scalp and hair conditions

Introduction

being highly exposed to the environment, the scalp and hair are common sources of issues, in particular, dandruff from dry flaky skin such as by atopic eczema, seborrheic dermatitis, psoriasis (scaly, silvery, sharply defined skin patches), scalp folliculitis, allergic contact dermatitis (eg. reaction to hair products (dyes, shampoos), causing severe itching and inflammation)
the nuchal area is a common site for seborrhoeic cysts which may become infected
tinea capitis (ringworm) is a contagious fungal infection causing bald spots, broken hairs, and scaly, painful rashes.
swimming is a major issue for many as it can cause a range of issues (see below)
head lice is an issue in school children
scabies rarely involves the scalp unless patient is immunocompromised or vulnerable such as with Norwegian scabies
solar kerotoses and skin cancers are relatively common on the scalp and tops of ears in the elderly in particular
in addition, alopecia or other hair problems are an issue for many - these can represent endocrine issues such as thyroiditis
less commonly, conditions such as:
- lichen planus - itchy, purplish-colored lesions or bumps with flat tops appear that may be covered by thin, white lines
- scleroderma - skin thickening and shiny areas
- graft-versus-host disease after organ transplantation - sunburn-like, itchy, painful rash appears that can cover up to 50% of the body
- lupus
- Netherton’s syndrome causes hair strands with brittle, dry, knotty appearance “bamboo hair”

wet hair is more easily damaged as the outer layers swell and lift as they absorb water and become more like shingles on a roof
salt water further impacts hair as the salt draws out moisture from hair making it more brittle as well as from skin which also increases issues with dry skin / atopic eczema
chlorinated water can also draw moisture from hair and skin as for salt water but can also bleach the hair especially if it has been dyed which can result in a muddy stringy look (or a difficult to counteract green tinge due to copper in the pool water) and may have an even greater drying effect on scalp skin than salt water impacting the scalp moisture barrier which may result in dry, flaky, itchy scalp especially in those with atopic eczema
this damage can be further exacerbated by UV light from the sun
keeping your hair wet, especially thick hair, for a prolonged period as the prolonged warm humid environment favors yeast growth which exacerbates seborrheic dermatitis
swimming can also lead to painful otitis externa
prolonged and frequent exposure to cold water such as regular surfing in Bass Strait waters can also cause bony growths in the ear canals (“surfer's ear” or external auditory canal exostoses) which can impact ear canal drainage, further increase risk of otitis externa and hearing loss

rinse hair with fresh tap water before and after swimming
- rinsing beforehand will allow the hair to swell with fresh water which means less absorption of pool or salt water
  - consider combining this with a “leave-in” conditioner type product
plait hair and wear a well fitted swimming cap or consider tying hair into a bun to minimise contact with long hair
wear a hat to reduce UV exposure (better than hair products with UV protection)
after swimming:
- rinsing afterwards obviously reduces the contact time of pool chemicals or salt
- clean scalp and hair from salt and chemicals with a good moisturing shampoo
- do not leave hair wet for prolonged periods but avoid heat styling as heat will further dry out and damage hair - if you must, use a gentle heat to dry the hair
once or twice a week consider a oil-based conditioner treatment - coconut oil (or argan oil for those with thin hair)