Scalp health
Barrier, microbiome and the follicle environment
The scalp as the follicle’s environment
Key takeaway for patientsHealthy hair starts with a calm scalp. Persistent itching, scaling or soreness is a skin problem, and it can be assessed and treated as one.
The scalp is skin with an unusually high density of hair follicles, sebaceous glands and blood vessels. Its barrier, its sebum and its resident microbes, the yeast Malassezia among them, normally exist in balance.
When that balance is disturbed, the result is inflammation: flaking, itching or redness. Inflammation around the follicle is associated with shedding and poorer growth.
Key elements of a healthy scalp
- Barrier function
- The outer layer holds water in and keeps irritants out.
- Sebum production
- Sebaceous glands lubricate the skin and the hair.
- Microbial balance
- Resident organisms live on sebum without provoking the immune system.
- Blood supply
- Vessels around each follicle deliver oxygen and nutrients.
Factors that disturb the scalp
Several factors tip the scalp toward inflammation:
- Overgrowth of Malassezia
- Associated with dandruff and seborrhoeic dermatitis.
- Inflammatory skin conditions
- Such as psoriasis and eczema.
- Harsh products and over-washing
- Strip lipids and damage the barrier.
- Stress and hormonal change
- Alter sebum production and immune responses.
Clinical management and physician guidance
A scalp complaint is assessed as a skin condition.
- Scalp examination
- Scale, redness and the pattern of any hair loss, sometimes with dermoscopy.
- Physician-guided care
- Care for the underlying skin condition, as your physician decides.
- Monitoring and follow-up
- Symptoms and markers are reviewed over time, and the plan is adjusted to them.
Research focus in scalp biology
| Core focus area | Biological target | Clinical relevance |
|---|---|---|
| Barrier | Lipids of the stratum corneum | Water loss and irritation |
| Microbiome | Malassezia yeasts | Dandruff and seborrhoeic dermatitis |
| Sebum | Sebaceous gland activity | Lubrication and microbial growth |
| Perifollicular inflammation | Immune cells around the follicle | Shedding and growth |
Frequently asked questions
- Is dandruff caused by a dry scalp?
- Usually not. It is linked with a yeast that lives on sebum and with the skin’s reaction to it.
- Can scalp problems cause hair loss?
- Inflammation around follicles is associated with shedding, which often recovers when the scalp settles.
- When should I be seen?
- If there is soreness, thick scale, patchy loss or no response to simple measures.
Academic references and literature
- Borda LJ, Wikramanayake TC (2015). Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol, 3(2). PMID 27148560.
- Trüeb RM et al. (2018). Scalp Condition Impacts Hair Growth and Retention via Oxidative Stress. Int J Trichology, 10(6), 262-270. PMID 30783333.
- Grice EA, Segre JA (2011). The skin microbiome. Nat Rev Microbiol, 9(4), 244-53. PMID 21407241.
This guide belongs to the Hair Growth program