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• Proper Diagnosis of Dandruff, Seborrheic Dermatitis and Scalp Psoriasis

• HairSite Editorial

• 4/24/00

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Central to Dandruff, Seborrheic Dermatitis, and Psoriasis are symptoms such as severe itch, excessive flakes, tightness of the scalp, oily scalp, occasional scalp pain, poor hair condition and even hair loss. Yes, they can cause hair loss.

Dandruff
Your scalp sheds skin cells as part of its normal cell reproduction. But with Dandruff, scalp cell production is abnormally rapid. The cells collect together on the scalp forming flakes. When these flakes break free, they are readily seen in their hair and on clothing. Dandruff also causes the scalp to itch. And when scratched, the scalp can become irritated, leading to physical discomfort as well as hair loss.

Seborrheic Dermatitis
Seborrheic Dermatitis appears as lesions or rashes covered by sometimes oily, yellowish or whitish scale. This condition can appear on areas of the skin which have an abundance of oil glands, typically the scalp, nose, and eyebrows. As with Dandruff, the rapid build-up and scaling of cells is one aspect of the problem and results in flakes and itching.

Scalp Psoriasis
Psoriasis is characterized by accelerated cell production and thickening of the outer layer of the skin. These cells do not eventually flake, but build up to form plaques. Plaques are reddish and silver-scaled, and they often itch. They sometimes cover large areas of the scalp, and can be very difficult to treat. The exact cause of Psoriasis is unknown, but immunological and biochemical abnormalities are contenders. Psoriasis also tends to run in families. In most cases, Psoriasis can cause a substantial amout of hair loss.

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There are many factors that may contribute to scalp inflammation. For example, according to McNeil Consumer Products in Canada, scientists have also confirmed that dandruff and other forms of dermatitis conditions can be caused by a microscopic fungus called Pityrosporum Ovale. It is known that this fungus can cause a mild infection at the roots of the hair and cause itch and flakes.

Scalp inflammation is also commonly reported by people using Rogaine or topical minoxidil, that's why some people called it "minoxidil burn". It appears that people who are using 5% minoxidil are suffering more from scalp inflammation than those using 2%. Some doctors say that it is the alcohol in Rogaine that is causing the problem whereas others, eg: Dr. Proctor, a hair specialist in the U.S says that it is propylene glycol in Rogaine that is causing the problem. It is unclear why this condition is more prevalent among people who are using 5% topical minoxidil than 2%.

Please note that scalp inflammation can happen even if you are not using Rogaine or topical minoxidil. In fact, there is no scientific study which shows that topical minoxidil is the cause of scalp inflammation. Some people are simply more prone to certain scalp conditions than others. Besides topical minoxidil, Retin-A is also known to be associated with scalp inflammation. Specifically, scalp treated with Retin-A will become vulnerable to sunlight and may develop an inflammatory reactions due to sun's exposure. In addition, some suggested that inflammation may be related to bacterial activity on the scalp. Researchers Young et al. proposed that inflammation is a direct cause of bacteria that inhibits in the hair follicles. 

According to Dr. Razack, another hair specialist in the U.S and author of the book "Conquering Hair Loss", many researchers have suggested that scalp inflammation is closely related to hair loss. There was a clinical study conducted by Young et al in 1991 showing that 96% of the participants in the study who have androgenic alopecia have also demostrated some kind of inflammatory response on their scalps. In another study conducted by Abell et al., inflammation was present in over 75% of the scalp biopsies obtained from close to 700 patients with androgenic alopecia.  

Other causes of scalp inflammation are long term use of hair dyes, anti-frizz and various hair styling products that has a high alcohol content.

Few realize that the crustings and flakes on the scalp are the major culprit in scalp inflammation related hair loss. Although both the crustings and flakes are simply dead skin on your scalp, they are responsible for physically pulling my hair off as they are breaking loose from the scalp.

For more in-depth analysis on inflammation and hair loss, a good reference would be the book "Conquering Hair Loss". However, we are not going to get into the technicalities here since what we really want is to talk about the treatments available for scalp inflammation.

Cooler Showers
As a start, Dr. Jorizzo recommends people shampoo with cooler water. Hot water makes the itching worse. Cold water has the opposite effect.

Neutrogen T-Gel
The first thing that everyone should try is Neutrogen T-Gel. It is the least expensive of all treatments, about US $8 a bottle and virtually any drug store sells it as an over-the-counter shampoo. No prescription is required. Although it doesn't work for everyone, some have repoted good results without having to turn to other more expensive alternatives. People should definitely give T-Gel a try before anything else. However, not everyone responds to T-Gel. In fact, some really dislike the shampoo. In some cases, T-Gel can dry up your hair and leave stains on your scalp.

Nizoral Shampoo
If T-Gel fails, the next product that we recommend is Nizoral shampoo. It is more expensive than T-Gel and a prescription is required for U.S residents. Nizoral costs well over US $30 for one bottle in New York City and we guarantee you can find a much better deal ordering over the internet.  The active ingredient in Nizoral is 2% ketoconazole which in addition to being an anti-fungal agent, is also an antiandrogen and immunosupressant. All these attributes are beneficial to hair growth. Nizoral is intended to be used only once or twice a week. So it is important that you alternate Nizoral with another shampoo for hair loss during the course of the week.

Nizoral Conditioning Shampoo
Many people complain that while Nizoral shampoo works for them, it also makes their hair and scalp dry. In fact, even people who have oily hair and scalp complain that Nizoral is too drying for the hair. Good news: Nizoral Conditioning Shampoo is now available. However, it is not widely available in every country at this point (not even in the U.S - to our knowledge) and your best bet is to shop for it on the internet. This is a great shampoo, it works just as well as regular Nizoral shampoo, has the same active ingredient - 2% ketoconazole and does not leave your hair and scalp dry. This one is now on our favorite list. It is slightly more expensive than regular Nizoral shampoo.

Tarsum
Tarsum is an under-rated treatment for scalp inflammatory conditions. It does not receive the same recognition as Nizoral or T-Gel. However, many have reported that Tarsum works a lot better than both Nizoral and T-Gel. Tarsum is an targeted scalp treatment. It is a shampoo/gel and is intended to be applied directly onto affected areas. The active ingredient in Tarsum is L.C.D coal tar solution equivalent to 2% coal tar. Other ingredients includesalicylic acid, sodium chloride, cocamide DEA, TEA lauryl sulfate and sodium lauryl sulfate.

Dermovate
If both T-Gel and Nizoral fail, then your next weapon is Dermovate, or sometimes called Temovate in North America. It is a topical scalp lotion that is available by prescription only for U.S residents. Dermovate is not cheap. A 50ml bottle costs over US $60 in New York City. However, you are supposed to place only a few drops on affected areas and a 50ml bottle should last you more than two months. The active ingredient in Dermovate is Clobetasol 17-propionate 0.05%, which is a kind of cortisone. Dermovate is extremely effective and it works almost instantaneoulsy. Depending on the severity of your conditions, continuous application for  up to six weeks may be required before your scalp is clear of all flakes and crust. Once your conditions have been stablizied, then you use Dermovate only when needed. For those who use Rogaine or topical minoxidil, Dermovate should be applied shortly after you put on Rogaine. Also, for best results, it is highly recommended that you include both Nizoral shampoo and Dermovate in your regimen. Do not apply Dermovate to your scalp over an extended period of time. Discontinue treatment as soon as you have achieved the desired results. People develop tolerance to Dermovate fairly quickly and it is best to use the topical lotion only when needed.

DermaSmooth
If everything fails, this is probably your last resort. DermaSmooth is a type of corticosteroid. It is formulated with Fluocinolone Acetonide (0.01%), Isopropyl Alcohol (1.6%) in a base containing Peanut Oil, Mineral Oil, Isopropyl Myristate, Oleth-2 and Balsam Pine. This topical lotion feels exactly like oil and it is only recommended for night time application. DermaSmooth is specially formulated for stubborn inflammatory conditions such as scalp psoriasis. It is also extremely effective against the formation of crusts and flakes on your scalp. People should see a substantial reduction in crusts and scales after 2 - 3 treatments. According to the manufacturer, clinical studies showed that 83% of the patients experienced 50% - 100% improvement within 3 weeks. The peanut oil in DermaSmooth seeps between crusts and scales and softens them until they fall off, allowing the topical steroid to reach the diseased scalp. It is recommended that you wet your hair and scalp thoroughly between using DermaSmooth. 

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