Common Hair and Scalp Diseases

Psoriasis of the Scalp
Psoriasis is an inflammatory, systemic skin disease characterized by red, scaly lesions that may involve portions of the body or nearly the entire body. A genetic predisposition is indicated by the number of psoriatic patients who have relatives with psoriasis. While the underlying cause of psoriasis is still unknown, considerable evidence points to dysfunction of the immune system as a cause or contributing factor.

While psoriatic lesions can appear anywhere on the body, the scalp is one of the most frequent sites. The scalp may be the first site affected in children and young adults, and in some persons it remains the only site affected.

Psoriasis has many levels of severity and many different clinical features ranging from shedding of grayish scales to pustular eruptions. Severe forms of psoriasis may be associated with other inflammatory conditions, especially psoriatic arthritis and inflammatory bowel disease.

Psoriasis of the scalp usually has a distinctive appearance of inflamed skin overlain with silvery scales. In severely progressive disease the psoriatic lesions may merge into a solid mass of scales over the entire scalp, with temporary or permanent hair loss. Psoriasis of the scalp and seborrheic dermatitis of the scalp have many features in common and may be confused unless properly diagnosed. Atopic dermatitis, an inflammatory, extremely pruritic skin disease, may also resemble psoriasis; scalp involvement in atopic dermatitis is more frequent in infants and children but does occur also in adults. Because treatment is different for each of these diseases, correct diagnosis is essential to appropriate treatment.

Scalp Psoriasis Involved eyebrow body Psoriasis Psoriatic nails

Seborrheic Dermatitis of the Scalp
Excessive oiliness of the skin is a feature of seborrheic dermatitis, but the condition is not a disorder of sebum production. The underlying cause of seborrheic dermatitis is unknown. It shares some features with psoriasis, and some investigators have proposed that seborrheic dermatitis and psoriasis may have some genetic predispositions in common. Other investigators have made a case for fungal infection being responsible for the major features of seborrheic dermatitis. Excessive skin oiliness may be a predisposing factor.

Seborrheic dermatitis is seen most frequently in infants up to 3 months old (when the condition is called "cradle cap"), and in adults over age 30-40, more commonly in men than in women. It is seen frequently in persons infected with the human immunodeficiency virus (HIV), indicating that immune system dysfunction is an underlying or contributing cause of seborrheic dermatitis. An immune dysfunction is also suggested by the frequency of secondary fungal and bacterial infections.

involved chest wall eyebrows and hairline naso-labial fold
Chest eyebrows and hairline labia-nasal fold

The symptoms and clinical features of seborrheic dermatitis of the scalp include:
  • Flaking of whitish to brownish scales from the scalp, the condition commonly called dandruff;
  • Greasy crusts on the scalp that become greasy yellow-to-brown scales when they fall off;
  • Inflamed, boggy patches underlying the crusts;
  • Extension of inflammation to the ears, eyelids, eyebrows, cheeks and nostrils; and,
  • Moderate to intense pruritus (itchiness) that may lead the patient to scratch vigorously, causing injury and additional inflammation, as well as openings for secondary infection.
Mild to moderate seborrheic dermatitis may be kept in check by frequent shampooing with over-the-counter anti-dandruff shampoos. More severe disease requires medical attention appropriate to the condition; seborrheic dermatitis and psoriasis of the scalp share many features and must be differentiated before treatment.

When a diagnosis of seborrheic dermatitis is confirmed, medical treatment may include topical corticosteroids to reduce inflammation, shampoos containing anti-inflammatory and anti-microbial ingredients, and topical or systemic antibiotics or anti-fungal agents to treat infection.

Lupus Erythematosus
Lupus erythematosus is also a disease of unknown, but probably autoimmune origin. Systemic lupus erythematosus (SLE) involves multiple organs and is progressively disabling. Discoid lupus erythematosus (DLE) is a form that involves only the skin; characteristic features are patchy skin inflammation, scaling of the skin, plugging of hair follicles, telangiectasia (rupture of small blood vessels just under the surface of the skin), Butterfly rash (melasma) and excessive skin dryness. DLE can result in scalp scarring and permanent hair loss. Neither form of lupus erythematous can be self-treated; all lupus patients should be under the care of a dermatologist or other physician with knowledge and experience of lupus symptoms and treatment.

telangiectasia Discoid lupus erythematosus (DLE) Butterfly rash (melasma) Patchy hair loss
Telangiectasia Discoid rash Malar rash Patchy hair loss

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