Dandruff

Written by Kristina Collins, M.D., FAAD

If you have ever noticed white flakes in your hair or dry patches on your scalp, you are probably experiencing dandruff. Those flakes may even fall onto your clothes or cause a terrible itch on your scalp. While they can definitely be annoying and sometimes embarrassing, they are extremely common. The medical name for dandruff is seborrheic dermatitis and when it occurs in a more severe form, with thicker plaques on the scalp, it can be called sebopsoriasis. When hormones start ramping up during puberty, oil production increases on the skin, including the scalp, and this increased oil production, as well as overgrowth of a certain form of yeast called malassezia, can lead to dandruff. Stress, dry/cold weather, and infrequent hair washing can make the problem worse. Remember, dandruff is not contagious and affects almost everyone at some point.

If you are experiencing dandruff, don’t worry! There are several things you can do at home to control dandruff and get rid of the flakes.

  • First, increase the frequency that you wash your hair. If you have straight hair, start washing every day, and if you have very curly hair consider increasing your wash to twice per week.
  • You can use over-the-counter anti-dandruff shampoos as an initial step. Best results may occur if you alternate with two different types of anti-dandruff shampoos. The main “active ingredients” you will find in these medicated shampoos include selenium sulfide 1%, zinc pyrithione, tar, salicylic acid, or ketoconazole. It can work really well to pick out two different shampoos with different active ingredients and alternate them. Other EWG verified shampoo products that can also help with itchy and dry scalps include those from Acure and Ethique.
  • Apply the dandruff shampoo and work it into the scalp only. As you rinse your hair, gravity will clean the rest of your hair.
  • Rinse with lukewarm water that is not too hot.
  • Towel dry or blow-dry your hair on the cool setting using a light, gentle touch.

Once your dandruff resolves you can stop using the anti-dandruff shampoo or just use it intermittently to keep the flakes at bay. If your dandruff does not improve after a couple of weeks, you may need to see a dermatologist for prescription-strength solutions. Sometimes similar flakes can occur in the eyebrows, beard area, behind the ears, or around the nose — this is also called seborrheic dermatitis. If this occurs you can first try to use your anti-dandruff shampoo as a wash on the affected areas of skin.

Alopecia

Written by Kristina Collins, M.D., FAAD

Alopecia is the medical term for hair loss, and although you may think of hair loss as only affecting older people, there are some types of hair loss that can occur in your adolescent years or even younger.

Alopecia areata

In this type of hair loss, inflammation in the skin of the scalp surrounding the hair follicles causes patches of complete hair loss. These are often small circular areas but can become larger or even affect the entire scalp. When alopecia areata occurs, a visit to the dermatologist will be necessary to obtain prescription medication or possibly have injections of steroids into the scalp. Fortunately, this type of alopecia usually resolves with treatment and without leaving a scar.

Traction alopecia

Repetitive use of certain types of tight hairstyles, such as braids and ponytails can cause hair loss in the areas in which the scalp is pulled the tightest. The same type of hair loss can happen in areas of pressure due to certain types of hats or helmets. It is really important to relieve the traction on these areas if you notice this occurring because this type of hair loss can actually scar the scalp. This can be a common condition in Black girls and women due to high heat, chemicals, and tight hairstyles that pull at the hair root (i.e., weaves, braids, dreadlocks, and hair extensions).

Other Concerns

Written by Kristina Collins, M.D., FAAD

Telogen effluvium

This is a widespread thinning of the hair that does not leave discrete patches of hair loss. It commonly occurs about three months after a major stressor, like a medical illness or stressful life event. Some people have experienced telogen effluvium after an infection with coronavirus and this problem has become more common overall with the stress of the current pandemic. Luckily, this type of hair loss resolves on its own after several months. If you do notice excessive thinning of the hair, you may want to see your doctor to rule out any concerning problems like nutritional deficiency, anemia, or thyroid imbalance. Assuming you are healthy and eating a well-balanced diet, the best thing you can do is take good care of your hair, avoid damaging styling methods, and focus on overall wellness. Some people find topical minoxidil helpful in encouraging hair to reenter the growth phase but keep in mind that its use is not FDA approved for those under the age of 18. Consult a doctor prior to use.

Ringworm of the scalp (tinea capitis)

A fungal infection can occur on the scalp which can lead to a ring-shaped area of redness, flaking, and inflammation with hair loss. You will want to see a doctor if this is occurring as you will likely need a prescription to get rid of the fungus.

Trichotillomania

People with trichotillomania have an uncontrollable urge to pull out hairs from their scalp, eyebrows, or eyelashes. If you are affected by this condition, therapy and behavioral modification techniques can help you overcome it.

Pilar cyst

Sometimes a large “bump” can occur on the scalp, and as it grows larger, some hair loss can occur over the top of it. These large bumps are called pilar cysts and some people may be more likely to get them because of genes they inherited from their biological parents. These are not dangerous but you may need to see a dermatologist for removal if they grow too large and become noticeable or affect your hair growth.

Folliculitis

Sometimes, due to sweat or bacteria overgrowth, pus-filled bumps can occur on the scalp or other areas of your body with hair. If you notice acne-like bumps on your scalp, you may want to make sure to rinse your hair out after getting sweaty from sports or exercise and also use shampoo with salicylic acid in it.