We’ve already determined that in order to have healthy hair, we need to maintain a healthy scalp. For this reason, it’s important to understand the conditions that affect our scalp, mainly dandruff, psoriasis, and dry scalp, and to learn how we get them, how we can avoid them, and how we can clear up the mess if and when it occurs.
More than half of the U.S. population is affected by dandruff, a condition of the scalp in which a fungus called malassezia feeds on the skin’s natural oils. For some women, overproduction of the fungus can cause scalp irritation, redness, and flaking, which can accelerate the body’s normal shedding of dead skin cells and production of new ones. While the process usually takes 28 days, it can take as little as 7 to 10 days when dandruff is present. This rewed-up rate produces scales that flake individually, so if you notice large white or gray flakes, itchiness, and either dryness in a specific area or excessive oiliness all over the scalp, there’s a good chance you have dandruff.
A flaky scalp can be caused by a variety of things, from overuse of hair products to hormonal changes to stress.
“Our skin cells shed all the time,” explains Hilary Baldwin, associate professor of dermatology at the State University of New York at Downstate Medical Center. “In dandruff, cells are immature so they stick together and form greasy, visible patches of skin that can flake off and may be visible on your shoulders. With severe dandruff, your scalp may itch so much that the flakes can be scratched off at the most inopportune moments.” Dandruff may get better or worse during any hormonal fluctuation, according to Baldwin, from puberty when women begin to produce more oils to pregnancy when hormonal levels are completely out of whack, to menopause when your scalp starts to dry out. “Stress can have a lot to do with dandruff and can make it less tolerable,” she says.
You can have dandruff and an oily scalp, but more women find it associated with a dry one. A dry scalp is evident by smaller, more powdery flakes and a tight, itchy-feeling scalp and often becomes worse during the winter when the air is drier and the rest of your skin needs a little extra moisturizing, too. To avoid dry scalp, use a conditioning shampoo, refrain from shampooing every day, avoid heat from blow-drying, use a humidifier to combat indoor heat, and wear a hat to protect your head outside. Maintaining a healthy scalp will do more than keep you from having to deal with dandruff and dry scalp. “Other scalp problems include scalp cysts, which have to be surgically removed if they become large enough, and scalp folliculitis, which is acne on the scalp,” says Amy Beth Lewis, assistant clinical professor of dermatology at Downstate Medical Center and a New York—based dermatologist. “If you scratch often or start picking at the bumps, your scalp may bleed, and infections and other problems may occur.” She says oral antibiotics offer a possible solution to curing the problem as well.
Flacky Facts
Turn your head upside down and brush or vigorously rub your scalp with your fingertips over a dark towel. If you see tiny, dry powdery flakes you have dry scalp. Use a clarifying shampoo with cider vinegar to remove buildup from products, and then try an oil treatment or scalp cream to moisturize. If the flakes are larger or look moist and greasy, you have dandruff. If the flakes are larger and look moist or greasy and your scalp is irritated, you may have seborrhea.
If you’ve been coloring, perming, relaxing, or straightening your hair, your scalp can become oily, flaky, and inflamed, which may mean you have a severe form of dandruff called seborrhea or seborrheic dermatitis, which can develop when the sebaceous glands are overactive as a result of emotional tension or poor diet. It can also turn up as a byproduct of an allergy, hormonal imbalance, or infection. Some studies show that dandruff is often related to poor metabolism of refined carbohydrates and a deficiency of B vitamins. Improving your diet and taking antioxidants may help the cause. If you treat it with a strong dandruff shampoo, it may only make it worse.
Unfortunately, you can be genetically predisposed to both seborreic dermatitis and psoriasis, and they can both be aggravated by stress, which causes additional scaling and flaking. A loss of moisture caused by certain styling habits such as blow-drying can also dry out your scalp. Here’s how to smooth things over.
MYTH: Conditioning the scalp and hair helps keep hair clean and healthy.
FACT: Using conditioners on the scalp can actually clog pores. Conditioners should only be applied to hair, never to the scalp.
Not many women know that gentle shampoos that contain tea tree oil, rosemary, or sage can control damage without drying out your scalp or hair. Alternate with a dandruff shampoo or revise your daily hair care regimen to incorporate a shampoo with an antifungal ingredient that can get rid of flakes and keep new ones from forming. Some shampoos contain pyrithione zinc (ZPT) to help control and prevent dandruff. Others include selenium sulfide and ketoconazole, which reduce the amount of fungus on the scalp and help keep flakes from recurring. While approved by the FDA to fight dandruff, these ingredients may not be the best choices for great-looking hair and can leave your locks looking dried out, which will ultimately happen as you age. As you get older, the amount of sebum produced by the sebaceous glands diminishes, leaving your hair dry. To help retard this process, add two tablespoons of vegetable oil plus vitamin E and cod liver oil supplements to the daily diet, brush hair nightly, indulge in occasional pre-shampoo oil treatments, and refrain from shampooing more often than twice a week or try one of the following dandruff-controlling shampoos.
If you’d rather have a root canal than be caught with a dandruff shampoo in your shower, you need to change your attitude. Some of the most effective dandruff shampoos can clear up your problem pronto, so they’re worth the investment. Here’s a look at the most well-known brands on the market. Products that contain pyrithione zinc as an active ingredient, like Head and Shoulders, are designed to kill the fungus that causes dandruff and help decrease irritation that’s present with dandruff. “Women are afraid to strip color or perms from their hair or dry it out,” says Baldwin. “Pyrithione zinc doesn’t do that. And it’s not a temporary solution. You can make it part of your hair- cleansing routine for life, especially now that there are different formulations for men, African-American hair, conditioners, and two-in-one versions to travel with or take to the gym.” To make the product work better, Baldwin suggests getting out of the shower immediately after washing your hair, so you don’t spend an excessive amount of time under the showerhead and wash the active ingredients down the drain. Head and Shoulders Intensive Treatment and Selsun Blue also contain selenium sulfide to help decrease the irritation that’s present with dandruff. A second over-the-counter option is a product with salicylic acid, which eats away at the thick, greasy scales so that flakes are less visible on your clothing after you shampoo. Ketoconazole is another ingredient that’s reportedly effective in targeting the fungal overgrowth that causes dandruff. According to McNeil Consumer Healthcare in Pennsylvania, the company behind Nizoral A-D, which utilizes ketoconazole as a main ingredient, one in three Americans suffers from this embarrassing condition. Ketoconazole adheres to the scalp’s natural proteins to provide protection and relief from dandruff for days in between washing. This is ideal for women who may skip a day or so between washing their hair. The formula also provides comfort and moisture to hair, making it shiny and manageable.
Scalp Massage
As we’ve already determined, a healthy scalp is the basis for healthy hair. It’s important to massage your scalp on a regular basis, starting at the nape of your neck and massaging upward with your spread fingertips moving in a slow circular motion. Follow by putting your fingers close together with one hand on each side of the top of your head, and zigzag back and forth from forehead to crown.
If over-the-counter brands don’t get the job done, a doctor might prescribe a medicated shampoo that will. Capex shampoo, a topical corticosteroid with FDA approval for the treatment of severe dandruff, contains a low-potency topical steroid called fluocinolone acetonide to reduce inflammation and itching. “There are other topical steroids on the market in solution, foam, or lotion bases,” says Mary Madden, senior product manager for Galderma, “but they often contain alcohol and have to be spot-treated and massaged into the part with your fingers. A shampoo formulation is the easiest way to uniformly distribute the product, get it to do what it needs to do, and conveniently rinse out.” Capex shampoo cleanses scales, sebum, oil, and dirt from the hair and scalp while hydrating it so that solution can penetrate more effectively, and its anti-inflammatory properties cause a decrease in scaling, flaking, and itching.
Tar is another common antidandruff ingredient formulated to decrease the rapid turnover of skin cells. Neutrogena T-Gel is one such formula designed to reduce scaling without any strong anti-inflammatory activity and few surfactants to keep lathering to a minimum. It’s ideal for women with scalp diseases who don’t want to introduce another disorder. A word of caution: Some tar-based shampoos can smell bad and may dry out your hair.
Moisturizing oils and steroid drops are another combination treatment. According to Lewis, oils applied to the scalp and left on overnight with a shower cap can cut through scaly flaking and allow medication from your shampoo to work even better. She suggests layering oils with steroid drops as another solution. In this tiered approach, a mild medicated shampoo is alternated with a more medicated shampoo as well as some oils and steroid drops a couple of times a week or when stress levels are high. If you don’t love the smell, alternate a medicated shampoo with your regular shampoo or use a regular conditioner.
In fact, many products that are used on the scalp for itching and flaking are topical steroids, and these days they come in the form of mousses or alcohol-based gels. One of the newest solutions on the market is another drug called Luxiq, which is available in a foam or mousse delivery system and can be used day or night. Apply after styling your hair and it will be easily absorbed, which means you can wear a lightweight formula during the day or a greasier version smoothed on before bed so that it works all night. For women who are unwilling to wash their hair more than every two weeks, such as African-American women with braids who want to keep them intact, shampoos won’t help; oral and injected steroids are another option. “Some people need steroid injections in the scalp to get deeper into the area that’s causing the problem,” says Baldwin. “Great for those who can’t stand touching their scalp with creams or greasy products, injectable steroids have a deep effect that lasts for a month.”
Try these homemade treatments to maintain a healthy scalp and steer clear of dandruff for good. If they don’t work for you, at least they’ll add a little extra nourishment to your hair.
Don’t trust your beauty skills? Go to a pro. From coast to coast, salons are adding scalp treatments to their menus to keep you ahead of the game when it comes to dandruff.
At New York’s Paul Labrecque Salon, try a healthy scalp treatment. First, your scalp will be exfoliated with peppermint essential oil; then lemongrass oil will be applied to the cuticle to close it down, repair damage, and restructure the hair. Hair will feel silkier, smoother, and healthier immediately after the process. A five-week supply of lemongrass can be purchased to continue treatments at home.
At the Los Angeles-based Steam, hair is brushed with a wood-tipped brush to stimulate and revitalize the scalp by bringing the blood flow to the surface and nourish hair follicles and hair strands by bringing natural oils from roots to end. Next, essential oils are applied to the scalp in sections from the top of the head to the nape of the neck, and the neck and shoulders are massaged to help oil rejuvenate the scalp and penetrate the hair shaft. After a rinse and shampoo, the conditioning treatment is applied and hair is steamed for ten minutes to open the cuticle layer and help the conditioner penetrate before the final rinse. Keep in mind that essential oil scalp treatments several times a month will increase blood flow and nourish your hair follicles, so your scalp and hair look their best.
A chronic genetic condition, psoriasis forms when the skin sheds cells too quickly and they pile up and form thick red scaly patches commonly found on the scalp, elbows, hands, and knees. If the scales stick to the scalp, you may have psoriasis. According to Maria Darnell, director of information services for Hill Dermaceuticals, the makers of Derma-Smoothe FS, psoriasis first manifests itself on the scalp, drying it out and causing crust and scales to form over the pores through which the hair grows. “It basically forms a helmet over the hair follicle and starts to weaken it,” says Darnell, who says that although it may spread to other parts of the body, once psoriasis is found on the scalp, it will always remain on the scalp. “You can learn to treat and control, it but you will always have it,” she adds. “Your body may go into remission or learn how to manage it more effectively.”
“Psoriasis results from inheriting the wrong genes from your parents,” says Mark Lebwohl, professor and chairman of the department of dermatology at Mount Sinai School of Medicine, who adds that the disease is also affected by environmental factors including stress and is more common in cold climates than warmer ones. “Characterized by sharply demarcated areas of scaling in the scalp, psoriasis can be treated with a number of different agents, such as shampoos with steroids, fungal preparations like ketoconazole and salicylic acid, which eat away at the scales, or tar, which suppresses inflammation in the scalp.” Liquid solutions can be difficult to apply and messy, so most popular treatments come in the form of gels, solutions, lotions, or foams that target the scales and the inflammation.
“Many products designed to treat psoriasis offer strong doses of steroids, only it’s not a matter of how strong a steroid is but how well it’s delivered and whether or not the area is exposed long enough to reduce inflammation,” says Darnell, and cites the oil-based Derma-Smoothe as an example. After a thin layer is applied to a wet scalp, massaged gently, and left overnight, the scales start to loosen and soften. A few hours later, the oil can be washed off with a gentle, nonmedicated shampoo and the scales begin to fall off, allowing the steroid to penetrate the scalp so that hair can grow in healthy again.
Retinoid cream may help for mild cases. For more severe cases, doctors recommend UV light therapy, cortisone creams, coal tar shampoos, antihistamines for itching, PUVA (a medication called psoralen in conjunction with UV light therapy), Accutane, Dovonex, or other prescription meds. Mud from the Dead Sea, rich in potassium chloride, calcium, and magnesium chloride, is also said to help psoriasis.
Recent innovations include olux clobetsol propionate and luxique betamethasone valerate, which turn to liquid when they reach the body’s surface temperature. According to Dr. Lebwohl, corticol steroids and other topical preparations are also recommended.
“If you’re using an over-the-counter medicated shampoo and it’s not controlling your dandruff—for example, if you still see flaking on your shoulders and you find yourself itching all the time—see your dermatologist,” advises Lewis. “Your doctor can determine exactly what the problem is by taking a family history or looking at other parts of your body like your elbows, knees, between your eyebrows or on your nasal folds for similar reactions, including dryness, flaking, and scaling,” Baldwin agrees. “If you’re using pyrithinone zinc and it’s not working, I wouldn’t bother with any other active ingredients. Go directly to your dermatologist.” Do so before the chain of reactions starts to unfold. Baldwin continues, “If you have bleeding or pus on the scalp, some people get carried away with scratching and get secondarily effected. They can even scratch enough to make the lymph nodes swell and cause an infection, so it’s no wonder shampoo stings when you put it on.”
If you don’t ask for help, you could be in serious trouble. “Some women come in in tears, while others have given up,” says Baldwin. “Occasionally, we’ll see someone with a bad scalp who has come in with another problem and won’t mention the scalp issue. When it’s finally addressed, she will say she’s used everything and nothing has worked. Women can get incredibly distraught, when, if treated correctly, many scalp problems can be controlled quickly—two or three days to stop the itch and about a week to get rid of the flakes.”
Scalp problems like dandruff and psoriasis can be irritating, but at least there are plenty of treatment options. Never underestimate the importance of maintaining a healthy scalp. Suddenly, something as innocuous as going gray doesn’t seem like such a big deal in comparison, does it? If you’re beginning to notice a bit more salt than pepper in your locks, this may just be your chance to enter this new phase of your life with a whole new shade!