Flaky scalp can mean a lot of things
In my clinic, one of the most common dermatological complaints I often encounter is a scaly erythematous (reddish) patch on the scalp, which sometimes can involve the entire body. This rash can be very irritating, especially when it occurs on the facial area as it can cause a lot of embarrassment and lower self-esteem.
It often emerges during a specially chaotic time in one’s life, when it manifests as a stubborn, flaky rash that will set up camp around one’s eyebrows, sides of the nose and the back of one’s ears. Sometimes, one may just dismiss it as a simple case of dry skin, like the case of Adrian who vacationed in Canada for two months and was experiencing its harsh winters for the first time.
Adrian tried to slather it with Vaseline and Aquaphor, only to have the irritation spread to his scalp, chin, and underarms. So when he arrived in the Philippines, his top priority on his itinerary was to visit me.
Seborrheic Dermatitis (SD) and dandruff are common dermatological problems that affect the seborrheic areas (upper back/chest, face/forehead, navel, under the breasts, groin etc.) of the body. They are considered the same basic condition, sharing many features and responding to similar treatments, differing only in locality and severity.
Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD affects the scalp as well as face, retro-auricular area, and the upper chest, causing flaking, scaling, inflammation and pruritus, and can have marked erythema. Flaking in SD and dandruff is usually white-to-yellowish and may be oily or dry.
SD is a common dermatological disorder in the United States and worldwide. Its incidence peaks during three age periods—in the first three months of life, during puberty, and in adulthood with an apex at 40 to 60 years of age.
In infants up to three months of age, SD involves the scalp (termed “cradle cap”), the face, and diaper area. Incidence can be up to 42%. In adolescents and adults, SD affects the scalp and other seborrheic areas on the face, upper chest, axillae, and inguinal folds. Incidence is one to three percent of the general adult population. Men are affected more frequently than women (3.0% vs. 2.6%) in all age groups, suggesting that SD may be associated with sex hormones such as androgens.
SD is more prevalent in immune-compromised patients such as HIV/AIDS patients, organ transplant recipients, and patients with lymphoma or any other kind of cancer. The incidence among HIV patients ranges from 30% to 83%. Most cases of SD in HIV patients are diagnosed with CD4+ T lymphocyte counts between 200 and 500/mm3, and decreased CD4+ counts are often associated with worse SD. Fewer cases of SD were reported when CD4+ T cells were more than 500/mm3. These observations suggest that immunological defects may play a role in SD.
SD is also associated with neurological disorders and psychiatric diseases, including Parkinson’s disease, neuroleptic-induced parkinsonism, tardive dyskinesia, traumatic brain injury, epilepsy, facial nerve palsy, spinal cord injury and mood depression, chronic alcoholic pancreatitis, hepatitis C virus, and is prevalent in patients with congenital disorders such as Down syndrome. Furthermore, seborrhea-like dermatitis of the face may also develop in patients treated for psoriasis with psoralen and ultraviolet A (PUVA) therapy.
Compared with SD, dandruff is much more common, and affects approximately 50% of the general adult population worldwide. It is also more prevalent in males than females. Dandruff starts at puberty, reaches peak incidence and severity at the age of about 20 years, and becomes less prevalent among people over 50. Incidence varies between different ethnic groups: In a study in the US and China, dandruff prevalence was 81–95% in African-Americans, 66–82% in Caucasians, and 30–42% in Chinese.
It is important to know that skin with SD is easily irritated. Here are some suggestions on what to do if you have SD:
1. Be gentle when washing your skin. Avoid deodorant soaps and skincare products that contain fragrances. Rinse thoroughly.
2. Use alcohol-free skin and hair care products.
3. Reduce stress.
4. Protect skin from cold, dry weather. To reduce flares, dress for the weather. This includes wearing a hat when outdoors.
5. Learn (and avoid) what triggers your flare-ups.
- Stress
- Cold, dry weather
- Taking hot showers and baths, especially during cold, dry weather. Hot water can dry your skin and scalp.
- Using harsh detergents, strong soap, solvent, chemical on your scalp and skin
- Becoming sweaty. Sweat cools your body. In doing so, it also dries out your skin. The salt from sweat can also trigger a flare.
- Being around harsh chemicals. The fumes from drying paint, new carpeting, and cleaning products trigger a flare in some people.
- Developing an infection, proliferation of the fungus Malassezia species
- Smoking, alcohol, spicy foods, caffeine, foods made by yeasts or fungi.
6. Avoid Western diet (cheese, excessive carbohydrates like doughnuts, muffins, bread products).
7. Wear loose-fitting, soft cotton clothing.
8. If you use hair spray, styling products, hair gel, pomade, apply sparingly.
9. Protect your skin with sunscreen that contains zinc oxide or titanium oxide – heat and sun can also trigger it.
10. Treat a flare-up as soon as it starts.
11. In extremely severe cases, consult a board-certified dermatologist.
12. Avoid drugs that trigger SD such as: Dopamine antagonist, immunosuppressants, psoralen and psoralen plus ultraviolet A Lithium, Haloperidol, Griseofulvin, Fluorouracil
13. Do not abuse steroid use.
14. Check for presence of other triggers: Autonomic Dysfunction, dementia, major depression, stroke, Hyperandrogenism (hormonal imbalance) etc.