Scalp problems can be concerning. Even if you have a common condition, such as dandruff, which affects around 50% of people, you might feel self-conscious and worried about the scalp problem getting worse [1].
Scalp problems can also be itchy and painful. Left untreated, they can even lead to hair loss. Here, we outline the causes of 8 scalp problems with examples, photos, and treatments to help you tackle your scalp complaints.
Dandruff — scientifically known as pityriasis capitis — is one of the most common scalp conditions, with around half of people affected.
Dandruff consists of small grey or white flakes of skin that come away from the scalp. You might see these flakes in your hair or on your clothes. Flakes are often more visible if you have darker hair.
Dandruff mostly affects people aged 15 to 50 [1]. You start to produce more scalp sebum when you hit puberty, so this may explain why people start to get dandruff when they’re in their teens. Sebum levels decline as you get older, especially for women [3].
Dandruff is easily treatable with a medicated shampoo. Shampoos containing zinc pyrithione, such as Head & Shoulders anti-dandruff shampoo, are effective for treating dandruff [2]. Other treatments may be used, depending on the severity of the condition.
The table below shows effective active ingredients and common UK treatments that contain each one [2]:
Some theories suggest that applying apple cider vinegar to your hair and scalp can help reduce growth of the Malassezia fungus, though more research is needed to explore this link.
Seborrheic dermatitis is a severe form of dandruff [4]. Like dandruff, it stems from Malassezia fungus growth. However, while dandruff is restricted to the scalp, seborrheic dermatitis can also affect the face, lips, eyelids, and even your chest.
Seborrheic dermatitis appears as reddish-pink plaques on the skin, accompanied by greasy-looking yellow-white scales. The lesions are usually symmetrical across the scalp and are often itchy and uncomfortable.
Seborrheic dermatitis is more likely to flare up in winter. It may be triggered by stress and lack of sleep [4]. Like most scalp conditions, seborrheic dermatitis isn’t contagious, and there are treatments available to manage and relieve symptoms.
Seborrheic dermatitis affects three groups more than others:
While anyone can get seborrheic dermatitis, it’s more prevalent among people who have a compromised immune system and certain neurological disorders, such as Parkinson’s disease [4].
Seborrheic dermatitis also has some autoimmune characteristics and is more common in people who have other autoimmune conditions.
Scalp treatments for seborrheic dermatitis are similar to those for dandruff since the underlying causes are similar. Antifungal agents and anti-inflammatory medical treatments can address the underlying problem while relieving itchy scalp and discomfort.
Medicated shampoos containing coal tar, salicylic acid, and selenium sulphide can all help treat seborrheic dermatitis in adults [5]. Learn more about treating seborrheic dermatitis on the NHS.
Cradle cap is seborrheic dermatitis that affects babies. It’s a benign condition and it’s very common, affecting up to 40% of infants under three months [4].
The cause of cradle cap hasn’t been established, but researchers believe it could be linked to the mother’s hormone levels [6].
In adults, cradle cap is known as seborrheic dermatitis. While it’s possible to develop seborrheic dermatitis after a hair transplant, there’s currently no evidence that the two are linked.
However, it is common for your new hair grafts to form hair transplant scabs that eventually flake off, especially in the weeks immediately following surgery. This may look like cradle cap, but it’s actually just your grafts healing.
If you’re concerned about scabs on your scalp following your procedure, get in touch with your hair transplant surgeon for advice.
Cradle cap usually clears up by itself without treatment [6]. Maintain your baby’s scalp health by using a mild baby shampoo. Emollients like baby oil may also help break up the scale, which can then be removed gently with a soft toothbrush [6].
Some antifungal creams may help if the affected skin doesn’t improve with these gentle measures. Speak to your paediatrician for recommendations.
Psoriasis is a chronic immune-mediated condition [7]. That means it happens when your body has an atypical immune response to a trigger. In the case of scalp psoriasis, the immune response makes your skin cells proliferate too quickly, causing a scaly red or pink rash to appear, sometimes with a silvery outline.
While psoriasis can affect any area of the body, up to 80% of psoriasis sufferers have scalp psoriasis [8]. This auto-immune skin disease often appears around the hairline. Flare-ups can be itchy and even painful, so it’s important to manage your psoriasis to stop it from interrupting your daily life.
Approximately 1.7% of the UK population has psoriasis [9]. It tends to affect white people more than those of other ethnicities [10]. It’s also more likely to occur in adults than children.
There’s currently no cure for psoriasis, but there are several treatments that can help manage it [11]:
The appropriate treatment will depend on the severity of your condition. See your GP for recommendations based on your specific symptoms.
Folliculitis is a common skin condition characterised by inflammation of the hair follicles. It’s often triggered by bacterial infections, which is why folliculitis after a hair transplant can occur. It can also be caused by irritated or blocked hair follicles.
Symptoms of folliculitis typically include red, itchy bumps or pustules around the hair follicles, which can crust over. These bumps can be tender or even painful. Scalp tenderness can be limited to one spot or may be spread across the head.
There are several types of folliculitis [12]:
Mild folliculitis may not require treatment. Cases often clear up on their own.
Folliculitis treatment is related to the cause of the condition. You may need antibiotics to treat any underlying hair follicle infection.
In addition, the following folliculitis treatments can be effective:
Learn more about folliculitis according to the NHS.
Commonly known as ringworm, tinea capitis is a fungal infection of the scalp. It can be inflammatory or non-inflammatory. The inflammatory skin condition can lead to scarring alopecia (a type of irreversible hair loss that leaves scarring around the follicles).
Ringworm mostly affects children, although it can impact anyone [13]. People with a weakened immune system are more likely to be affected.
The most common way to treat ringworm is with specific antifungal medications. Prescribed medication may include the following:
The prescribed antifungal medication should usually be taken for at least one month. Not all antifungal treatments work for tinea capitis, so consult with your GP if you suspect you or your child has ringworm.
Lichen planopilaris is a type of scarring alopecia characterised by inflammation and caused by autoimmune activity [14]. It’s a type of lichen planus that impacts areas where hair grows.
There’s no standard pattern to lichen planopilaris. It can affect any area of the scalp, and symptoms include itchiness, pain, and burning around the affected area. You’re also likely to see redness and scaling.
Lichen planopilaris is most prevalent in women over the age of 55 [15]. It’s also more likely to impact white people than those of other ethnicities.
Hair loss caused by lichen planopilaris is usually permanent. Stopping the progression of the disease is often the best outcome.
There’s no single treatment that will eliminate lichen planopilaris, but there are plenty of ways to control your symptoms and prevent future flare-ups. These include:
Head lice are a very common scalp problem, particularly among children. Head lice are tiny parasitic insects that feed off the blood in the scalp. They lay eggs in your hair — these are known as nits — which hatch to create more lice.
Head lice spread easily between people who are in close contact, and they can also be spread by sharing hairbrushes, towels, and hats.
Symptoms of head lice include itchiness, as well as seeing small lice or eggs on the scalp and hair shafts. Lice can be white, brown, or black in colour, while eggs are usually white or light brown.
Children aged 5 to 13 tend to be most affected by head lice [16]. Girls with longer hair may be more likely to pick up head lice than those with shorter hair.
Adults who work with children are also more likely to be exposed to head lice than those in the general population.
Wet combing is the first line of treatment for removing head lice. Buy a specialist comb from a pharmacy and use this to comb through the hair while in the bath or shower.
Apply lots of conditioner before combing. This makes the combing process easier and can make it easier to spot lice in the comb.
Wet comb the hair every four days to catch and remove any newly hatched lice. Head lice may all have been removed by day 17, but if you catch more lice at this point, continue with the wet combing technique.
There are also medicated lotions and sprays you can use to kill head lice in some cases. These include:
Some of these products require a prescription, but many are available over the counter from pharmacies and supermarkets.
Allergic contact dermatitis is a type of scalp eczema that’s triggered by a reaction to a substance. It’s characterised by a red itchy rash that appears across the scalp. The skin can become blistered, dry, and cracked, leading to scabs forming on the skin.
While eczema doesn’t normally cause hair loss, it can cause intense itching that can lead to breakage or thinning.
Anyone can develop allergic contact dermatitis, although it’s most commonly seen in those with red hair and fair skin [17]. Women are also more likely to be affected as they’re more likely to use fragranced hair and skin products.
The best way to reduce contact dermatitis flare-ups is to avoid exposure to the trigger that can cause your allergic reaction. If you’re not sure what’s triggering your contact dermatitis, stop using your regular haircare products and soaps, and replace them with a gentle, fragrance-free emollient cream like E45.
Try to avoid hair tests for allergies as they’re not usually accurate; your GP can refer you for allergy testing if necessary.
When the skin rashes have settled, gradually reintroduce your preferred products one by one to see if you can isolate the trigger.
Many of the scalp problems listed above can lead to hair loss if left untreated. Some conditions lead to hair follicle scarring, which damages the hair bulb and leads to permanent hair loss conditions like frontal fibrosing alopecia.
Some scalp disorders can be avoided with good hair and scalp hygiene:
Some scalp conditions are unavoidable. Head lice can spread easily, and most children will catch them at some point. Other scalp problems like psoriasis and lichen planopilaris are caused by autoimmune conditions, which are generally unavoidable.
In these cases, fast diagnosis and treatment is the best way to manage your condition.
Worried about your scalp or thinning hair? Schedule a checkup with your GP to rule out any underlying causes. You can then book a free consultation with our trichology team to get to the root of your scalp problems.
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