Wednesday, April 5, 2023

Scalp Issues and Hair Health

You’ve probably heard that a healthy scalp equals healthy hair. But did you know there are specific hair problems caused by common skin disorders, and some fairly simple ways to address them?

Before we go any further - if you don’t already know what’s going on with an itchy, flaky, peeling, irritated scalp, see a doctor or dermatologist. If you have a chronic problem, get a diagnosis, make sure you work with a medical professional. Also, there are some product-links for which I may receive a small commission if clicked, at no cost to you and providing none of your personal information to me.

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 with small, de-pigmented patches. The flakes aren’t the normal flaking as if you didn’t wash your hair for a couple weeks - skin with seborrheic dermatitis produces skin cells faster than normal. Skin can be hypersensitive to heat, cold, pressure, friction, dry air.

Seborrheic dermatitis also 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.”

While we think of dandruff shampoos as “medicated,” used to treat symptoms we can see, then stopped when those symptoms go away, you can’t see the oxidative stress and chronic, low-grade inflammation that can occur with seborrheic dermatitis. The active ingredients in dandruff shampoos are not only anti-yeast, they also have anti-inflammatory effects that have proven themselves effective over and over in studies done on real, itchy, irritated people! These shampoos are great hair-health management tools, provided you can find a product you like.

Hair issues related to Seborrheic dermatitis: 

  • Decreased hair shaft width
  • Hair thinning (hair loss)
  • Decreased shine
  • Reduction in one version of structural protein in hair that lends flexibility
  • Hair cuticles are more susceptible to damage
  • Increased oxidative stress

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.
  • If oils make your scalp itchy or red, do not apply them to the scalp. Keep conditioners off the scalp too.
  • 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.
  • 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.
  • 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, and you can’t get the other medications 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!

Hair issues related to Atopic dermatitis: 

  • Hair cuticles more susceptible to damage - surface roughness.
  • Reduction in one version of structural protein in hair that lends flexibility
  • Increased oxidative stress
  • Reduced water content (affects elasticity)

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: This is a more systemic disease of 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. 

Hair issues related to Psoriasis: 

  • Decreased hair diameter
  • Hair loss
  • Reduction in one version of structural protein in hair that lends flexibility
  • Increased oxidative stress
  • Hair cuticles more susceptible to damage - surface roughness.
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 may need more than over-the-counter treatments.

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

  • Put some of your shampoo in a sterilized (rinse out with isopropyl alcohol) color-applicator or 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: 

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.
  • No soggy scalp. 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 all the stuff in it).
  • 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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