Solutions to hair and scalp problems

Alopecia, dandruff and itchy scalps are serious problems that can affect us all and make life a misery. We've spoken to leading trichologist (a specialist of hair problems) Iain Sallis to get his expert advice on how these nasty issues can be treated.

Hair and scalp problems

What are some of the most common issues people come to you for?

Eight per cent of the people who come into my clinic are women, and the most common issue I see is a general diffuse shedding of the hair throughout the scalp. This is a very misdiagnosed and misunderstood problem which is compounded by doctors not understanding the psychological severity of general thinning hair to a woman (it's like losing their femininity!).

Hair thinning is usually a side effect of an underlying undiagnosed medical problem. The worst thing a person can do in that situation is try an over-the-counter 'hair loss' remedy, as it will just prolong the situation. See a professional who knows what they are talking about instead.

What is alopecia caused by and what treatment options are available?

Alopecia simply means hair loss (it comes from the ancient Greek for 'fox' - aloplex - as the Greeks thought that we shed our coats like foxes did at the end of winter). Alopecia areata is one of the most common hair loss disorders and it is an autoimmune disorder. This means that the body’s own defense system is attacking the hair follicles, and this makes it very difficult to treat because it is not an 'illness' per se. Fortunately, more often than not, the hair comes back of its own accord.

Sometimes medication can help, and treatments can be prescribed by a GP for alopecia, like a topical steroid lotion. If this does not work, intra-lesional steroid therapy (steroid injections) into the scalp can be quite effective.

What is scalp psoriasis?

Scalp psoriasis is usually characterised by thick, silvery white scale on patches of very red skin, though it can take on many forms and be a very confusing disorder! It is caused by the immune system, which affects the rate of our skin turnover. Skin sheds approximately every 24 days, and this means the bottom layer of the skin takes 24 days to get to the top.

In psoriasis suffers, this is reduced to about 12 days, which leaves the skin 'open' in a microscopic way, and this leads to the reddening and soreness. The increased turnover itself causes the scales and thickening of the skin. Psoriasis is a very common problem. About 2% of the entire population are affected, of all ages and both sexes. There is a genetic tendency to suffer from psoriasis, so it also tends to run in families. But it’s also influenced by many environmental factors. It is definitely not contagious though, and is not due to an allergy.

What treatment options are available for psorisasis?

As with most scaling conditions there is no cure, but there are many controlling methods that can be employed with great effectiveness. This usually means a 'lifestyle' change as much as a trip to the doctors. Sufferers can benefit from a diet with reduced sugar and dairy, and in some cases, supplements of Omegas 3, 6 and 9 have been relatively effective in helping with the symptoms.

Coal tar shampoos used regularly are the most effective control method for scalp psoriasis. This can be used along with a steroid lotion for any severe inflammation.

What treatment options are available to people who are worried about balding (women in particular) and how should they go about getting medical attention?

Hair loss is distressing and upsetting, especially for women, and up to 1 in 3 women will suffer from some form of hair loss in their life. it can have a devastating effect on the sufferer. Diffuse hair loss is very common; usually women initially notice their hair becoming fine and fly away before any one actually sees the difference. This can be the start of chronic thinning, and can be many result of many factors - diet, medication, illness and even severe stress can all have an effect on the hair cycle and lead to thinning hair.

Genetic thinning comes under this banner too. Just as men suffer from 'male pattern baldness' there is a female version too, and it affects just as many women as it does men, the key difference being the type of 'pattern' it takes and that it is more likely to happen after menopause.

Most hair loss problems can helped, but only if the underlying problem is identified and treated by someone who knows what they are doing, and not by using off the shelf remedies or weekly treatments such as laser.

What is the worst thing someone with thinning hair can do to themselves?

Most hair loss problems are progressive if they are not diagnosed and rectified; so the worst thing a person can do is ignore the problem and think it will go away by itself. Also, taking the over-the-counter hair supplements are near to useless for most hair loss disorders.

Blood tests are almost always required to correctly diagnose the problem, so beware of people who call themselves hair experts and offer to treat your problem with laser or high frequency machines. They never ,because they never get to the 'root' of the problem.

Dandruff is a common irritant many people face. What causes it?

A very common and confusing problem, dandruff is not caused by dry skin, reactions to products, or not rinsing properly. It is simply that our skin reacts to an excessive yeast proliferation by shedding more quickly than it should, so a greater number of dead cells are sloughing off the skin. These clump together to cause the flakes we call ‘dandruff’.

How can you treat dandruff?

Dandruff can easily be controlled by an anti-dandruff shampoo (amazingly enough!). A simple off-the-shelf product with a mild anti-fungal ingredient that controls the over-production of the yeast should help solve the problem.

If, after using an anti-dandruff shampoo, you still find you are having a flaky scalp, then you’re not dealing with dandruff and you probably have seborrhoeic dermatitis that requires a stronger type of medicated shampoo.

Itchy scalp is another common, every day problem. What are some of the causes of this?

Itchy scalps can be for a number of reasons. The most common is called Seborrhoeic Dermatitis and is the ‘big brother’ of dandruff (caused by the same yeast, but a more severe reaction). Other problems may include eczema, dermatitis, low vitamin levels, diabetes, thyroid disorders and of course head lice!

How can you treat an itchy scalp?

The treatments are varied, but the scalp can be soothed by the use of a coal tar shampoo. Further investigation may be needed to get to the underlying problem though, as it may be part of a bigger issue.

What supermarket or affordable hair products do you recommend for maintaining healthy hair and scalp, or what ingredients in hair products should be avoided?

Most of the hoo-hah about hair products is marketing speak. Hair products do vary in quality, but there is nothing particular that you should avoid - there's no such thing as an evil shampoo! The only time I would suggest looking at a specific product is either if you are sensitive to a particular ingredient (usually either the perfume or preservative). Then obviously use a shampoo for sensitive skin.

For a very itchy or flaky scalp, you would need to use a more medicated shampoo. Do not fall into the trap of thinking that the irritation is due to harsh ingredients and start using baby shampoo. Shampoos and conditioners are quite inert products and do not usually react with the scalp.