The scalp: More than just hair

Hair loss refers to abnormal hair loss on any part of the body. Baldness refers specifically to hair loss on the scalp [6].

Several conditions may result in hair loss, but the most common is androgenetic alopecia, a form of hair loss affected by hormonal and genetic factors. It takes a different form in men and women with distinctive patterns of hair loss.

There may be other causes of alopecia: alopecia areata (an autoimmune disease that causes sudden loss of patches of hair), hormone imbalances, nutritional deficiencies, side effects of some drugs, or stress.

Treatment [7]

There are effective pharmaceutical and surgical options for slowing down, or even reversing, hair loss. It is vital to treat any underlying disease and, if possible, to discontinue taking any drugs that may be causing alopecia.

Vitamins (over the counter) – If hair loss is due to a nutritional deficiency, some supplements may be beneficial. However, if they are not factors, they will only have a limited effect. Vitamins B7, C, D, and E, as well as iron, zinc, and fatty omega-3 acids, are often acknowledged to promote scalp health.

Minoxidil (over the counter) – Available as a liquid, foam, or shampoo, this treatment directly stimulates hair follicles, encouraging hair to grow back. However, it is apparently not effective for treating frontal alopecia, where the hair is receding. To get satisfactory results, minoxidil needs to be used for at least six months. It is worth noting that the new hair that grows back is finer and more fragile at first [8]. Side effects: dry scalp, irritations, etc.

Finasteride (by prescription) – Administered orally in men, this treatment must be continued for several months. Its use in women is more controversial. Side effects (in men): decreased libido, erectile problems, suicidal thoughts [9].

Hair transplant – Private hair transplantation under local anesthetic—sometimes using a computer-assisted robot—is an effective, but very expensive, option for correcting hair loss. Theoretically, transplanted hair is permanent, although it may fall out later because of heredity. Side effects: pain and discomfort during surgery [10].

Low-level laser treatment – Recent publications seem to indicate that “photobiomodulation” using low-intensity laser treatment is showing safe, promising results [11].

Dandruff is small flakes of dead skin (scales), which are harmless but sometimes embarrassing [12]. They are often the result of dry skin, especially in the winter when the air is dry. However, some skin conditions, such as seborrheic dermatitis, eczema, and psoriasis, can also cause it.

Seborrheic dermatitis is a common skin condition that mainly affects your scalp. Although its exact causes have not been fully established, it might be connected with yeast (fungi), excess oil in the scalp (sebum), or an inflammatory reaction. It is not contagious and does not cause permanent hair loss [13].

Symptoms

The main symptoms of seborrheic dermatitis are flaking skin on your scalp, hair, eyebrows, beard, or moustache. There may also be patches of greasy skin covered with flaky white or yellow scales, as well as ring-shaped irritation, often accompanied by itching. These symptoms tend to flare up with stress, fatigue, or a change of season.

Treatment

Seborrheic dermatitis may go away on its own, but treatments such as medicated shampoos, lotions, or creams may be needed to clear up symptoms and prevent flare-ups. Some over-the-counter products, including selenium-sulfide- or tar-based products, may relieve symptoms. Irritating hair products such as strongly scented shampoos and scratching should be avoided to limit irritation. It is also important to carefully follow the instructions for each product (frequency, application time, rinsing, etc.) to maximize effectiveness.

Atopia is a genetic predisposition to developing a number of allergic diseases, such as eczema, hay fever, asthma, and hives (urticaria).

Atopic eczema (atopic dermatitis) is a cyclical, chronic inflammatory skin disease characterized by itching. Although it is more common in children, it can appear at any age. The disease can manifest with periods of worsening symptoms (flare-ups) alternating with symptom-free periods. It is associated with a mutation in the genes that protect the skin [14].

Symptoms

• Intense itching that can disturb a newborn’s sleep or cause scratching-related abrasions in older children.
• Skin irritations with redness, thickened skin, a rough, swollen texture, and small blisters, which may ooze and then form crusts.
• Dry skin outside of the areas with eczema

Treatment [15]

• Tips for treating eczema (particularly in children):
• Moisturize the skin with a suitable cream, ointment, or lotion;
• Treat the eczema with anti-inflammatory creams (corticosteroids);
• Relieve itching and avoid scratching, to prevent making irritations worse;
• Prevent infections by maintaining good skin hygiene;
• Identify and avoid potential triggers such as irritants, dust mites, animals, pollen, and strong emotions.

Many hair problems are caused by factors that cannot be controlled, such as age, heredity, atopia (tendency toward allergies), so-called autoimmune diseases, or excessive sebum production. Some even require medical treatment.

However, we can take action on some factors to maintain healthy hair:

• reduce stress;
• maintain appropriate humidity at home, especially in the winter;
• adopt a balanced, high-iron, high-zinc diet;
• avoid or limit hairstyles that are too tight, such as dreadlocks, braids, and ponytails that pull on the hair too much;
• limit or avoid hair care that is inappropriate, irritating, or done too often.

The ideal frequency for washing your hair varies with several factors, including age, hair type, and activity level (sweating), exposure to dirt, and use of styling products. It is generally recommended that you wash your hair every other day or 2–3 times a week [16].

The American Academy of Dermatology recommends the following steps to keep your hair healthy [17].

1. Learn your hair type (curly, straight, fine, coarse, oily, dry) so you can choose the right products
2. Wash your hair based on what it needs
3. Apply shampoo to your scalp, instead of the entire length of your hair
4. Use conditioner after washing your hair to detangle it
5. Be gentle with your hair: it is very delicate when wet. Use a wide-toothed comb instead of a fine-toothed comb or a brush.

Although there is not much scientific evidence about scalp massage protecting against hair loss, some studies seem to indicate that it might promote new hair growth by stimulating blood flow. As well, like any kind of massage, it has a pleasant, relaxing effect [18].

According to the Mayo Clinic, a medical consultation is recommended if hair problems persist despite following treatments rigorously or if you have female hair loss along a frontal line (such as frontal fibrosing alopecia, an autoimmune disease). As well, sudden loss of patches of hair or excessive hair loss not during a hair wash, for example, on a pillowcase, may be indicative of a disease that requires treatment [7].

Scalp disorders may cause psychological stress for some people, impact quality of life, and result in significant expenses for various products and treatments. In many cases, it is advisable, and sometimes even essential, to see a healthcare professional.