Scalp disorders

0


What is it about ?

Frequent skin conditions often affect the scalp as well. Scalp conditions are often accompanied by abnormalities in the ears and nails. The doctor will therefore examine them as well. The most common causes of scalp involvement are eczema and psoriasis.

How to recognize scalp conditions?

Most common causes:

  • THE’seborrheic eczema (or seborrheic dermatitis) is a condition that affects the skin where there are many glands that produce sebum (sebaceous glands). The production of sebum is increased (seborrhea). The skin is red, it peels (peeling), which produces dry or oily scales (skin dandruff), and this is accompanied by itching. The condition mainly affects the scalp. Sometimes the eyebrows, eyelids, ear, skin folds, upper trunk, armpits, cleft between the buttocks, groin area, or genital area are also affected.
  • THE’atopic eczema causes a rash accompanied by itching (pruritus). It mainly affects skin folds, face, neck and eyelids. Over time, the skin can also become thicker and rougher. Atopic eczema is often associated withasthma, to hay fever and food allergies. Atopic eczema often begins in childhood. Usually, the disease affects several family members.
  • the psoriasis Most often presents as red, hard, thick, delineated patches (plaque psoriasis) with a white layer of skin flakes (scales). They can appear mainly in the navel, armpits, knees, elbows, nails, scalp and between the buttocks.
  • The irritant contact dermatitis is triggered by an external irritant. Inflammation is accompanied by redness and itching. Some products that can irritate the scalp include hair dyes, perfumes, and shampoos. People with sensitive skin and allergic predispositions are at greater risk of developing contact dermatitis.

Other causes:

  • A folliculitis is an inflammation affecting a hair follicle. It can be recognized by the formation of a red ball, painful and hard to the touch. When it fills with pus, a yellow tip appears, which can burst spontaneously. Folliculitis can heal without leaving scars.
  • The neurodermatitis is an itchy (itchy) skin condition that is fed by rubbing and scratching. The triggering factor is often unknown. At the level of the scalp, the nape of the neck is the characteristic location. The skin becomes thicker and darker. In exceptional cases, a scar is formed.
  • The ringworm (tinea capitis), a skin yeast infection appears as scaly patches, in which the hair is broken or has disappeared. This baldness can be permanent.
    Scalp yeast infection is most commonly seen in children and people with dark skin.
  • THE’impetigo is a skin infection that begins with scabs or macules. In children, lesions usually appear on the face. Exceptionally, the infection spreads all over the body.
  • The lice feed on human blood. Small, itchy (itchy) blisters form where lice bite. Lice and their larvae are easily visible to the naked eye.
  • A increased sensitivity of the scalp may be itchy, tingling and burning, with no visible abnormalities. This condition mainly affects people who suffer from a psychiatric disorder or chronic pain.

Hair loss (alopecia)

Among the conditions that cause hair loss, some can also affect the scalp.

  • THE’alopecia areata (alopecia areata) is a condition characterized by the formation of bald patches of circular shape on the head. The hair all around is normal. Patches of baldness do not have scar tissue.
  • Some rare autoimmune conditions, in which the immune system attacks cells in the body, can cause scarring baldness. Hair loss is usually associated with intense itching, red scalp discoloration, and peeling.
  • Handling of the hair can also lead to baldness. In this context, the hair falls out due to excessive tension exerted on its root. This is the case for example in the trichotillomania is a mental condition characterized by a person’s overwhelming need to pull out their hair, which creates patches of baldness with fuzzy edges. The phenomenon is usually limited to the hair, but it often happens that the person also attacks the hair in different places on the body. This condition is part of obsessive-compulsive disorder.

Isolated lesions

  • Benign skin tumors
    • a atheroma (sebaceous cyst) is a lump that forms under the skin, starting from a blocked hair follicle. A black tip is often visible in its center. Cysts can appear anywhere on the body, but their characteristic locations are the face and scalp.
    • The seborrheic warts or keratoses look like irregularly shaped birthmarks. Their surface is very rough and their color is most often yellowish-brown. They can measure up to 3 centimeters.
    • a lipoma is a benign tumor made of fatty tissue, which can appear anywhere on the body.
  • The solar or actinic keratosis develops on areas of skin exposed to the sun. As this condition is potentially a precursor to skin cancer, it is important to detect this lesion as soon as possible. Solar keratosis presents as a small, round lesion that is completely asymptomatic. The lesion can reach several centimeters, flake off and evolve to form a hard layer of skin.
  • The malignant skin tumors : basal cell carcinomas, squamous cell carcinomas and melanoma.

How is the diagnosis made?

Diagnosis can be very difficult because many conditions are similar. Even so, your doctor can often already make a diagnosis after a detailed discussion and physical examination. Often, seborrheic eczema and scalp psoriasis are particularly difficult to distinguish, except when other areas of the skin are affected and aid in the diagnosis.
Your doctor will ask you questions about the symptoms and progression of the lesions:

  • Did the condition start suddenly or have you noticed the lesion for some time?
  • Do you suffer from itching ?
  • Is it possibly a relapse?
  • Do you have an allergy?
  • Do you feel pain?
  • Are there any skin disorders in your family?
  • Do you have any other symptoms?

During the physical examination, the doctor examines the lesions, and the rest of the skin, hair and nails. He will be attentive, among other things, to the location, delimitation and presence of skin dandruff (scales), blisters and ulcers.
Laboratory tests may include:

  • a blood test (allergy tests, antibodies, inflammations);
  • a microscopic examination of a few cells taken from the lesion;
  • culture of fluid or pus to identify possible bacteria and fungi.

If a malignant disease is suspected, a small piece of tissue will be taken for further examinations (biopsy).
In addition, the doctor can also perform skin tests in order to detect an allergy.

What can you do ?

Try to eliminate as many causes as possible for scalp conditions:

  • Avoid contact with products to which you are allergic.
  • Avoid or minimize the use of cosmetics.
  • If you have dry skin, use a moisturizing bath or shower oil or cream, preferably without preservatives or fragrances.
  • It is important to have good hygiene of the skin and the hair, but it is not good to wash them too often with water and soap.
  • Always dry yourself off thoroughly after bathing or showering.
  • If necessary, adapt your clothes: wear gloves if you have a contact allergy, cover your arms and legs if you have an allergy to the sun.
  • Avoid exposing yourself to the sun during the hottest hours (between 12 p.m. and 3 p.m.).
  • Avoid exposure to cigarette smoke.
  • Try not to scratch, you may make the lesions worse. It may be helpful to trim your fingernails flush to help you do this.
  • Wash your hands thoroughly and regularly to prevent the spread of infections.
  • If you have seborrheic eczema, an anti-dandruff shampoo or an anti-fungal shampoo may ease the symptoms.
  • Lice can be treated at home with a lice comb. If the result is not satisfactory after 2 weeks, consult a doctor.
  • Thick crusts can be softened and removed with the help of body oil and topical salicylic acid treatment, which the pharmacist can prepare for you.

What can your doctor do?

Your doctor will find the most appropriate treatment based on the severity of your condition. This usually consists of the local application of ointments and creams.

  • Faced with an infection by a bacteria or a fungus, treatment with antibiotics or antimycotics will be prescribed.
  • Eczema and itching are treated with cortisone creams. The use of these creams should be limited to a short time.
  • In exceptional cases, treatment should be started in the form of tablets. Always follow your doctor’s instructions carefully.
  • In the case of benign tumors, mainly liquid nitrogen is used.
  • For malignant tumors, treatment may involve liquid nitrogen, phototherapy, creams that kill cells (cytotoxics), creams that stimulate the immune system, radiation therapy, or electrocoagulation of the lesion (which means that ‘it is’ burned’ by means of an electric current).

To learn more about the specific treatment for each of these skin conditions, please consult the corresponding patient guides.

Want to know more?

Source

Foreign clinical practice guide ‘Hoofdhuidproblemen’ (2017), updated on 24.05.2017 and adapted to the Belgian context on 22.01.2019 – ebpracticenet