The scalp is a hub for several dermatological conditions that lead to hair loss and skin rashes, which can negatively impact patients’ self-esteem and self-confidence. The causes of these conditions are diverse and include genetics, malnutrition (e.g., vitamin deficiencies), infections, and autoimmune diseases. In this article, we will cover the most common scalp pathologies, as well as the proposed treatment for each condition.

Scalp Psoriasis

Psoriasis is an inflammatory skin condition characterized by an abnormal rate of skin cell turnover, leading to plaques with thick scales on the scalp. Note that psoriasis is not confined to a specific region of the skin, as it could spread all over the body with some predilections (e.g., elbows, knees, scalp). Oftentimes, the skin lesions will manifest as discrete scaly plaques along the hairline, which can reach the forehead and the sides of the scalp. Generally speaking, psoriasis does not cause any itchiness to the scalp, which explains its extensive spread before detecting it.

Treatment Treating psoriasis requires a careful inspection by a certified dermatologist who will confirm the diagnosis and suggest a therapeutic approach based on the extensiveness and severity of the patient’s condition. The most commonly prescribed drugs include topical corticosteroids, which downregulate the action of the immune system – an entity thought to be a major trigger of psoriatic flare-ups. Other topical medications may include vitamin D, vitamin A, coal tar shampoo, and anthralin. When psoriasis is mainly on the scalp, using these topical medications becomes challenging, which is why your dermatologist may prescribe lotions, gels, liquids, foams, or sprays to cover the hair and scalp areas.

In some cases, the patient may not respond to conventional therapies, which warrants the use of other measures, such as oral medications, phototherapy, and skin injections.

Scalp Eczema (contact dermatitis)

Contact dermatitis is a type of inflammatory eczema that gets triggered by an environmental agent. When this condition affects the scalp, it is most often the result of shampoo overuse (medical types), exposure to chemicals (e.g., bleach), or chronic heat applied to the scalp. Perhaps the most neglected trigger of contact dermatitis is the home preparations of topical products to enhance the appearance of hair follicles, which often contain allergenic chemicals.

Eczema of the scalp appears as itchy, scaly patches along the hairline and ears, with potentially cystic formations during the acute phase.

Treatment The treatment of scalp eczema is complex and involves a multistep process to make lifestyle modifications and take pharmacological drugs. First and foremost, patients will need to identify the trigger of their condition (e.g., chemical shampoo, gel) to eliminate it from their daily routine. To do this, dermatologists recommend that you write down a list of everything you get in contact with. After a few flareups, you will start to see a pattern between being exposed to a specific agent and the manifestation of inflammatory signs and symptoms on your scalp.

This process involves listing:

• What you ate
• The weather on that day
• Emotional status
• The hair products you used

When it comes to pharmacological drugs, your doctor may prescribe corticosteroids, mometasone (Elocon), or fluocinolone acetonide (Synalar).

Seborrheic dermatitis

Similar to other dermatological conditions, the exact causes of seborrheic dermatitis are still unknown. This pathology is commonly seen in newborns and infants, as well as middle-aged adults. The primary location affected by seborrheic dermatitis is the scalp, where it presents as yellowish, greasy scales with underlying red, patchy areas. According to researchers, this condition is the result of skin microbiota dysbiosis and an immune component that overreacts to harmless microbes. Malassezia furfur is the main suspect of triggering seborrheic dermatitis.

Treatment Depending on the location of the lesions, your dermatologist may recommend using antifungal shampoos (e.g., ketoconazole), topical corticosteroids, and in some cases, oral corticosteroids. When the scalp is covered with diffuse scaling, your doctor may prescribe mineral oil or olive oil to use for washing your hair, which will help remove the thick tissue before shampooing with ketoconazole. An alternative is an overnight application of a coal tarkeratolytic combination or phenol-saline solution with or without occlusion with a plastic shower cap followed by shampooing in the morning.

Alopecia Areata

Alopecia areata, or AA, is an autoimmune disease that affects the skin, leading to pattern baldness covered with thick patches. AA often manifests discretely, as the patient does not experience any rashes or itchiness that require immediate attention. Instead, bundles of hair seamlessly fall, leaving behind completely bald areas. The exact cause of AA is unknown; however, the vast majority of patients recover spontaneously after a few months. In some rare cases, the disease is linked to other maladies, such as thyroid disease.

Some drugs that cause pattern hair loss (not necessarily AA) include:

Cholesteroldrugs These drugs belong to a family known as statins, which were documented to cause hair loss when used for a long time. Drugs, such as atorvastatin and simvastatin, are firmly thought to cause hair loss. However, the newer generation of statins (e.g., rosuvastatin) seems to be safe in this area.

Anticoagulants The most common drug in this category is warfarin, which is used as a prophylactic and therapeutic drug to manage patients with a high risk of clot formation. Unfortunately, some patients taking warfarin reported hair loss, but we still don’t have a clear understanding of the underlying mechanism.

Psoriasismedication Acitretin (Soriatane) is a commonly prescribed drug to treat psoriasis that could cause hair loss as a side effect.

Treatment The treatment focuses on injecting steroids inside the lesions or taking some pharmacological drugs. If hair loss is the result of a medication, the interruption of that drug is the best approach.

Takeaway message The scalp is often the area of active inflammatory and infectious skin conditions that lead to hair loss and visible rashes. Becoming familiar with these conditions is crucial to be able to quickly identify that something is not right with your skin, which accelerates the process of receiving therapy.

Here you can read more about different skin conditions: https://itsitchy.com/do-i-have-psoriasis-eczema-or-is-it-something-else/

Written by Zac Hyde M.D.