Do you feel itching, tingling, pain and redness on your scalp? Does your scalp feel tight and itchy? If yes, you may have a sensitive scalp.
In this article, we’ll take you through the signs of sensitive scalp, and hair and scalp conditions linked to it, including excerpts from Haircare Bible: A Dermatologist’s Tips on Haircare and Hair Loss by Dr. Teo Wan Lin, Dermatologist at TWL Specialist Skin & Laser Centre.
Do I have a sensitive scalp or is it a symptom of another condition?
Do you have an itch, redness or pain on your scalp? You may have an undiagnosed inflammatory scalp disease. Scalp “sensitivity” without any underlying scalp condition is a very rare condition attributed to abnormal nerve sensations known as scalp dysaesthesia.
It is far more common to have an underlying cause such as seborrheic dermatitis, which is due to proliferation of a yeast known as malassezia furfur in an individual with excess production of oil. It is also more common in tropical and humid climates such as Singapore, as such climates encourage this yeast to grow. Otherwise, malassezia is an ordinary inhabitant of one’s skin and scalp.
Under normal conditions, it does not cause any issues. However, under humid and sweaty environments, this yeast can proliferate to cause scalp inflammation and flaking. If you have scalp flaking which does not respond to over the counter anti-dandruff shampoos, usually contain zinc pyrithione as an antifungal agent, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.
Other causes of scalp inflammation would be scalp eczema due to excessively dry scalp/skin conditions, scalp psoriasis which may be the case especially if one has a family history of psoriasis or rashes on one’s body. If you have been in contact with a ringworm infected cat or dog, do have your scalp and skin checked by a dermatologist as these infections are contagious. They could also cause a form of scalp inflammation presenting as a red, scaly and itchy patches with hair loss.
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Is my sensitive scalp causing hair loss?
Most cases of scalp inflammation due to eczema, seborrheic dermatitis, scalp folliculitis or psoriasis should not cause hair loss. However, severe inflammation can push the hair growth cycle into a stage of telogen effluvium which is when hair reaches the end of its cycle and falls out, similar to hair loss that occurs after a major illness or post-pregnancy. In addition, if one picks and peels off crusted areas over the scalp, this can also cause damage to the hair root and lead to hair loss.
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There are other causes of hair loss such as alopecia areata, which is an autoimmune disorder causing one’s immune system to attack hair follicles, leading to hair loss. This usually has no symptoms other than the appearance of round patches of hair loss over one’s scalp. Scarring causes of hair loss include folliculitis decalvans, which is the end-stage of a type of scalp folliculitis, whereby the hair follicles themselves are constantly inflamed and infected. Children may be more susceptible to tinea capitis, which is a fungal scalp infection that can lead to scarring hair loss if untreated.
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Suspect suffering from a hair inflammatory disorder; scalp folliculitis?
Scalp folliculitis is an inflammatory disorder of the hair follicles in the scalp, also known as “acne necrotica miliaris” or “Proprionibacterium folliculitis”.
It is characterised by small, very itchy pustules on the scalp, often most troublesome on the frontal hairline. Depending on the severity, there may be only a small number or may appear as very numerous lesions. Due to the itch, they are hard to leave alone and overtime often become sore and crusted.
Causes of Scalp Folliculitis
Although the cause of scalp folliculitis is not well understood, it is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include:
● Bacteria (especially Cutibacterium acnes, but in severe cases, also Staphylococcus aureus)
● Mites (Demodex folliculorum)
● Yeasts (Malassezia species)
Treatment for Scalp Folliculitis
Treatment plan includes washing the folliculitis affected scalp with a mild normal shampoo as often as desired. In some cases, antidandruff shampoos containing anti-fungal agents such as ketoconazole or ciclopirox are helpful in mitigating scalp folliculitis. If patients desire, hair conditioner can be used.
The Copper Peptide Hair Regrowth Shampoo contains Zinc Pyrithione – an anti-fungal and anti-dandruff agent. It is dermatologist-formulated for sensitive scalps and hair loss.
The following medications may be helpful for scalp folliculitis:
● Topical antibiotics eg fusidic acid gel, clindamycin solution, erythromycin solution
● Mild topical steroid lotions or creams
● Oral antihistamines
● Oral antibiotics, such as the consumption of tetracycline in the long-term
● Oral isotretinoin, as a long-term, low dose treatment option
Severe Forms of Scalp Folliculitis
One such severe form of scalp folliculitis is acne necrotica. It is also known as “acne varioliformis” or “acne frontalis”. In this condition, first, the larger follicular spots (papules) become inflamed then secondly they tend to develop blackened crusts, finally leaving permanent pox-like scars. It is to be noted that acne necrotica may affect the face, scalp or other areas.
Another rare and severe form of scalp folliculitis, sometimes associated with hidradenitis suppurativa, acne conglobata and spinal arthritis (spondyloarthropathy), is perifolliculitis capitis abscedens et suffodiens. It is also known as “dissecting cellulitis” or folliculitis, or “perifolliculitis capitis”. It rarely occurs in white-skinned individuals, females and children and most often affects black adult men. In this case, large nodules and cysts accompany smaller follicular papules and pustules, from which purulent material can be expressed. Temporary hair loss over the lesions eventually results in permanent scarring and bald patches.
Because dissecting cellulitis is very resistant to treatment, the severity of the condition can be reduced with oral treatment such as isotretinoin, antibiotics, dapsone and injectables such as systemic steroids. If you have been diagnosed with dissecting cellulitis, you will need to be on long term treatment and followup with an accredited dermatologist to prevent scarring.
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