Inflamed hair follicles from scalp infections.
Do I Have A Scalp Infection?
Typical features of scalp infections include itching, discomfort or pain, discharge, skin flakes or dandruff, dry scaly rash and of course, hair loss. Not all of the symptoms need to be present to diagnose scalp infections. In certain cases, hair loss might be the only presenting symptom.
Our hair follicles are situated across three levels of skin – the epidermis or the most superficial layer, the dermis or the middle layer where collagen matrix and tiny blood vessels lie, and the subcutaneous fat. Scalp infections in any of these layers can affect delicate hair follicles and disrupt their function.
A doctor will need to examine your scalp closely and consider taking skin scrapings for a definitive diagnosis, though this is rarely required. Using high-powered magnification to characterise the rash can be helpful.
Types Of Scalp Infection
Folliculitis is a scalp infection of the hair follicle that is similar to a pimple. Sebum and dirt gets trapped in the pore and bacteria flourish, causing inflammation. This can be seen as redness surrounding the hair follicle, sometimes causing itching or pain. Folliculitis can also be associated with pus discharge. Sufficient inflammation may cause scarring that can permanently damage the architecture of the hair follicles, leading to hair loss.
How do I treat folliculitis?
Bacterial folliculitis is treated with a course of oral or topical antibiotics depending on the severity of the condition. There may also be a need for treatment with painkillers and anti-itching tablets.
Dandruff is a term used to describe flaky deposits of dead skin that form on the scalp. The condition is actually part of a continuum of skin conditions called seborrheic dermatitis, dandruff being the milder form, before inflammation starts. Mild cases of dandruff may be transient and would not cause hair loss.
How do I treat dandruff?
Dandruff, being an uninflamed form of seborrheic dermatitis, requires milder treatment. A specialised shampoo will be prescribed and advice will be given on how to use it effectively.
Seborrheic dermatitis that involves the scalp can cause transient hair loss and is a fairly common scalp condition seen in both adults and infants. “Seb derm”, as it’s known for short, is a scalp infection that is poorly understood, but a few contributory factors have been identified. Genetics (Causcasian populations are more susceptible), dry skin, head injuries, stroke, psychiatric conditions and chronic fatigue syndrome all seem to be associated with seborrheic dermatitis.
However, it is the levels of male hormones or androgens in the body (which stimulate secretion of sebum, cholesterol and fatty acids onto the scalp) that are most closely associated with seborrheic dermatitis. This fatty mixture allows bacteria and yeast, in particular the malassezia family of yeasts, to flourish. When there is an overgrowth of malassezia, scalp inflammation occurs.
Seborrheic dermatitis is characterised by itching discomfort, dry flakes and scales noticed on the scalp or hair, redness of the underlying skin, possible clear to turbid discharge and hair loss over the affected areas.
How do I treat seborrheic dermatitis?
Seborrheic dermatitis requires a multi-pronged approach for effective treatment.
Firstly, the skin needs to be conditioned to ensure it is moisturised and has appropriate levels of sebum, and to clear away the flaky dry skin. A shampoo containing selenium will be prescribed to you as well as a scalp exfoliation mask.
Secondly, the patient can use a shampoo that counteracts malassezia yeast once a week. As this usually contains strong medication, it is not suitable for daily or prolonged use.
Thirdly, if there is a high degree of inflammation and itching, a medication used to control itching will be prescribed – an applied corticosteroid.
Despite your best efforts to control seborrheic dermatitis and dandruff, these conditions can recur. Continued follow up will be arranged to ensure adherence to treatment.
Before any treatment can be prescribed, the cause of the scalp infection needs to be ascertained.
If any of the scalp infections caused significant hair loss, the hair may regrow after the infection is treated. To speed up the growth of hair, one should use a combination of scalp tonics, hair growth supplements, topical minoxidil and in-clinic scalp treatments, as prescribed by a hair restoration physician.