Skin Disorders of the Scalp

Overview

The human scalp is susceptible to several skin conditions that, though generally not curable, can usually be managed with over-the-counter or prescription treatments. These conditions have similar symptoms, so sufferers may have trouble distinguishing which condition is affecting them. Here is a guide to some of the most common scalp disorders.

Dandruff

Dandruff is related to the normal bodily process of shedding dead skin cells. Except for itchy, inflamed skin, which may be an indication of seborrheic dermatitis, dandruff can be caused by too-frequent shampooing, allergy or oversensitivity to certain hair care products, a diet with insufficient zinc or B vitamins, oily buildup due to infrequent shampooing or excessively dry skin. Rarer cases may be brought on by a fungus called malassezia. Dandruff can vary in severity from light flaking to the "snow shower" effect that can be embarrassing if left untreated. Ordinary dandruff is non-contagious and medically inconsequential.

Dandruff Treatments

Most dandruff is manageable with non-prescription shampoos. The active ingredient in such shampoos is typically zinc pyrithione, coal tar extract, ketoconazole or selenium sulfide. Each of these active ingredients attacks the dandruff in a different way, killing fungus, retarding skin cell death or removing scale. Some people respond better to one shampoo than another, and some trial and error may be required to find the most effective product. If dandruff persists, a dermatologist may prescribe a stronger shampoo or make a close examination of the scalp to determine whether there is a different underlying cause.

Seborrhea and Seborrheic Dermatitis

Production of sebum, a substance that causes oiliness and acne, normally peaks in adolescence and then declines. However, many adults suffer from seborrhea, a common scalp condition that causes excess sebum production, resulting in unattractive, oily hair. Seborrheic dermatitis is a related but more severe (as well as chronic and incurable) condition that presents with redness, crusting, itching and inflammation in addition to the oiliness of seborrhea. Though not dangerous in itself, seborrheic dermatitis can cause infection if sufferers scratch affected areas.

Psoriasis

With similar symptoms to seborrheic dermatitis, such as redness, flakiness and oiliness, psoriasis can sometimes be identified only with a physician's visual examination. The condition, which has as many as eight variations, can be difficult to get under control. Often brought on by stress, cuts, scrapes, insect bites, cold and dry weather, infections, or use of tobacco or alcohol, psoriasis can appear drier and scalier than seborrheic dermatitis and is also likely to appear elsewhere on the skin. At its worst, psoriasis can be more serious and much more unsightly than the other conditions described here, even duplicating some of the more damaging effects of arthritis.

Treatments

Seborrhea or seborrheic dermatitis can often be managed with dandruff-type shampoos. Additional over-the-counter measures include non-prescription antifungal or hydrocortisone creams. Resistant seborrheic dermatitis may require a prescription shampoo. Treatment of psoriasis, however, can be more challenging. Medicines ranging from over-the-counter preparations to strong prescriptions can include topical retinoid creams, steroids, calcineurin inhibitors, and oral medicines such as methotrexate, cyclosporine, hydroxyurea and immunomodulators. A physician may also recommend light therapy (up to and including laser procedures) and lifestyle changes to reduce the effects of psoriasis.