Psoriasis is a common skin condition characterized by a thick scale on well-defined, red, thickened skin. It can often affect the scalp, either affecting a small area or spreading to the whole of the scalp. There is often constant flaking, which may have no symptoms or be itchy. Only in very severe cases does scalp psoriasis lead to hair loss. In such cases the hair usually grows back after time.
Appropriate shampoos and leave on scalp preparations are generally effective. Dr Ophelia will give you a skincare plan to explain how these should be used. Immunosuppressive therapies and biologic agents are helpful in more severe cases.
Seborrhoeic dermatitis causes red, itchy and flaky skin on hair bearing areas of the body. Mild seborrhoeic dermatitis of the scalp is known as dandruff. Babies can also get a form of seborrhoeic dermatitis of the scalp (cradle cap) and nappy area. Seborrhoeic dermatitis is thought to be an eczema like reaction to an overgrowth of harmless yeast called Malassezia on the skin. Cold weather and stress can also be triggers for seborrhoeic dermatitis.
Good clinical examination is normally sufficient to establish a diagnosis of seborrhoeic dermatitis. Affected areas are red with greasy skin flakes. The most common sites are the scalp, face (eyebrows, nose, cheeks, ears), chest and in the skin folds. Medicated shampoos and cream treatments as usually effective, especially when given by Dr Ophelia as part of a clear skincare plan.
Fungal infection of the scalp is known as tinea capitis. It is common in children, and less often seen in adults. Tinea capitis can present with a dry scaling and smooth areas of hair loss. A kerion or very inflamed mass, if left untreated, can result in permanent scarring and hair loss. Neck lymph nodes can also be significantly enlarged.
The diagnosis is often suspected if there is a combination of scale and hair loss, and sometimes scrapings from the scalp or hair clippings can help isolate the fungus. Fortunately, Dr Ophelia finds that tinea capitis usually responds well to tablet antifungal treatments.
Lichen planopilaris is a rare inflammatory condition that causes scarring hair loss. It can also affect the skin, mucosa and nails. Smooth, white patches of hair loss occur and redness and scale may be present around the hair follicles. Symptoms can be absent, but can also be associated with pain and itching. Dr Ophelia will undertake a diagnosis by careful examination and by taking a history. A scalp biopsy is sometimes required to help confirm this diagnosis.
Dr Ophelia will recommend that treatment be sought early, with the aim of preventing the condition from progressing and causing further hair loss. It should also be explained to patients that this condition tends to ‘burn itself out’ naturally with time. However, Dr Ophelia will advise on topical, oral and injection based therapies to manage the active period of the condition.
Frontal fibrosing alopecia
Frontal fibrosing alopecia is a localized form of lichen planopilaris, where scarring and hair loss occurs in the hair line. Post menopausal women are most commonly affected, though it can occur in younger women and men. The exact cause of frontal fibrosing alopecia is currently unknown. However, environmental factors such as sunscreen and cosmetic use have been associated with the condition.
Once a diagnosis has been made, treatment options include the same topical, oral and injection-based therapies offered for lichen planopilaris.
Folliculitis decalvans is a scarring form of hair loss. It is characterized by redness and pustules which occur around the hair follicles and lead to destruction of the hair follicles and hair loss. Any hair bearing area can be affected such as the scalp, beard, underarm and pubic area. There are often scar like patches of hair loss, with pustules surrounding the hair follicles. Multiple hairs can be seen coming out of a single follicle, giving a ‘tufted’ appearance. Dr Ophelia will formulate a management plan with you that might include antibacterial washes, topical and tablet treatments.
Traction alopecia is caused by repeated and prolonged tension on the hair. It can affect people of any background or sex. However, it is commonly described in women who wear tight ponytails, plaits, weaves, dreadlocks and the use of hair extensions. It is also seen in Sikh males who twist their uncut hair beneath their turbans. The clinical pattern of hair loss depends on the causative hair care practice. Often hair can be thinner or absent in the hairline at the front or sides of the scalp. Initially, hair loss is non-scarring but if left untreated unopposed tension can lead to permanent destruction or scarring of the hair follicles. Dr Ophelia will make her diagnosis on history and clinical examination findings. To exclude other causes, a scalp biopsy might sometimes be required and characteristic findings may be found.
Education on hair care practices to limit tension and exposure to chemicals/ heat is vital in managing traction alopecia. Further treatment options can include topical treatments, oral medications or injection-based therapies.
Central Centrifugal Cicatricial Alopecia (CCCA)
Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss, most commonly seen in darker skinned patients. Some evidence points to the cause of CCCA being genetic. However, there is also a correlation with chemical/ heat hair care practices such as hot combs, relaxers, extensions and weaves.
Hair shaft breakage is often an early sign of CCCA. Hair loss occurs at the crown, and extends outwards. There is a loss of follicular openings, so the scalp appears shiny. Patients either have no symptoms, or experience itch or pain.
Dr Ophelia will usually make her diagnosis clinically or a scalp biopsy may be needed to confirm the diagnosis. Treatment options include education about hair care practices, topical and oral therapies, and PRF.
Trichotillomania is characterized by a repeated urge to pull at one’s own hair, resulting in hair loss. It can affect males and female, but is more common in children. The cause of trichotillomania is unknown, but it is thought to be a coping mechanism to stress or anxiety. Patches of hair loss usually occur on the scalp, but facial and body hair can also be affected. Clinical examination can reveal short, broken or absent hairs. Children normally grow out of trichotillomania, but repeated removal of hairs can lead to irreversible scarring.Treatment usually involves some form of behavioral therapy, and there is evidence that some medications can be useful in this condition.