Scalp Health

Scalp health depends on barrier integrity, sebum composition and the balance of the resident microbiome, particularly Malassezia yeasts. Dandruff and seborrhoeic dermatitis sit on the same spectrum and respond to antifungal shampoos rather than to moisturising. Psoriasis, lichen planopilaris and scarring alopecias look superficially similar but need dermatological diagnosis — scarring hair loss is irreversible if treated late, which makes persistent scalp pain, burning or visible follicle loss a referral trigger.

1) Use a medicated shampoo — ketoconazole 2%, zinc pyrithione or selenium sulphide — two to three times weekly, leaving it on for several minutes. 2) Rotate active ingredients every few months to limit yeast tolerance. 3) Wash regularly; under-washing lets sebum and yeast accumulate, and infrequent washing is a common self-inflicted cause. 4) Rinse thoroughly and avoid heavy silicone or oil products that occlude the scalp. 5) Correct low ferritin, zinc or vitamin D, all associated with scalp and hair complaints. 6) Manage stress, which reliably triggers seborrhoeic flares. 7) Avoid very hot water and harsh sulphate detergents that strip the barrier. 8) See a dermatologist for scarring, pain, or scale that does not respond within 8 weeks.

• •Regular washing with medicated shampoo
• •Rotating active ingredients
• •Avoiding occlusive styling products
• •Stress management
• •Correcting iron and vitamin D deficiency
• •Avoiding very hot water