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Let your hair down

Many customers will be plagued by hair and scalp conditions at some point in their lifetime and pharmacy staff can be on hand to help them navigate these, sometimes embarrassing, problems.

Despite being one of the industries most affected by the Covid-19 pandemic, the haircare business is booming! In fact, the hair and beauty industry is set to grow by 16 per cent in 2023, according to research carried out by American Express Shop Small.

A new hairstyle can truly increase an individual’s confidence, but contrary to popular belief, it is not just the hairdressers where support is available. Pharmacy teams are a vital resource for those seeking support for scalp health and hair loss. Some conditions can be managed with pharmacy products, but staff also need to know when they should refer customers for medical advice. Understanding the symptoms, causes and treatments of these common conditions is therefore vital.

Scalp talk

An itchy and flaky scalp has many possible causes, including dermatitis, psoriasis and reactions to certain hair products. It’s important to look after the scalp, in the same way people look after their facial skin, with a regular cleansing and moisturising regime. This is where pharmacy teams come in, to recommend the right products to customers.

“The scalp needs to be balanced for hair to grow,” says Eva Proudman FIT IAT, consultant trichologist. “It is made from skin, just like the rest of the body. Washing the scalp every day, or occasionally every two days, will keep the scalp in balance, while brushing the hair will only remove dirt and debris. Hair is at its weakest when it’s wet. Using a comb or brush with wide teeth or bristles, rather than one with bristles close together, causes less friction and breakage.”

Scratching the itch

Many different types of dermatitis can affect the scalp, causing dryness, itching, scaling and inflammation. During a flare-up, the scalp may also be weepy and sore. Seborrheic dermatitis is the most common type of dermatitis affecting the scalp, but other types can also cause troublesome symptoms.

Atopic eczema may make the scalp very itchy. If the scalp is scratched, this can break the skin and lead to an infection. Allergic contact dermatitis may be triggered by repeated exposure to a chemical in contact with the skin. Triggers include everyday hair products (such as shampoo, hairspray or hair dye), hair coverings or accessories, such as a swimming cap, hair clip or hat. The allergic reaction may lead to inflammation on the scalp, with burning, swelling or tenderness. Irritant contact dermatitis causes similar symptoms but is not an allergic reaction. It occurs when a particular substance irritates the skin’s surface.

“Hair dye is a common trigger of both allergic and irritant contact dermatitis,” says Eva. “Sometimes perfume in shampoos and conditioners, or even oils, can irritate the scalp as well. Irritant contact dermatitis tends to present fairly quickly, causing a prickling sensation on the scalp, whereas allergic reactions may take longer to develop.”

With any form of eczema, the skin needs to be kept well-moisturised with an emollient lotion, gel or spray. But this can be more difficult with scalp skin when it is covered by hair, especially long or thick hair. The key is to part the hair to reach the scalp and massage emollients directly into the skin. Many people prefer to moisturise their scalp in the evening and then rinse the emollient out in the morning. If the scalp is very scaly, a salicylic acid and tar-based ointment may be effective. However, these products can be messy to apply.

Normal shampoos and conditioners containing detergents and fragrances may worsen an irritated scalp. Some people wash their hair in an emollient, but these can leave hair looking greasy. Medicated shampoos for scalp conditions may help but these need to be washed off thoroughly to prevent irritation. It’s important to steer clear of anything that dries out the scalp and hairdryers should be used on a cool setting, as hot air increases dryness and itching.

Diet and hair

What people eat, and drink, can affect the health of the hair and scalp. Stephanie Sey, expert trichologist for Nizoral, recommends eating a balanced diet comprising of carbohydrates, healthy fats, proteins, fibre, vitamins, and minerals. “Eating a diet that is rich in fresh vegetables, meat and fruit supports healthy growth for thick, full hair,” she says. “Supplements are only required when the body doesn’t get the necessary nutrients from their diet, or they have a specific deficiency such as for iron or vitamin D. Vitamins B1, B7, and B2 are also great to help with the maintenance of healthy skin and hair.”

Eva Proudman FIT IAT, consultant trichologist, stresses the importance of an overall healthy lifestyle. “Aim for low stress, good sleep and a healthy diet,” she says. “Hair is around 10 per cent water and needs good hydration. If someone has a hair problem, a trichologist will often do blood tests to check their nutrient levels and tailor any dietary changes or supplements to suit them. The over-the-counter supplements for scalp and hair health often have many active ingredients crammed into them, which means there’s a bit of everything but it’s not a targeted approach.”

Wake and flake

Dandruff (an itchy, flaky scalp) occurs when the scalp sheds dead skin cells. This has many causes, including seborrheic dermatitis, psoriasis, eczema and ringworm. In most people, mild dandruff can be managed with pharmacy products.

“Customers are sometimes in desperate need of a fast, effective product recommendation,” says Stephanie Sey, expert trichologist for Nizoral. “This is due to symptoms being typically ‘embarrassing’ and the preconception that if someone has dandruff, it means they’re dirty or unkept. Aside from the physical and mental impact, dandruff can also cause the scalp to itch, the skin to flake, and as a result scalps can become sensitive and sometimes sore.”

As a first step, customers should use an anti-dandruff shampoo, containing either zinc pyrithione, salicylic acid, selenium sulphide, ketoconazole or coal tar. “Dandruff doesn’t always itch and there may be no inflammation,” says Eva. “It can be due to a build-up of product residue on the scalp falling as flakes. This may be managed with anti-dandruff ingredients such as salicylic acid or astringents, rather than anti-fungal products.”

It’s important to try different anti-dandruff products to see what works best. If a customer’s symptoms are very troublesome, persist after a month or have spread to other parts of their body, they should speak to their GP.

Grease is the word

Seborrheic dermatitis is particularly common on the scalp, face and chest. It affects around four in every 100 adults and is more common in men than women. In babies, a similar condition is known as ‘cradle cap’. The symptoms in adults vary from person to person, but the scalp is often greasy and scaly, with yellow-brown flakes that may be confused with dandruff. Seborrheic dermatitis may also trigger a red rash around the eyebrows, eyelids and sides of the nose.

Seborrheic dermatitis is an inflammatory overreaction to Malassezia yeasts that live naturally on the scalp. Why some people develop the condition, yet others don’t, remains unclear, although people with immune system problems (e.g. HIV) or Parkinson’s disease may be more prone.

“Seborrheic dermatitis is an imbalance of natural yeast,” says Eva. “The weather is a big factor in flare ups, especially in the autumn and winter, when it’s dry and warm inside but cold and damp outside. Too much spicy food, seafood, chocolate and wine may also make it worse.”

The condition should be treated with anti-fungal shampoos or shampoos containing selenium sulphide or zinc pyrithione. “To get on top of seborrheic dermatitis, it’s important to wash the hair daily initially to soften the flakes and remove the itching and inflammation,” adds Eva. “Ketoconazole may make the scalp dry and the hair dull, and some people find that piroctone olamine is better tolerated.”

It’s important to read the product instructions carefully. Ketoconazole shampoos should be massaged into the scalp, left on for two or three minutes and then rinsed off. Tar-based shampoos may also help the symptoms. Once these clear up, anti-fungal shampoos should be used once a week as an ongoing preventative measure. If the symptoms aren’t clearing up, customers should speak to their GP. Inflamed skin may need to be treated with a topical corticosteroid or other prescribed medicines.

Scaling up

Around 80 per cent of people with psoriasis have scalp psoriasis, often around their hairline, on their forehead and behind their ears. The scalp may feel itchy and tight, with thick scales and dandruff-like flakes. “In scalp psoriasis, skin cells are produced at five times the rate they should do, leading to the formation of raised psoriatic plaques,” says Eva. “This can be very itchy and may lead to bleeding if people are scratching their scalp.”

Some shampoos for scalp psoriasis (e.g., coal tar) can be bought over the pharmacy counter, but customers should be encouraged to speak to their GP as they may need stronger prescribed treatments as well. Some treatments need to be left on the scalp for a certain period of time and then rinsed out, while others may need to be left on the scalp. It’s important to make sure the treatments are reaching the scalp skin rather than simply being left on the hair. It can take a few weeks, or even months, for some of the treatments to work fully.

“A GP will often prescribe steroid lotions to thin the psoriatic plaques,” says Eva. “A trichologist will often use a combination of cade oil and salicylic acid to soften the plaques without causing bleeding. Some people with scalp psoriasis find that by using the trichologist’s product regularly, they can then use the steroid lotion from their GP more sparingly. But it’s important to follow the professional advice they’ve been given.”

Combing or brushing the hair may help to remove any loose scales but it’s important not to scratch the already-sensitive scalp as this could lead to an infection. “People shouldn’t use anything aggressive or sharp or potentially irritating on scalp psoriasis,” says Eva.

Using oil to soften the scalp may make scaling easier to remove. Pharmacy staff should advise customers with scalp psoriasis that they may be able to use hair treatments (including perms and dyes), but that it’s important to do a patch test first – and not use these if the scalp skin is broken.

The hair necessities

The word ‘alopecia’ means hair loss. There are many different types of alopecia; these may be caused by an underlying medical condition or may have no identifiable cause. Alopecia areata is thought to be an autoimmune condition, and many other forms of hair loss seem to be due to inflammation around the hair follicles.

Alopecia is more than just a cosmetic problem. It can cause physical symptoms, such as itching and irritation. It can also have a psychological and emotional impact and trigger complications such as problems with regulating body temperature and increased sensitivity to light and sunlight. If someone has any hair loss, they should speak to their GP, who may refer them to a dermatologist or recommend a trichologist.

This is a common form of hair loss and may also be called androgenetic alopecia. It can affect people of any age but is more common in men over 50 and women over 65. Pattern hair loss is thought to be caused by a mixture of genetic and hormonal factors. The affected hair follicles produce hairs that progressively become smaller in diameter, shorter in length and lighter in colour. Eventually they stop producing hair completely.

In men, the typical pattern of hair loss is a receding hairline with loss of hair from the top and front of the head. Women tend to notice thinning at the crown of their head and don’t usually experience total baldness.

There’s no cure for androgenetic alopecia, but the hair loss may be slowed down with certain treatments. Oral finasteride and/or topical minoxidil solution or foam may reduce hair loss in men, while topical minoxidil solution or foam may improve the hair loss in women.

Hirsutism affects around five to 10 per cent of women and is more common in those of Mediterranean or Middle Eastern descent. It causes excessive growth of thick and coarse hair on the body – often, the upper lip, chin, central chest, lower back and thighs. The excessive hair growth is usually due to increased androgen (male hormone) production, increased skin sensitivity to androgens, or both. It’s more common for women to grow extra facial or body hair as they get older, especially after the menopause. In premenopausal women, the most common cause is polycystic ovary syndrome (PCOS).

Some women use hair reduction and hair removal methods (e.g., shaving, depilatories or waxing) to remove excess hair, or they may try physical treatments (e.g. electrolysis or laser). Depending on the underlying cause, a doctor may prescribe medicines such as elfornithine cream to slow down the growth of unwanted hair.

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