QoM Archives - Page 4 of 5 -

August’s QOM- What’s the difference between dry scalp and dandruff?

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Hey Doc, need some help. How do u differentiate between dry scalp and dandruff, and what’s the treatment for each? What causes or aggravates them? Pls help.

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A completely dry scalp i.e. where there is no oil and the skin cracked is actually not common. There are persons who have genetic and other unusual skin disorders where all of their skin including their scalp is dry. What people often refer to as “dry scalp” is actually dandruff. A flaky scalp does not necessarily mean it is dry. There are also other conditions that can result in a flaky scalp: psoriasis, discoid lupus and other scarring type hair loss.

For most persons they are experiencing seborrhoeic dermatitis which most often refer to as dandruff. Seborrhoeic dermatitis is caused by inflammation of the scalp caused by a fungus that lives on the scalp that feeds on the sebum that our scalp hairs produce. The scalp produces a lot of sebum even more than the face. Your hair type which is excessively curly does not make you be aware of it. For other races with straighter hair it is quite obvious how oily their hair can get. You actually do not need to oil the scalp ever.

The number one thing to alleviate dandruff is to wash your hair often. Do not go a week without washing your hair. You will see a difference in how your scalp reacts. Antifungal shampoos used directly on the scalp can be helpful. Ketoconazole, Selenium sulfide, Zinc Pyrithione II, and Tea tree oil containing shampoos are helpful. Leave them on for ten minutes. Rinse then wash your hair with the regular shampoo afterwards.

About

Dr. Llorenia Muir-Green is a practising dermatologist in Jamaica. She has an avid interest in hair and scalp disorders. She is a member of the Medical Association of Jamaica, Dermatology Association of Jamaica and is an Associate Member of the Caribbean Dermatology Association. She was a recipient of the 2013 Fellowship in Hair and Scalp Disorders at the University of British Columbia.

Have a question you would like to be answered? Send in your question to ask@askthehairdoc.com. Remember to follow me on Facebook, Twitter, Instagram and Google Plus.

June’s QOM

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Hi Doc,

I just realized that I need to find an effective shampoo for my daughter as she has been on a local swim team for the last 2 years and currently trains about 4 days a week. Can you provide information on exactly what chlorine does to the hair and the right products and treatment for “swimmers hair” ? She wears her swim cap of course, and it does help a little as her hair is never really soaked.

juneqom

Photo credit: Facebook Fan Kerry-Ann

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Chlorine is no one’s friend. It has been shown mainly in wool (and similarly in hair) to cleave the thioester bonds which bind 18 MEA (a major hair integral lipid) to the cuticle. It also oxidises the disulphide bonds in the proteins of the hair thus degrading them. This results in increased friction between the hair fibres and of course increased fragility of the hair. It can decrease the melanin in the hair causing it to become lighter over time.

As you know the swim caps are not designed to keep the hair from getting wet. There are some that keep the hair drier than others. The best thing to do is to coat the hair with conditioner or oil or a butter such as shea butter and then place the cap on. This also doubles as a deep conditioning treatment and gives little space for the water to eat away at the hair. After swimming wash hair with a good swimmer’s shampoo. These usually have Vit C or sodium thiosulphate to remove residual chlorine. They also contain EDTA to remove copper found in the algaecides present in the pool. Copper deposition is responsible for green tinge in lighter hued hairs. It doesn’t show in black hair but the copper is certainly deposited. Follow with a conditioner. Hope that helps!

QOM-May

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Dear Doc,

My 5 year old son has been scratching his head like crazy in the past few weeks. There are some bumps at the back of his scalp. It’s driving me nuts! The barber keeps scolding me for not using any oil for his dry scalp. Right now I’m using some Sulfur 8 shampoo but that is only somewhat helpful. I don’t know what else to do! Help!!!! Thankfully his brother is not affected.

Dry Scalper

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Dear Dry Scalper,

This is so commonplace it isn’t funny. It also pains me that your barber didn’t tell you that your son needs immediate treatment and shouldn’t return to him until treated. Seborrhoeic dermatitis or what people call “dry scalp” or “dandruff” is only seen in children and adults who have already undergone puberty. A special kind of infantile seb derm is seen in children under the age of one. Any pre-pubertal child who has “dry scalp” has scalp ringworm aka Tinea capitis until proven otherwise.

tinea capitis

photo obtained form quizlet.com

You need to carry your son to a GP or dermatologist. His scalp infection will only go away with oral medication that he will need to take for a month to six weeks. If improperly treated he will have permanent hair loss in the affected area. I have seen adult men who cannot grow their hair out because of improper treatment of their scalp fungus. It is not a pretty look.

You will have to wash his hair on a daily basis or as often as possible with an antifungal shampoo and use an antifungal cream on the area twice a day. This will cut down the spread of the condition to other children. He must not share any caps, hats, brushes, combs, towels, pillows and cases with anyone. Anything that he uses on his head must be washed on a weekly basis.

Do not carry him to a barber until his scalp is properly treated and he is clear of the fungus. For the future, look at the hygienic practices of any barber you take him to. A lot of times kids get it from other kids, their barbers or from any pets that they may have.

QOM- April

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Dear Doc,

I was diagnosed with Lichen Planopilaris over a year ago. I have been getting scalp injections with cortisone shots and taking my pills to stop it from spreading. So far it seems ok. Can I ever get a hair transplant in the future?

Distressed male

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Dear Distressed Male,

Lichen Planopilaris is a form of scarring alopecia which means that your body is attacking your hair follicle and replacing it with scar tissue. This disease can be seen only in the scalp or be associated with the form more predominant in the skin (Lichen Planus).

The problem with this disease is that there is no guarantee that it would ever go into remission or be “burnt out”. A hair transplant surgeon may only attempt to do restoration if your disease has been inactive for at least one year off of medication. However, there is no guarantee that the grafts will take. What is even worse is the possibility for the surgery itself to reactivate the disease. This is not uncommon.

I do hope that your disease can be controlled. This is quite a frustrating disease.

Question of the Month -March

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Hi Doc,

I have food allergies to wheat. I’m diligent with buying gluten free foods. Lately I’ve been noticing that my scalp has been burning/itching when I use products with wheat in them? Should I be avoiding these as well? Am I being ridiculous?

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Hi Gluten-Free,

Your world may be becoming a bit more complicated. There has been some evidence that persons with food allergies such as wheat, egg, or oat, are also allergic to the proteins in topical form i.e. skin product, hair product. These persons however had Atopic Eczema which is commonly seen with persons who have food allergies. You did not mention that you had Atopic eczema, but the possibility for you to become allergic topically to wheat proteins, is not improbable.

Even without these food allergies, there is a chance for regular persons, who do not have food allergies, to develop what we call a Contact Dermatitis (Eczema) to these proteins. Sadly, these hydrolysed wheat proteins are everywhere. They are popular as they have been found to help soothe irritated skin and helping to restore elasticity to the hair shaft.

So what will that mean for you?

You may have to try avoiding all hair and skin products with wheat proteins and see if that makes a difference. Ideally you should have what is called an allergy testing by an allergist or a dermatologist who has special interest in allergy testing.

References

Varjonen, E., Petman, L. and Mäkinen-Kiljunen, S. (2000), Immediate contact allergy from hydrolyzed wheat in a cosmetic cream. Allergy, 55: 294–296.

Varjonen, E., Vainio, E. and Kalimo, K. (2000), Antigliadin IgE – indicator of wheat allergy in atopic dermatitis. Allergy, 55: 386–391.

Mailhol, C., Lauwers-Cances, V., Rancé, F., Paul, C. and Giordano-Labadie, F. (2009), Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: a study in 641 children. Allergy, 64: 801–806