Scalp conditions

This chapter covers the common scalp conditions that pharmacists are likely to encounter dandruff (pityriasis capitis), seborrhoeic dermatitis, cradle cap, scalp psoriasis and scalp ringworm (tinea capitis). Head lice, another common scalp problem, is covered in Chapter 17. 

---

Medicated Dandruff Shampoos. Dandmff is a scalp condition characterized by the production of excessive cellular material (18). A number of shampoos have been marketed which are designed to control and alleviate this condition, and many additives have been included in shampoo compositions to classify them as treatment products for dandmff. These additives include antimicrobial additives, eg, quaternary ammonium salts keratolytic agents, eg, saUcychc acid and sulfur heavy metals, eg, cadmium sulfide coal tar resorcinol and many others. More recent (ca 1993) systems use selenium sulfide [7488-56-4] or zinc pyrithione [13463-41 -7] as active antidandmff shampoo additives. Both of these additives are classified as dmgs, but can be found in over-the-counter products. A stronger version, incorporating the use of higher levels of selenium sulfide in a shampoo, is available but requires a prescription for purchase. 

Squamometry X is particularly gratifying in the assessment of both dandruff severity and efficacy of its treatment.6,7,14,33,34,37,38,42 Similarly, seborrheic dermatitis can be evaluated noninvasively.40,41 In these related scalp conditions, some correlation can be established between SQMI and the load in Malassezia spp.33,37,38,40,41,60... 

For which one of the following scalp conditions is there no non-prescription treatment available ... 

Nicolaides and Rothman [134] have shown with small sample sizes that hair from blacks contains more lipid than hair from Caucasians. Gershbein and O Neill [142] examined the distribution of fatty alcohols of human hair lipid to determine the relative amounts of fatty alcohols and sterols with regard to sex, race, and scalp condition. Samples originated from Caucasians and blacks, both full head and balding, and from Caucasian women. The data indicated essentially no differences among these parameters between the two racial groups or between the sexes. 

Skin Tufted hair folliculitis, an inflammatory scalp condition causing scaling and pruritus, has been reported in a woman being given trastuzumab [174 ]. 

The process of pulverized cuUet reduction yields a product having near-batch equivalent sizing (—12 mesh (<1.7 mm mm)) and in a furnace-ready condition. Foil-backed paper, lead and other metals, and some tableware ceramics can be removed in an oversized scalping operation after the first pass through the system. Other contaminants are reduced to a fine particle size that can be assimilated into the glass composition during melting. 

Elder flower infusion can simply be poured over the hair and scalp after a shampoo to brighten fair hair and condition dry hair. To make an antidandruff hair rinse, boil a quarter of water, remove from heat and add 4 handfuls elder blossoms. Allow to steep 1 hour. Strain and add 1 quart of apple cider vinegar. Bottle and store in refrigerator. After shampooing, leave on as a final rinse. 

Seborrheic dermatitis typically occurs around the areas of skin rich in sebaceous follicles (e.g., the face, ears, scalp, and upper trunk). In infants with involvement ofthe scalp, the condition is commonly referred to as cradle cap. Diaper dermatitis results in erythematous patches, skin erosions, vesicles, and ulcerations. Although commonly seen in infants, it can occur in adults who wear diapers for incontinence. 

Cradle cap is a form of seborrhoeic dermatitis of the scalp affecting babies aged 1-3 months. The condition is not contagious and can be treated by rubbing baby oil into the scalp, leaving it overnight and shampooing afterwards. 

C may be treated initially with corticosteroid scalp application D is a lifelong condition E is a form of food allergy... 

Trichotillomania, listed in the DSM-IV under Impulse Control Disorders Not Elsewhere Classified ( 252), is characterized by impulses to pull out one s hair, often involving multiple sites (scalp, eyebrows, and eyelashes commonly pubic, axillary, chest, and rectal areas less commonly) ( 253). Some clinicians have proposed that this condition is a variant of OCD, based on similarities in phenomenology, family history, and response to treatment. Originally thought to occur more frequently in females, it has become evident that it may affect males just as often. Many victims of this disorder have histories beginning in childhood and refractoriness to all attempted remedies. Co-morbidity of trichotillomania with mood, anxiety, substance abuse, and eating disorders is also common (254). Others have noted that trichotillomania may also coexist with mental retardation and psychotic disorders (see Appendix Q). 

Antiviral Efficacy and Clinical Use. Imiquimod (Aldara) is applied topically to treat condylomata acuminate infections that cause genital and perianal warts.42 It can also be used to treat certain skin conditions such as actinic keratoses of the face and scalp. 

Hair dyes must meet a number of conditions related to their end use. Color can be assessed by colorimetry [49], The limits of precision are set by the substrate on which the measurement is performed. Studies on test subjects are difficult because of the uneven natural hair color and the background color of the scalp. Tresses are hard to prepare at a constant quality level. Measurements on wool cloth give reproducible results, but for oxidation dyes the shades are not identical to those produced on hair. Colorimetric methods are therefore useful only for comparative measurements on the same object, for example, in lightfastness tests. Because hair must be redyed after four to six weeks due to growth, the fastness required of hair dyes is generally less than that needed for textiles. However, stability is still a problem with many indo dyes (see Section 5.4.3). Some of them... 

This appears as areas of reddened and flaky skin and can be a lifelong condition although it tends to flare up in the teens and twenties and then again in old age. About 1 person in 50 suffers from psoriasis at some time in their life. Why it occurs is still not understood. Psoriasis is caused by over-reactive skin cells in the lower layer of the epidermis dividing 20 times faster than normal. A normal skin cell takes around 4 weeks to mature and reach the surface of the skin, there to be shed. Psoriatic cells go through this process in only two days and they accumulate at the surface as a layer of dead skin. Skin affected by psoriasis has a thickened epidermis with an excessive growth of blood vessels, and there are clusters of immune cells. Plaque psoriasis is the most common and occurs on the knees, elbows, lower back, and scalp. 

Topical corticosteroids are usually given in combination with other topical treatments for the treatment of chronic plaque psoriasis. Sensitive areas, such as the face, should be treated with a mild corticosteroid and other areas, such as the scalp, with moderate to potent corticosteroids. In general, use should be maintained as early improvements in the condition are not maintained if use is halted. Such a pattern of use may worsen the condition, possibly causing a deterioration of the condition to unstable forms, such as erythrodermic or pustular psoriasis. Co-administration of topical medicaments usually involves alternating administration of each product. Scalp psoriasis is normally treated with softening emollients in combination with salicylic acid with coal tar or sulphur. 

The EFAs LA and ALA are present in human diet in abundant amounts, and, hence, EFA deficiency is uncommon. In certain specific conditions, such as total parentaral nutrition (TPN) and severe malabsorption, occasionally EFA deficiency could be seen. The current TPN solutions contain adequate amounts of EFAs. The manifestations of an EFA deficiency include dry and scaly skin, hepatospleenomegaly, immunodeficiency, inappropriate water loss through the skin, dehydration, scalp dermatitis, alopecia, and depigmentation of hair (9, 10). EFAs are distributed widely in normal human diet. The main dietary sources of EFAs are as follows. 

---