The Ultimate Guide to Scalp Care

The Ultimate Guide to Scalp Care featured image
Florian Sommet / Trunk Archive
This article first appeared in the Spring 2020 issue of New Beauty. Click here to subscribe

It’s gone from the have-to-hide-in-the-shower shampoo to a study in the ultra-science. Ahead, a definitive guide to scalp care and the latest healthy-scalp solutions taking strands by storm.

What Does an Unhealthy Scalp Look Like?

This fact probably won’t come as a scalp surprise, but dandruff is the most common scalp condition. And, if you’ve ever had it, you know it oftentimes makes your scalp itch. According to the American Academy of Dermatology (AAD), dandruff can develop due to multiple reasons—including some medical conditions, hair care habits or oily skin. The AAD also states that you can usually treat mild dandruff at home by regularly washing your hair. If a “regular” shampoo doesn’t do it for your dandruff, choosing a dandruff-specific shampoo with ingredients like zinc pyrithione, salicylic acid, sulfur, selenium sulfide, ketoconazole, and coal tar shampoo, is recommended.

For most people, dandruff does not require medical attention, according to the AAD. If your dandruff doesn’t go away or if you develop severe dandruff, visit a board-certified dermatologist. “Your dermatologist may prescribe stronger dandruff shampoo or medication,” the AAD states. “Your dermatologist also knows whether your dandruff is a sign of a medical condition, such as seborrheic dermatitis, psoriasis, fungal infections of the scalp, or eczema.”

What Is Scalp Psoriasis?

According to the AAD, scalp psoriasis can look a lot like dandruff, and many people who have scalp psoriasis see flaking. But they are not totally the same. Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp, and it can show up in patches or cover the entire scalp. “Psoriasis is long-lasting, while dandruff may come and go,” explains Dallas dermatologist Elizabeth Bahar Houshmand, MD, who adds that with psoriasis, you will have a family history. Some other differentiators: “Psoriasis is more scaly than flaky—they are plaques versus the flakes in dandruff.”

Montclair, NJ dermatologist Jeanine B. Downie, MD adds that, unfortunately, it’s not always easy to tell and adds another condition—seborrheic dermatitis—into the mix . “If you have a history of psoriasis, and you have violet silvery patches on your elbow knees, it might be psoriasis. But if you have no history of psoriasis, it might be sebhorrheic dermatitis. In my opinion, dandruff and seborrheic dermatitis are the same thing. Knowing your stress level or hormonal changes does not help either, because psoriasis and dermatitis can be negatively affected by both. Even biopsies can be conflicting because they look similar under the microscope—but, sometimes, a biopsy can help.”

How Can I Keep My Scalp Healthy?

While it may not be a cure-all, trichologist Shab Reslan recommends regular scalp massages for the health of your hair. And this is one solution that’s—surprise—free. “You can have a friend or partner give you one while you watch your favorite show,” she says. “Or, even spend a couple extra minutes in the shower while your conditioner is applied and massage your scalp slowly using the cushions of your fingers. The stimulations and blood circulation promote healthier hair and scalp.”

It may be up for debate if finding a friend who wants to deliver a head massage is easier than purchasing a product, but one thing is certain: As both stylists and brands learn more about the link between healthy hair and a healthy scalp, “scalp health is undeniably a hot topic,” Reslan says. She counts Neuma ReNeu Scalp Therapy ($28) and Christophe Robin Purifying Scalp Scrub ($53) as two scalp products that hit the top on her “favorites” list. Celebrity hairstylist

Creighton Bowman is also a fan of the product route, and his number-one solution is long-time staple Head & Shoulders ($23). “I like using it on the ‘hot spots’ of the head that are dry,” he says.

What Are Some Treatments for a Healthier Scalp?

HydraFacial is another traditionally skin care–focused brand that’s taking on the scalp-care revolution with its HydraFacial Keravive. The brand says it decided to launch the three-step treatment—which involves an in−office cleansing, exfoliation and hydration steps, and a take-home spray—because it found its customers are “very aware of the detrimental effects of poor scalp health, including visible signs of flaking, dry and itchy scalp, and limp and damaged hair.”

Dr. Downie likes spraying ISDIN Lambdapil Spray on patients’ scalps to encourage hair growth and overall healthier hair. “I tell them not to scratch, and I encourage them to limit the heat they use on their hair and scalp,” she says. “All of those steps work wonders.”

Can an Unhealthy Scalp Lead to Hair Loss?

Smithtown, NY facial plastic surgeon James Marotta, MD sees many patients “very concerned with scalp health and hair health in general,” but by the time they come to him, it’s a bit more than some flakes on the shoulders. Because statistics show hair loss is a universal problem, affecting 85 percent of men and 40 percent of women by the age of 50, that’s a whole lot of people who most likely share the same concerns.

Dr. Marotta also says to think of the scalp as the “soil” that grows the “plants”—i.e., the healthy hair. “If the scalp is unhealthy, it will affect hair health and hair growth,” he explains. “Treatments for specific scalp conditions can improve hair health and hair growth. If there are sores, patches of hair loss, redness, itching, or scaling anywhere on your scalp, seek evaluation and treatment.”

When patients visit Beverly Hills, CA hair restoration surgeon Dr. Craig L. Ziering, it’s almost solely because of hair-loss reasons, but he doesn’t deny that an oily scalp and dandruff can be problematic. “Medicated shampoos can manage these conditions and function by cleansing the scalp, along with mechanical cleansing created by vigorous finger action during shampooing, to remove any debris.”

Researchers have also zeroed in on the scalp’s microbiota as the origin of inflammation, adds Dr. Ziering. “Microorganisms have been identified residing deep within the hair follicle, which places them in close proximity to immune-privileged regions. If they compromise function by their presence deep within the follicle, hair cycling and regeneration may be affected.” As researchers continue to examine the scalp’s microbiome, doctors are hopeful their findings may lead to new therapies for cicatricial or scarring alopecias, which can lead to irreversible hair loss.

The Dos and Don’ts for a Healthy Scalp

Do: Wash Your Hair

Reslan says infrequent hair washing is a huge detriment to the quality of your hair growth. “Buildup and sebum [the oil the scalp produces] can clog your follicles and cause inflammation. Keeping your scalp in this constant state can lead to weaker and thinner hair growth over time.”

Don’t: Run Too Hot

Dr. Marotta, who also specializes in hair restoration surgery, stresses the importance of avoiding overdrying by showering with water that is too hot or excessively blow-drying the hair.

Do: “Anti-” Up

Dr. Marotta says that for scalps with specific conditions like dandruff or seborrheic dermatitis for example, “treatment with anti-dandruff shampoos or anti-fungal creams may be necessary.”

Don’t: Overdo the Dry Shampoo

Perhaps the biggest debate of them all: What role does dry shampoo play in scalp health? When used properly, it is a great hair-refresher, Reslan says, but, when used incorrectly—like in cases where it is applied directly to the scalp or not properly washed out—it can lead to problems.

Do: Understand What Sebum Does

Another often-heard scalp concern: sebum buildup. “Sebum is an oily substance produced by the sebaceous gland for the physiologic purpose of lubricating the hair follicle,” explains Dr. Ziering. However, he believes any correlation between excessive oil production and hair loss is much ado about nothing. “An oily scalp can be easily managed by over-the-counter medicated shampoos. The use of these scalp-cleansing solutions will prevent the remote possibility of the sebum buildup that can create an inflammatory state within the hair follicle.”

Don’t: Forget That Your Scalp Is Skin

Spoiler alert: The scalp is skin, and treating it with the same care we give our facial routines might not be such a bad idea—a concept not lost on Drunk Elephant founder Tiffany Masterson. That’s why she’s rolling out a two-year-in-the-making line with celebrity hairstylist and longtime friend Chris McMillian of Jennifer Aniston fame, and it does not fool around in the efficacious ingredient department. The four-product collection includes Cocomino Glossing Shampoo ($34), Cocomino Marula Cream Conditioner ($27), Wild Marula Tangle Spray ($27) and the alpha- and betahydroxy acid–packed T.L.C. Happi Scalp Scrub ($39), all of which follow the brand’s clean-compatible philosophy.

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