Scalp conditions can affect either the hair or the scalp, or both. It is a unique area of skin which contains a high density of hair follicles and oil glands that can be infected or inflamed. When this happens, you may experience rash, itch, flakiness, tenderness, or even hair loss over your scalp.
Seborrheic dermatitis is a common scalp condition that causes the scalp to be oily, itchy and inflamed. While its cause is not fully understood, the condition occurs more commonly in individuals with oily skin, and is linked to the proliferation of a yeast group called Malassezia. Other than the scalp, seborrheic dermatitis may occur over other body areas that contain numerous oil glands, such as the eyebrows, eyelids, cheeks, upper chest and back. In severe cases, scarring and hair loss can occur due to inflammation or scratching. Seborrheic dermatitis needs to be managed long term as it can recur after successful treatments.
Pityriasis capitis, also known as dandruff, is a milder form of seborrhoeic dermatitis affecting just the scalp, albeit without the presence of visible inflammation. It is extremely common and can affect up to 50% of the world’s population. When you develop dandruff, your scalp itches and flakes off due to irritation from the dysregulation of oil glands together with the presence of the yeast group Malassezia. Both seborrhoeic dermatitis and dandruff cause flaking, but to different extents. In seborrheic dermatitis, scales are larger, greasy and yellow, worsened by the presence of an inflamed and itchy scalp.
This is a long term recurring skin condition which can affect the scalp, causing it to itch and turn dry and flaky. When you have psoriasis of the scalp, red, demarcated patches of skin with silver scales commonly develop. The immune system is thought to be involved which causes skin cells to proliferate and shed at a faster rate, resulting in thickened patches of skin and scales. Psoriasis affects other areas of the body such as the elbows, knees, back and abdomen. About 70 percent of patients with psoriasis have mild disease which can be controlled with topical treatment, but when psoriasis involves the scalp, it can significantly impact one’s quality of life. Individuals do not usually experience hair loss, but temporary hair loss may develop with vigorous scratching or due to the stress of developing psoriasis.
Certain chemicals may irritate your scalp and cause it to be dry, itchy and tender. Contact dermatitis develops when your skin gets inflamed after reacting to an external substance. When this happens, some areas of the scalp may swell up, accompanied by red patches that are scaly and itchy. Such substances may be chemicals that are found in hair dyes, bleaching lotions, medicated shampoos or certain hair grooming products. You could be allergic to these chemicals or it could be that these chemicals irritate your scalp. In areas of scalp with significant inflammation, contact dermatitis may lead to hair loss.
Shampoos with antifungal activity such as ketoconazole, selenium sulfide or zinc pyrithione can effectively treat Malassezia on the scalp. If the scalp is covered with thick dense scales, keratolytics such as coal tar or salicylic acid can be applied to soften and break up the greasy scales. Combination therapy is often advised in the treatment of seborrhoeic dermatitis, and in severe and persistent conditions, antifungal tablets may be recommended.
Topical keratolytics such as salicylic acid or coal tar soften and remove thickened patches of skin in psoriasis, which also helps with penetration of other medications into the scalp. Calcipotriol, which is derived from Vitamin D, reduces the excessive proliferation of skin cells and normalises its growth.
In a red and inflamed scalp, steroid lotions may be prescribed for a short period to reduce and control the inflammation and itch of an acute flare. Calcineurin inhibitors can also be used as alternatives if steroids are often needed. The use of steroid lotions for a short period of time reduces inflammation and redness in contact dermatitis and psoriatic patches. When a longer duration of application is required, steroid-sparing calcineurin inhibitors are good alternatives.
PDRN Scalp Electroporation
PDRN or Polydeoxyribonucleotide is a powerful scalp healing treatment that is extracted from salmon DNA. With its anti-inflammatory and wound healing properties, PDRN is delivered into the scalp using a stable electric current and works at a cellular level to regenerate cells and repair scalp skin from the inside. It has been shown to improve both hair count and density in individuals with thin and weak hair.
Fotona Hair Restart Laser
When hair loss is experienced, laser hair rejuvenation uses Fotona’s Smooth Er:YAG fractional non-ablative treatment to produce safe and effective hair restoration results. Specialised super- long pulsed laser beams are delivered to the scalp which warms tissue in a controlled manner, achieving fast and slow thermal effects. What results is an increase in number and size of scalp blood vessels, and the production of more fibroblasts, which are triggered to form new collagen. Scalp tissue is strengthened when natural collagen production takes place. In addition, photobiomodulation improves the scalp’s cellular response, and dormant hair follicles are stimulated to transition from telogen phase to anagen phase. This process promotes hair growth and reduces hair loss. Any downtime of bleeding, pain or infection is minimal because no ablation is involved. With one treatment of Hair Restart laser treatment, noticeable vellus hair has been shown to grow in individuals within a month.
Appropriate treatments can be carried out once a diagnosis is made, by taking a detailed history and carrying out a scalp examination. If a particular substance or chemical has been identified to trigger your symptoms, the offending ingredient should be discontinued and avoided in future.
At Veritas, scalp treatments are designed to deep cleanse the scalp and allow for optimal infusion of minerals. A gentle Clear-Z scalp treatment improves conditions like dandruff by using a 360 degree rotating tip to thoroughly remove sebum and dead skin cells. Once the scalp is free of oil and sebum buildup, Aquapure electroporation can be applied to the cleansed scalp, where a stable electric current is conducted to assist the delivery of a blend of nutrients essential for hair growth into the scalp. Together with PDRN which reduces scalp inflammation and supports the growth of new blood vessels, important nutrients such as calcium pantothenate (for hair thickening) and panthenol (for hydration) boosts the scalp’s microcirculation for healthy hair growth.
When mild to moderate hair loss or thinning is present, treatments which support hair growth can be started once inflammation in the scalp is well controlled. Fotona Hair Restart laser treatment is one of the latest effective solutions that has been proven to improve hair density and strengthen scalp tissue via photo-biomodulation. This can be further complemented with medical grade home products such as Minoxidil and CG210 hair spray which reduces further hair loss, to give compelling results.
Basic scalp care to restore a dry itchy scalp back to its healthy condition includes Aromase Medipro’s Simply Hydro Shampoo, a non-steroidal gentle cleanser containing glycyrrhetinic acid complex which exerts natural anti-inflammatory effects on the scalp.
If hair loss is experienced concurrently over severely affected areas of the scalp, hair is able to regrow once the infection is treated and the scalp returns back to a healthy condition. With good scalp care, the scalp can be restored to a healthy state.
We recommend a weekly application of Scalp Purifying pre-shampoo from the Aromas Medipro range to remove stubborn flakes, paired with the daily use of Simply Fresh shampoo which controls sebum production and maintains a healthy skin barrier.
Dr Chua Cheng Yu
Dr Lena Fan