Maintaining a Healthy Scalp


There’s a common misconception that balding means there’s
something wrong with the scalp. But because hair actually starts
growing from below the scalp, the scalp itself has little to do with
hair loss or hair health.
When hair loss occurs because of male genetic hair loss (or any
other cause), the blood supply to the area drops because it isn’t
needed where there isn’t any hair. When surgeons transplant new
hair, the circulation in the scalp improves as the new hair grows
out (in effect recruiting the blood supply it needs). (You can find
more about hair transplantation in Part V.)
We generally tell patients that if they shampoo with a good com-
mercial product and use a conditioner once a day, the skin of the
scalp should remain moist and well taken care of.
You can impact your scalp circulation in a number of ways, some
of which may affect your hair indirectly. Things that are bad for the
scalp and its circulation include:
 Smoking: As shown in ultrasound studies, smoking reduces
scalp circulation. Because this occurs with each cigarette,
over time smoking may contribute to whatever hair loss is
occurring on the head. Most doctors strongly believe this con-
nection, although definitive scientific proof is lacking.
 Sun exposure: Repeated sunburns on the scalp may impact
structures deep in the scalp causing the hair producing cells
to shrink. Combining genetic hair loss and intense ultraviolet
light may speed up the balding process.
 Skin cancer: Skin cancer comes in three different types, two
of which can be deadly by spreading throughout your body
(malignant melanomas and squamous cell cancers). These
cancers almost always appear in sun exposed skin.
Melanomas can rapidly spread beyond the confines of the
local area and they can be very small flat, mole like, frequently
black tumors. The third type of cancer, basal cell cancer) usu-
ally remains local but it often produces ulcers on the skin, and
they can grow to a significant size.
When balding occurs, the scalp is exposed to the impact of
ultraviolet light from direct sunlight, and the skin changes
from a smooth, uniform colored skin, to a skin that has spots
and discolorations throughout. Hair protects the scalp from
direct sunlight and can produce enough shade to reduce the
risks of skin cancers.
 Dermatologic conditions: A variety of conditions can impact
the skin and scalp. See Chapter 5 for more.
 Folliculitis: This is an infection of the hair follicles. It appears
as acne or red or white bumps on the scalp skin and may have
to be treated with soaks, antibiotics, or a minor surgical inci-
sion. It should never be picked or scratched, as this may
increase the incidence of permanent scarring and may spread
the infection from an infected hair follicle to one that is not
infected.
Folliculitis rarely causes permanent hair loss, but it may cause
the hair to prematurely enter the telogen (sleep) phase of the
hair cycle.
 Chlorine and salt water: Frequent swimming in chlorine pools
or salt water without shampooing and conditioning afterward
has the ability to cause hair and scalp damage from the heavy
salt or chlorine exposure. The salt can dry the scalp.
Many patients believe that dandruff may cause balding, but this is
not true. Other patients report having an itchy or tingling scalp,
and they believe it’s a precursor of the balding process. This com-
plaint is actually quite common and may be a sign of early genetic
hair loss.

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