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March 9, 2015 at 9:12 AMComments: 0 Faves: 0

Common Scalp Conditions: Identification, Treatment, and Prevention

By Jeffrey VanWingen M.D. More Blogs by This Author

The scalp is center-stage on our body, something that we deal with every day as we arrange our hair.  Physiologically, it is one of the most dynamic areas of the body with tens of thousands of hair follicles, glands, nerves and highly concentrated blood vessels.  As such, when something goes wrong with the scalp, the issue is significant and obvious. 

This blog will examine the most common skin rashs of the scalp along with their treatment and prevention.

Scalp Physiology

The scalp consists of a thick-skinned area at the top of our head, densely populated with hair.  Beside each hair follicle exists a sebaceous gland, responsible for producing an oily protective secretion called sebum.  Nerve endings and blood vessels are quite dense under the superficial skin layers.  As such, the scalp is quite sensitive and dynamic in delivering nutrients to the vast numbers of hair follicles and glands.


Signs: Dandruff is the most common, and most visible, scalp condition.  Those telltale flakes can cause embarrassment when they spot dark colored clothing or cling to hair. 

Cause: Common dandruff is caused by the superficial layers of the scalp becoming dry and flaking. The condition is more common in the winter when indoor air is dry. Over blow-drying hair can also contribute.

Treatment: Common dandruff is readily treated with shampoos aimed at turning over and removing the dead skin layer while moisturizing the scalp.  Regular washing to turn over the skin layers is the first step in treating/preventing dandruff. If you are using a conditioner, make sure you treat just the ends of your hair or rinse it thoroughly from the scalp.  If something more is needed, try coal tar shampoo (T-gel brand for instance). This shampoo slows the turn-over of dead cells and can reduce the production of dandruff. Selenium based shampoos (Selsun Blue for instance) can also slow the skin turn-over. (The blue selenium can leave a residual hue to light or gray hair though, so thorough rinsing is important!)  Finally, scalp scrubs such as salicylic acid (like branded T-Sal) can remove and turn over the dead skin layer.  Sometimes, salicylic acid can leave the scalp irritated and promote more flaking, however.

Seborheic Dermatitis

Signs: Seborheic dermatitis is quite different than dry-skin dandruff.  It is caused by a waxy, scabby build-up from oil glands. It usually presents as raised, large yellowish flakes on the scalp around the border by the forehead, ears or back of the hair line. 

Cause: These conditions may be more common in the winter months when dry air causes oil glands to be more active.  Putting hair back wet or wearing a hat trapping sweat can contribute to this condition. 

Treatment: Washing regularly to turn-over oil production is the first step in treatment.  If this does not work, coal tar preparations, salicylic acid shampoo or selenium products may help when used regularly.  If these shampoos are not helpful, a steroid rinse available by prescription may offer relief.


Signs: Psoriasis can also be present on the scalp as scaly, itchy plaques that look somewhat like seborheic dermatitis, though less yellow and more white. Psoriasis is a condition, however, that is usually also present on other areas of the skin whereas seborrhea for the most part keeps to the skin on or near the scalp. 

Treatment: The above shampoos can help reduce psoriasis symptoms.  Systemic, injected medications that modulate the immune response in the body have offered the best defense against psoriasis. These are prescribed and monitored by a dermatologist.

Fungal Infections: Ring Worm

Fungi love warm, dark, fertile places.  The scalp is an excellent example of this.  Dandruff or seborrhea-like symptoms can often be attributed to a fungal infection called Malassezia.  This fungi lives off the dead skin cells that are plentiful on the scalp in the conducive environment.  Zinc pyrithione shampoo such as Head and Shoulders have antifungal properties and may kill the fungi reducing symptoms. Coal tar and selenium preparations may also help.  The antifungal ketoconazole is now available over the counter in a shampoo preparation called Nizoral.  If regular dandruff shampoos fail, it is worth pursuing one of these anti-fungal options.

More fastidious fungal infections can also be present on the scalp.  As fungal and other infections go, they are difficult to treat. 

Signs: Ringworm is characterized by a ring-shaped rash on the skin.  On the scalp, the fungus destroys the hair as it emerges from the skin and hair loss it typical.  It does not permanently destroy the hair, so dots are noticed at the scalp where the hair is emerging from the follicle. 

Treatment: Treatment involves taking an antifungal medication in a pill or liquid form (typically griseofulvin) for at lease a six week course.  Topical treatment with a cream, lotion or shampoo is considered ineffective on the scalp.  This fungal infection is commonly contracted with contact from another infected person or a pet.  It is a well-known scourge in competitive wrestling.

Scalp ringworm can become complicated, resulting in kerion.  Kerion is a painful, inflamed lesion on the scalp that swells and drains pus.  Usually this results from an overzealous foothold from the fungus.  Kerion can cause permanent scaring and hair loss.  Treatment involves draining the abscess pockets and treating aggressively with oral antibiotics and antifungal medications.

What To Do For a Scalp Condition

Scalp conditions are common and usually readily treated with products found at the pharmacy.  Identifying the cause is important in further prevention as well as regular washing of the scalp.  Simple dandruff is treated with one of several available dandruff preparations.  Identifying other causes of scalp issues such as seborheic dermatitis is important in directing treatment.  If introductory therapy is not effective, consider targeting a possible fungal infection. If symptoms of a more substantial fungal infection are present, see your doctor to consider oral therapy.

Live, and live well!

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