash that occurs on the scalp of recently born babies.
Cradle cap most commonly begins
sometime in the first 3 months. Similar symptoms in older children are more
likely to be dandruff than cradle cap. The rash is often prominent around the
ear, the eyebrows or the eyelids. It may appear in other locations as well,
where it is called seborrhoeic dermatitis rather than cradle cap. Some
countries use the term pityriasis capitis for cradle cap. It is extremely
common, with about half of all babies affected. Most of them have a mild
version of the disorder. Severe cradle cap is rare.
Symptoms
Cradle cap is seborrheic dermatitis
that affects infants. It presents on the scalp as greasy patches of scaling,
which appear thick, crusty, yellow, white or brown. The affected regions are
not usually itchy and do not bother the child. Other affected areas can include
the eyelids, ear, around the nose, and in the groin.
Cradle cap is not caused by a
bacterial infection, allergy, nor from poor hygiene. Cradle cap is also not
contagious. Doctors do not agree on what causes cradle cap, but the two most
common hypotheses include fungal infection and overactive sebaceous glands.
Cradle cap is an inflammatory condition.
In many cases, what is commonly
called cradle cap is actually a fungal infection. This infection may be related
to antibiotics given to the mother just before the infant's birth, or the
infection could be related to antibiotics routinely given to infants during the
first week of life.
Antibiotics kill both harmful
bacteria as well as the helpful bacteria that prevent the growth of yeast,
which is why people who are prone to fungal infections will often discover a
fungal infection after taking a round of antibiotics. In infants, the fungus is
mostly likely to appear on the scalp (cradle cap), diaper area (fungal diaper
rash, jock itch), ear (fungal ear infection, or an ear infection that does not
respond to antibiotics), or in the mouth (thrush).
Severity
If the condition thickens, turns
red and irritated, starts spreading, appears on other body parts, or if the
baby develops thrush (fungal mouth infection), fungal ear infection (an ear
infection that does not respond to antibiotics) or a persistent diaper rash,
medical intervention is recommended.
Severe cases of cradle cap,
especially with cracked or bleeding skin, can provide a place for bacteria to
grow. If the cradle cap is caused by a fungal infection which has worsened
significantly over days or weeks to allow bacterial growth (impetigo, most
commonly), a combination treatment of antibiotics and antifungals may be
necessary. Since it is difficult for a layperson to distinguish the difference
between sebaceous gland cradle cap, fungal cradle cap, or either of these
combined with a bacterial infection, medical advice should be sought if the
condition appears to worsen.
Cradle cap is occasionally linked
to immune disorders. If the baby is not thriving and has other health problems,
a doctor should be consulted.
Treatment
Treatment other than gentle washing
is frequently not necessary in most mild cases (flaking, with or without small
patches of yellow crusting), as the problem often resolves itself whether the
cause is sebaceous-gland-related or fungal, but since many patients (or
parents) are concerned about cosmetic issues, other options are often
considered. There is little adequate or controlled research to support or
negate the usefulness of most common home remedies at any age.
For infants: in cases that are
related to fungal infection, such as Tinea capitis, doctors may recommend a
treatment application of clotrimazole (commonly prescribed for jock itch or
athlete's foot) or miconazole (commonly prescribed for vaginal yeast infection).
For toddlers: doctors may recommend
a treatment with a mild dandruff shampoo such as Selsun Blue or Neutrogena
T-gel, even though the treatment may cause initial additional scalp irritation.
A doctor may instead prescribe an antifungal soap such as ketoconazole (2%)
shampoo, which can work in a single treatment and shows significantly less
irritation than over-the-counter shampoos such as selenium disulfide shampoos,
but no adequate and controlled study has been conducted for pediatric use as of
2010.
References:
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