Scalp Issues and Hair Health

You’ve probably heard that a healthy scalp equals healthy hair. There has been some research to address specifically which hair issues are related to scalp issues.

Long story short: If you have a chronic scalp issue, it probably affects your hair's condition (health), strength and even could affect hair density. People with scalp issues might want to give extra attention to hair-hydration and gentle care, while making scalp-health a hair-care priority.

Before we go any further - if you don’t already know what’s going on with an itchy, flaky, peeling, painful, or irritated scalp, see a doctor or dermatologist. If you have a chronic problem, get a diagnosis, work with a medical professional and follow up with them. 

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	Seborrheic Dermatitis	Atopic Dermatitis	Psoriasis
Hair loss / thinning	X		X
Decreased hair diameter (narrower hairs)	X		X
Increased susceptibility to cuticle damage	X	X	X
Decreased shine	X
Altered hair-protein production	X	X	X
Reduced water content (affects elasticity)		X

This table summarizes the results of research linked at the end of the post. Atopic dermatitis and seborrheic dermatitis overlap - they are both forms of eczema.

Eczema

According to the National Eczema Association, Atopic Dermatitis and Seborrheic Dermatitis are both forms of eczema, an inflammatory skin disease with a wide variety of symptoms depending on where it occurs and individual variables.

Seborrheic dermatitis: Inflammation, itching, irritation, redness, scaling / peeling (small or larger and greasy flakes). In deeper skin tones (Fitzpatrick Type IV, V, VI ), the affected skin may be lighter in color than surrounding skin, or there may be small, de-pigmented patches. The flakes aren’t the normal flaking as if you didn’t wash your hair for a week or two - flakes may be more abundant than normal, or thick and waxy. Skin can be hypersensitive to heat, cold, pressure, friction, dry air.

Seborrheic dermatitis is a form of eczema. It tends to involve a weakened skin barrier (it’s more easily irritated), and altered communities of microbes, possibly dominated by those that can provoke more inflammation, such as yeasts (i.e. Pityrosporum, a.k.a Malassezia,) or Staph bacteria. Those microbes are sources of “oxidative stress.” But they are not the cause of all problems, it's when we have an underlying skin susceptibility, when we have a fluctuation in hormones or our skin is aggravated by outside influences that this becomes a problem. Otherwise - microbes can actually help our skin stay healthy. An inflamed scalp under stress with it's microbial "armor" in disarray, does not produce hairs with optimal structural integrity. 

Manage Seborrheic dermatitis for stronger, healthier, more manageable hair:

• Use a shampoo or cleansing conditioner with the anti-yeast ingredients Pyrithione Zinc, Piroctone Olamine, Ketoconazole, or Selenium sulfide. See this page for lists of products. Use it regularly - read the label. Seborrheic dermatitis tends to be chronic, so to keep your scalp healthy so your hair will stay strong over it’s years-long life, think in terms of managing it with a medicated shampoo rather than just using the shampoo temporarily when the itching and flaking are most bothersome.
• Protect your scalp from: The sun, high heat, excess moisture or prolonged wet-scalp, cold-dry winds, hot-dry winds. Wear a hat or scarf/wrap that breathes or wicks moisture.
• Limit Irritants: If your scalp reacts to products, especially during a flare-up, stick with known products, change only 1 thing at a time, choose fragrance-free, simply formulated products if possible. If oils make your scalp itchy or red, do not apply them to the scalp. Keep conditioners off the scalp too. Seasonal allergies? Rinse or wash your hair frequently (as possible) to remove allergens.
• Hydrate your hair - see my “Low Porosity” page for tips, many are not focused on oils and conditioners, making them more compatible. Use products with humectants like Panthenol, Hydrolyzed proteins, peptides, glycerin, Sodium PCA, Hyaluronic acid. If you want to use hair oils, use them before washing to limit scalp-contact.
• Manage flakes: Use a salicylic acid shampoo if you tend to get “scalp build up.” If your scalp is flaring up, there will be lots of dead skin cells piled up, medications you apply can't go where they need to go in that state! Plus, accumulated skin cells make a cozy home for itch-provoking microbes. Salicylic acid shampoos can be used strategically to remove excess flaking for better management.

Atopic dermatitis is allergy-related itchy skin (like eczema) and is worse when you are exposed to allergens, whether that is seasonal allergies or a hair-care product, hair dye, perm or relaxer, highlighter, fabric softener on your pillowcases - whatever your allergies respond to! 

Manage Atopic dermatitis for stronger, healthier, more manageable hair:

• If you have known contact allergens, avoid them in all products.
• Avoid chemical hair treatments (perms, relaxers).
• If you want to color your hair, patch test 48-72 hours before coloring every time. If you have a stylist color your hair who finds that inconvenient, ask them to do it any time the product is reformulated (packaging changes, for example). Henna should be patch-tested too.
• For highlights, ask about using gentler (more dilute) solutions in the peroxide and developer to reduce irritation.
• Wash (or rinse) hair more often during allergy seasons. Cover your hair with a hat or scarf/bandanna or wrap if you are in a high-allergen area.
• Photograph or write down ingredient lists of favorite products. They can change without warning. Then you can also compare to other products.
• Choose fragrance-free products if fragrances aggravate any of your allergy symptoms (eyes, nose, headache).
• Don’t ignore short-lived skin irritation ("But it only itches for a couple minutes!"). Let that product go.
• Don’t dismiss irritation on only one part of the body. If a product makes your ears itch, you probably shouldn’t use it on your scalp.
• See a dermatologist if you can’t target specific problem-ingredients, they can do patch-testing to find allergies you didn’t know existed. They can also prescribe short-term topical anti-inflammatories if you need to calm down a flare quickly, or recommend medicated shampoos.
• Use humectants in hair care for elasticity and hydration, such as Panthenol, Hydrolyzed proteins, peptides, glycerin, Sodium PCA, Hyaluronic acid.
• Don’t wash your hair in hot water, it sets the skin up for irritation.

Psoriasis

Psoriasis is a systemic disease appearing on the skin that may occur with arthritis. It shares symptoms with Seborrheic dermatitis and Rosacea and Atopic dermatitis, but skin flaking may be more severe and may appear as thicker plaques. 

Manage Psoriasis for stronger, healthier, more manageable hair:

> All of the recommendations for Seborrheic dermatitis AND Atopic dermatitis apply to Psoriasis.

> Follow your dermatologist’s recommended treatments. Psoriasis treatment may involve prescription treatments.

> Tar and Salicylic acid shampoos are frequently used in Psoriasis. Those can be harsh on hair. Some tips to manage hair-health with medicated shampoos:

• Put some of your shampoo in a sterilized (rinse out with isopropyl alcohol) squeeze-top bottle to apply only to the scalp and avoid dehydrating your hair.
• Use a “shampoo brush” to gently massage the shampoo in - to distribute the product efficiently over the scalp.
• Use a pre-wash oil treatment on hair longer than ear to chin length. Lots more about how to do that can be found on this post. This treatment protects hair from dehydration during washing so it comes out better hydrated, more flexible and manageable.
• If you have short hair, massage and finger-comb, or brush your hair with a soft bustle brush before washing. This spreads oils through your hair to protect it from drying effects of shampoo.

Wait - does the "decreased hair shaft" or "hair loss" effects go away if I take good care of my scalp!?

Maybe. If it's related to Seborrheic dermatitis or Psoriasis only, then hair shaft-width or hair-density may improve. But if male and/or female pattern hair loss run in your family, there may be other variables to consider. More about that here. 

Fragrance-free, lower-irritant brands: 

• Cleure
• FragFree 
• No Nothing
• CLN
• Person and Covey (DHS) - Clear shampoo, Tar shampoo, and Sal (Salicylic acid shampoo), Conditioning Rinse
• Free & Clear Shampoo: Unmedicated, and with Zinc Pyrithione
• Cliniderm (Canadian)
• E45 Dermatological Dry Scalp Shampoo (European brand)
• Paula’s Choice
• Honest brand (fragrance-free)
• Seen
• Kristen Ess (Fragrance-free version) These do include oils.
• Philip Adam (Fragrance-free version)
• Aquaphor baby wash
• “The Unscented Company” Shampoo/body wash and conditioner
• BB&Co Shampoo/Body Wash and Conditioner (Fragrance free version)
• Unicure Shampoo and Conditioner
• See the tab (top-right) for a somewhat-annotated list of medicated shampoos. 🔝

To maintain scalp health overall:

• Protect your scalp from UV - wear a hat in the sun, cover your head with a scarf, or use sunscreen in your part and along your hairline. Light and deeper skin tones need UV protection - the scalp intercepts a lot of sun! Sunlight causes oxidative stress to the skin and changes the oils on your scalp. All skin tones need sun protection to stay optimally healthy - and not just on the scalp.

• Protect the scalp from “extremes”: Blasts of hot or cold air - protect with a hat, hood or cover. 

• Swimming. Wear a swim cap. Especially outdoors, or use a waterproof SPF on your scalp. Rinse your scalp and hair as soon as possible.

• Keep your scalp dry. Get your scalp dry after washing, swimming, being out in the rain, working out. Blot-dry with a towel, use a hair dryer on low or no heat to dry the scalp. Wear breathable or moisture-wicking headgear alone or under helmets (when helmets are required - needless to say, please protect your skull and brain).

• Scalp massage: A gentle scalp massage before washing loosens scales, gives you a chance to feel for lumps and bumps that might indicate a skin issue, and helps distribute oils.

• Cleanse when you need it. You know how often to wash your hair to keep your scalp from itching. Every person has different needs and yours may vary with season, activity, hairstyle or location.

Sources can be found here, here, here, here

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