"Scalp Disorder & Its Management"

Before we start understanding about different scalp diseases, we should have a basic knowledge of the scalp.  SCALP is nothing but an envelope made up of soft tissue for the cranial vault. Simply we can say that scalp is a covering of cranial vault. It consists of five(5) layers from above below called 1)Skin 2)Connective tissue 3)Epicranial aponeurosis 4) Loose arealar tissue & 5)Pericranium. First three layers are together termed as single unit. 

1)SKIN: Skin is the outer most layer of scalp bearing hairs & different sebaceous glands. 

2)CONNECTIVE TISSUE: This is called superficial fascia. Its a fibro-fatty layer. It connects skin to eponeurosis. It acts as a pathway for nerves & blood vessels. There is an anatomical importance of this layer of scalp. Blood vessels are attached to this connective tissues so when there is any cut to the vessels, it may lead to profuse bleeding but this layer prevents the vasospasm so there is no any active bleeding. 

3)EPICRANIAL APONEUROSIS: This is a thin layer where insertion of a muscle happens called occipitofrontalis. This layer provides a space which allows fluids & blood to pass from scalp to upper eye-lids. 

4)LOOSE AREOLAR TISSUE: It connects the upper three layers to the pericranium. Some eimissary veins present in this layer connecting the scalp veins & forming the intra-cranial venous sinuses. 

5)PERICRANIUM: Its a covering of the scalp bone called periosteum. 

So, this is brief knowledge about the scalp for better understanding its disorder with management. Now lets starts discussing different scalp disorders along with its management. There are different types of scalp disorder from fungal to viral &  bacterial & also some auto-immune ones. 

Because of the different scalp disorder, there are certain common sign & symptoms we generally face like excessive oiliness, excessive flaking, inflammation, patchy scabbing & intense pruritus. Some conditions because of infection, some because of allergic reaction, some because of immune responses and some due to scalp condition. So, on the basis of this scalp disorders are classified into different categories. 

A) FUNGAL INFECTION OF SCALP: 

The most common fungal infection of scalp is "ringworm" although infection is not caused by any worm but still name is "Ringworm". Instead of this there are other different fungal infection of the scalp which may vary from area to area as per the geographic zone in the world. 

Tinea capitis is the scientific name of  Ringworm. Tinea is a Latin word which means worm & Capitis is also a Latin word that means head so it means worm in head. Infection is caused by a group of fungi called Miscrosporum & Trichophyton not by a single fungus. Trichophyton are frequently infecting organisms. This infection is contagious & spreads from person to person by sharing pillow & hat, from hair shedding contact etc. It is commonly found among the children because they are get infected mostly in school so school going children are mostly infected. 

Types: Three(3) types of tinea capitis are found. 

1)Non-Inflammatory: In this type there is no any major sign of inflammation except the redness. There is reddish patch on the scalp surrounded by scales around. Gray hairs may appear because of dusting of fungus and hair breakage above the hair follicles. 

2)Inflammatory: There is intense inflammation of hair follicles with all the sing of inflammation. There is itching with oozing of pus & hair breakage too.

                                                                   Fig-Tinea Infection

3)Black dot: There is appearance of "black-dot" of infected hairs along with large patch of inflammation. Hairs lost in this type is permanently lost. 

Diagnosis: Because of similar features of seborrhoeic dermatitis & scalp psoriasis there may be some confusion for the proper diagnosis of tinea infection in scalp so it should be confirmed by laboratory test of specific fungal infection. 

Treatment: After the confirmatory diagnosis treatment should be started  as soon as possible. Anti-fungal drug ketokonazole & steroid to reduce the irritation caused by inflammation are given generally by the most of the dermatologists. 2-4 weeks duration is generally needed for combat it completely. 

B) BACTERIAL INFECTION OF SCALP: 

There are various types of bacteria & viruses present on our healthy skin without any harm but when they become invasive, it causes infection of scalp called in the form of  folliculitis, ance vulgaris, seborrhoeic dermatitis and last but not the least  pyroderma & tuberculosis of scalp are also seen. Folliculitis means inflammation of follicles & it present with or without abscess formation. It resembles pimple on the scalp with presence of hair in the center. Follicular pustules are inflammatory or infectious. 

C) VIRAL INFECTION OF SCALP:

The most common viral infection of scalp is herpes caused by herpes simplex or herpes zoster. Intense itching with burning, redness are commonly seen. Folliculitis may also be seen. Lesions are extremely painful. After proper diagnosis,anti-viral medications are given. 

D) PARASITIC INFECTION OF SCALP:

The most common parasitic infection of the scalp is pediculosis capitis known as head louse. It is  niche-living parasite of the human scalp. Female & male head louse are present.  After bite of head louse, area becomes inflamed & itchy. The first & most important symptom of head lice is intense itching. 

Site: The common places where infestation can occur easily, are school, nursing homes, military camp where people come in contact closely. It is not necessary that only dirty people get infected with lice, it only depends on how people come in contact with infected persons.   

Diagnosis: Scalp examination may reveal the red swollen patches on the affected area. There is cluster of grayish white eggs of louse are present & attached to the shaft of hairs. On the proper examination of scalp it also reveal the live lice also. 

Treatment: Lindane, Malathion, Carbaryl, Natural pyrethroids & synthetic pyrethroids are used for treating this scalp problem. They are generally used as insecticides. After applying on the scalp it should be left on the scalp for minimum 12 hours and then washed it off. Blow dry should not be done as it lowers the action of insecticides. Generally they kill all the lice on the scalp but it should be repeated 2-3 times in a month then finally not only lice all eggs are also killed. 

As it is infectious so it should be necessary to examine all the family members about the same & same anti-louse treatment should be given to all the family members. Combs  & brushes are also washed off before using . 

E) SEBORRHOEIC DERMATITIS:

Seborrhoeic dermatitis is a common inflammatory condition of scalp skin resulting scales white to yellow in color due to excessive oiliness of scalp called seborrhea. It can happen with or without reddened skin. 

Seborrhoeic dermatitis may occurs in babies also like younger than 3 months resulting in thick oily & yellow crusts on the scalp and also around the hair line. This is also called Cradle Cap. 

                                                                Fig-Cradle cap

Causation: The exact cause of seborrhoeic dermatitis is still not known. There are several factors which are considered to be the causal factor for it. 

First factor is excess sebum level which is commonly found in adolescent because their sebaceous glands are very active. Another factor is Malassezia yeast infection. Earlier it was  believed that Malassezia fufur is pathogenic yeast which is responsible for seborrhoeia. But later on it was confirmed that Malassezia globosa & Malassezia restricta are the main pathogens. 

Clinical Presentation: Generally seborrhoeic dermatitis includes the symptoms like skin lesions with plaques over the large area,, greasy oily skin; white or yellow skin scales; dandruff with itchy & red scalp and all these one resulting in hair loss in some extend. 

Treatment: The first line of treatment for seborrhoeic dermatitis is anti-fungal infection like ketokonazol shampoo & some tar-based shampoo also helpful. Most of the cases are recovered by this line of treatment but if some cases are not done then we have to move to another option. Topica corticosteroids are generally used for that cases but its long term use  may give some adverse affects like loss of scalp sensation to some extend & atrophy. 

Even this line of treatment is also not responding, oral therapy is recommended in those cases. 

F) CONTACT DERMATITIS: 

Contact dermatitis is an eczematous dermatitis characterized by inflammation & itching caused by an external agent after reaction with skin. This also causes allergic reaction & irritation by external agent which may be some shampoos or topical applications too. Some ingredients in hair dyes & hair care products are responsible for irritant & allergic contact dermatitis. Allergy can al so occur to hair nets, hats or wigs but allergy from shampoo is very rare one. 

Type: On this basis it is two type-Allergic Contact Dermatitis & Irritant Contact Dermatitis. 

Irritant Contact Dermatitis: It appears soon after contact with irritant agent. It is not so common like allergic contact dermatitis. 

Allergic Contact Dermatitis: It is more common in compare to irritant contact dermatitis. It does not appear immediately after contact with agent like irritant contact dermatitis. Allergic contact dermatitis has different degree of clinic presentations like mild scalp inflammation to chronic eczema, edematous swelling of face & neck.  It may remain for days to weeks even after withdrawal of agents. 

Treatment: Contact dermatitis is treated basically by topical corticosteroids and systemic corticosteroids are given for severe cases. Mild shampoo is advised to minimize the scalp irritation. 

 G) ATOPIC DERMATITIS:

Atopic dermatitis is a common skin & scalp & and pruritus is most frequent symptom. Its a very common inflammatory chronic condition of skin that may happen to all age group people but more common in children. 

Pruritus is the most marked symptom in affected persons but exacerbations & remissions may also occur. Scalp involvement is very common in atopic dermatitis elsewhere in the body. Childhood atopic dermatitis with scalp involvement is one of important feature Wiskott-Aldrich Syndrome, hyperimmunoglobulin E syndrome & hyperesinophilic syndrome. 

For the treatment purpose, tar shampoo is used & if some secondary bacterial infection will be there, oral anti-biotics are also prescribed at the same time. 

H) SCALP PSORIASIS:

Definition: Psoriasis is a chronic inflammatory auto-immune skin disease characterized by silvery scaling from the affected area with intense itching. When it forms in scalp, its called Scalp Psoriasis.

It may appear anywhere on the skin of body but mostly on scalp,knee,elbow,back,palm & sole. Its not contagious. Scalp Psoriasis can extend beyond the scalp & appears on the forehead,back of neck & behind the ears too. 

Word meaning & History: Psoriasis is a Greek word which means "itch". In the year 1841, Ferdinand Von Hebra who was a Vienesse Dermatologist working on Willan's note ascribed the name "Psoriasis" from the Greek work psora. He was the only person who described the clinical picture of psoriasis. Every year 29th Oct is the World Psoriasis Day around the globe & on that day thousands & thousands psoriatic patients are helped & treatment. 

Clinical features: Following features may be notices in scalp psoriasis.

1. Reddish Patch on the scalp: Some patches reddish or pinkish in color appear anywhere in the scalp and sometime it barely noticeable. Its thick & inflamed.
2. Silvery white scale: Scalp psoriasis can look like Dandruff because white scales are coming regularly from the scalp & patient may think that he or she is suffering from dandruff & that is why even after trying all the home remedies for dandruff , it is still there. And patient could not distinguish between the flaking of dandruff & silvery white scales of scalp psoriasis. 
3. Dry scalp: There is dryness of skin even so dry that it may cracks & bleeds. 
4. Itching: This is the most important & common symptom that patient may suffer. Itching is like mild to severe even patient's sleep is disturbed & it makes patient very irritable too. 
5. Bleeding: Because of itching patient always scratches his scalp & it may cause bleeding. Scratching also aggravates the psoriasis. 
6. Burning sensation: There is burning in the scalp & because of this affected area is sore . 

Causation:  Psoriasis is an auto-immune disorder & following factors could be aggravating factors for psoriasis: - 

1. Stress 
2. Common infections
3. Trauma(koebners phenomena)
4. Physical agents like HIV infection,alcoholism & smoking. 

Treatment: Psoriasis always remains unpredictable. Sometime it recovered completely without any trace mark but sometime it returns within the weeks,months or years. There is no cure for psoriasis, it only recovers & becomes latent. 

Treatment of scalp psoriasis varies because it is mild scaling to severe scaling even crusting . It may extend to forehead,neck & around the ears. Treatment also varies from person to person depending upon the severity of cases. Coal tar based preparation is mostly used for scalp psoriasis. Some creams based on salicylic acid are also beneficial. It just makes softening of scaling. Regular shampooing should also be done to remove the scales. 

 

                                       *HaveGoodHair & LiveGoodLife*