The Most Common Scalp Issues & How To Treat Them

It’s not hyperbole to say that everyone reading this article has had, or will have, a scalp issue or two at some point in his or her life. It's one of those you're-not-alone situations (everything from hair loss to dandruff is super common), yet it’s a topic we often don't feel comfortable talking about. Thus, many people suffer from easily treatable conditions quietly and alone — and that's no good.

If you're dealing with scalp problems, you shouldn’t be too embarrassed or afraid to seek treatment and advice. But here, we got the ball rolling for you. We reached out to some top dermatologists to get the lowdown on the most common scalp issues and how to deal with them.
Illustrated by Abbie Winters.
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The Problem: Dandruff/Seborrheic Dermatitis
Is your scalp itchy or irritated and stubbornly shedding white flakes? You probably have seborrheic dermatitis — more commonly known as dandruff. And you certainly aren't the only one worried about wearing black: Debra Jaliman, MD says that this is the most common scalp issue she sees.

Fayne L. Frey, MD, founder of FryFace.com, says up to 50% of the population “experiences dandruff at some point in their lives — usually individuals from adolescence to about age 50, when the sebaceous glands are most active.”

So what causes it? "[Dandruff happens] when dead skin cells don’t exfoliate normally, and they build up on the scalp," says Dr. Jaliman. "The scalp gets irritated, and there is peeling.” It can also occur when the scalp is overly dry or overly oily, says Michael Lin, MD, of Dr. Lin Skincare. Or it can be due to skin conditions such as eczema and psoriasis, or even a yeast-like fungus called malassezia.

Dr. Lin also says that hair products containing ingredients that irritate the scalp — such as sulfates and drying detergents — can contribute to the problem: “Sensitivity to ingredients in hair care products or hair dyes, especially paraphenylenediamine, can cause a red, itchy, scaly scalp. Washing too often with shampoos that contain harsh chemicals like sulfates or using too many styling products also may irritate your scalp, causing dandruff.” So be sure to check your favorite hair products to make sure they’re not the cause of your flaky scalp.

The Solution:

There are a few ways to treat dandruff, although keep in mind that these are treatments and not permanent cures. As Dr. Barry Resnik, founder of Resnik Skin Institute, cautions, “[seborrheic dermatitis] is a condition, not a disease, so it can’t be cured.” That said, there are ways to keep it under control and prevent it from acting up. All the docs we interviewed agree that the best way is to wash your hair with shampoos that contain anti-dandruff ingredients such as selenium, salicylic acid, zinc pyrithione, coal tar, or ketoconazole.

Don’t rush things, Dr. Jaliman warns: “I always instruct people to leave the shampoo on for five minutes, so it can completely penetrate the scalp.” Dr. Jaliman advises shampooing more frequently (such as daily or every other day). Dendy Engelman, MD also recommends massaging your scalp for five minutes daily "to loosen the skin” before shampooing. A diet high in antioxidant-rich vegetables can help reduce flare-ups as well, Dr. Resnik says.

If anti-dandruff shampoo and diet adjustments don’t do the trick, you may have to break out the big guns. “If there is still peeling and itching...sometimes, a prescription-strength topical steroid lotion or solution is required at night,” says Dr. Jaliman.

Dr. Resnik agrees: “More tenacious cases may need a topical cortisone lotion or even oral medicines to knock it out.” So try the shampoo first, and if the problem persists, see your doctor for a prescription. You’ll be back to wearing all black before you know it.
Illustrated by Abbie Winters.
The Problem: Scalp Psoriasis
To state the obvious, psoriasis — the itchy, scaly skin condition — isn't fun. It can affect all parts of your skin, but when it's on your scalp, it can feel like dandruff on steroids. According to Dr. Frey, psoriasis is “the most common cause of an inflammatory scalp condition [and] is a chronic, recurring condition that affects 2% of the population." Half of those with psoriasis get it on their scalps; often, it runs in the family. If you have it, Dr. Frey says you'll notice “red areas with silver-gray, scaly patches anywhere on the scalp, but especially along the hairline.”

The Solution:
“Unfortunately, it is not possible to prevent psoriasis,” says Dr. Frey, “but the condition is often controllable. Preventing flare-ups may be possible with shampoos containing tar or selenium sulfide.” Dr. Frey also suggests using keratolytic shampoos and topical steroids — and, in severe cases, oral medication or injectable immunobiologics.

Dr. Jaliman does suggest being careful when using tar shampoos, though. “It's important to note that, if you have blonde hair or color-treated light hair...tar shampoo will darken the hair and should not be used," she says. "If you have a sensitive skin type, you're more likely to see redness... So you may not want to use tar preparations either.”

You can try organic topical oils such as argan, coconut, even tea tree oil to help relieve itchiness and reduce scaling. Dr. Jaliman says fish oil supplements with omega-3 fatty acids or aloe vera have been found to be useful treatments as well. The first step, however, should absolutely be to see your doctor to confirm that what you have is indeed psoriasis — and to find out if he or she recommends a certain shampoo or treatment.

Illustrated by Abbie Winters.
The Problem: Ringworm
Yep, ringworm. “It sounds worse than it is,” assures Dr. Engelman. “Tinea capitis is an extremely common fungal infection that appears as scaly spots and patches of broken hair on the head in circular patterns. It is most commonly seen in children.”

If you’re child-free, it doesn’t necessarily mean that you’re in the clear, however. “This contagious condition is most commonly seen in prepubescents, but can be seen in anyone,” says Dr. Frey. “It is spread by contact with people, animals, and...soil. Sharing pillows, hairbrushes, and clothing (hats) may spread the condition.”

Dr. Resnik agrees that ringworm is very common. “It can be mistaken for bad dandruff if it is all over the scalp," he says. "Its most common presentation is a hairless patch, sometimes with black dots. The dots are hairs broken off at the scalp level.”

So, now you know what it is, what it looks like, and how you can get it. But how the heck do you get rid of it? Pretty easily, it turns out.

The Solution:
Luckily, Dr. Resnik says that ringworm “is usually easy to cure.” All you need is a prescription for an oral medication, as well as an anti-fungal shampoo. “Care should be taken to make sure all family members shampoo with an anti-fungal shampoo, as [ringworm] may be moved from person to person, and so cause reinfection," he says. "Don’t share towels, combs, or hats while under treatment.” In addition to making sure everyone gets on board with the anti-fungal shampoo, you should also check your family pets for infection.
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Illustrated by Abbie Winters.

The Problem: Hair Loss
If you’re noticing a drastic increase of the hair in your brush or in the shower drain, you might be experiencing hair loss. Before you can know how to treat it, however, you need to figure out the underlying cause.

“Hair loss and thinning can occur in both men and women for a variety of reasons,” says Dr. Lin. “Men and women naturally produce a hormone called Dihydrotestosterone (DHT). Some tend to produce excess DHT, which can cause hair to grow back thinner and more fragile." Other hair loss causes, he adds, "include iron-deficiency, auto-immune disease, low thyroid, and other hormonal imbalances.”

Both Dr. Lin and Dr. Resnik agree, however, that the most common type of hair loss is alopecia areata, which means area hair loss; it looks like a circular bald patch (or several). You’re more likely to have alopecia areata if you struggle with stress, if you have a family member with the condition, or if you suffer from an autoimmune disorder.

The Solution:
If you suspect you have alopecia areata, there’s good news: Your hair is most likely to grow back on its own. “[Alopecia areata] is self-healing, but topical medicines, as well as injections of cortisone, can hasten its departure,” Dr. Resnik says.

As for other hair loss causes, Dr. Lin says that blood tests can pinpoint the culprit. Once you know what the underlying issue is, you can get started on treating it. Dr. Lin recommends incorporating protein, fatty acids, and vitamins such as Biotin into your diet — but that’s just to start.

According to Dr. Lin, there have been plenty of breakthroughs in hair loss treatments recently, from laser devices such as the iGrow to oral medications such as Finasteride. However, “the ultimate hair treatment,” says Dr. Lin, “is the hair transplant. Newer techniques involve harvesting small follicular units, which can minimize the size of the harvest site scar. Both men and women can benefit from hair transplants.”

You can also try giving your hair some simple TLC by massaging it with organic oils or hair serums. Dr. Engelman recommends a serum like NuGene’s Anti-Hair Loss Serum for hair loss because it “revs up sluggish hair follicles with essential growth factors and cytokines, effectively addressing the root causes of hair loss and thinning. It works not only to prevent future hair loss, but to revitalize follicular activity that will restore a youthful head of hair.”

Finally, Dr. Lin recommends avoiding heat styling tools, blow-drying, hair dye and other harsh chemicals, tight braids, and brushing wet hair (if you must brush your hair when wet, use a wide-toothed comb) to prevent breakage and additional hair loss.

By being gentle to your hair and scalp (as well as following a healthy diet), you probably won’t even need to resort to fancy hair treatments to get back to a thick head of hair — although it does feel good to know that those treatments will be there if you need them.
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