The scalp is prone to infections from many different types of organisms. Fungi, yeast and bacteria are by far the commonest. Chronic and untreated scalp infection is one of the leading causes of hair loss. Scalp infections can trigger premature baldness, a reason why more men and women are found balding in their early 20’s and 30’s. Early detection is the best form of prevention as it leads to early treatment.

1) What are the types of Scalp Infections ?

2) What are the causes of Scalp Infection ?

3) How are Scalp Infections diagnosed ?

4) How can Scalp Infections be prevented ?

5) How are scalp infections treated ?

    a) Malassezia infections

    b) Ringworm infections

    c) Bacterial Folliculitis

    d) Lice Infestations

Malassezia infections

Also known as fungal infections of the scalp, these infections are seen more commonly in young people around puberty. The hormonal changes around puberty make the oil glands over-active resulting in excessive oil production on the scalp. This is often a breeding ground for the fungal organisms which then latch onto the scalp and start forming a colony.

The symptoms appear in the form of scalp itching and persistent dandruff flakes which keep coming back in spite of repeated shampooing. If chronic, it can cause considerable hair loss and baldness at an early age. While regular baldness would have started at a later age and proceeded slowly, with a complicating fungal infection, the baldness starts early and progresses faster.

Ringworm infections

Known as Tinea Capitis, it is a type of scalp fungal infection. The fungal organisms usually find their way into the scalp through a cut or a scrape. These infections most commonly occur after a hair cut at the barbers shop or after tonsuring head at temples.

Once inside the skin the fungal organisms multiply and spread outwards causing hair loss in round patches, typically appearing like rings, hence the name ringworm.

Bacterial Folliculitis

This is seen as multiple tiny pimples on the scalp, which often break and ooze. There are two varieties, superficial and deep. Most cases are of the superficial variety wherein the scalp is filled with tiny pimples but the damage to the hair is minimal. In the deep folliculitis the infection involves the entire hair follicle, leading to considerable hair loss and scarring.

Common ways of catching these infections are from contaminated waters, combs, pillow covers, salon equipments and unbelievable as it may sound, even through some soap nut powders and henna leaves.

Lice Infestations

The head lice infest the hair and scalp. Lice are barely visible wingless insects that live by sucking blood. It is mostly seen in school going children especially girls between the age of 6 to 12.

The infestation is spread by close personal contact and possibly by shared combs, bands, towels, caps and other personal items. People with lice usually have severe itching on the scalp. Lice and eggs can be found by looking through hair on the head.

    a) An oily scalp

    b) Contamination or cross infection

    c) Stress

An oily scalp

The scalp secretes its own natural oil called sebum which provides lubrication and facilitates the movement of hair. However this sebum when secreted in excess can lead to a host of problems. When first secreted, the sebum is semi-solid in nature, but after a while starts solidifying, forming sebum plugs, which get stuck to the hair and scalp.

Contamination or Cross infection

In addition to an oily scalp repeated and frequent exposure to contaminated items increases the chances of catching a fungal infection. Common ways of catching these infections are through contaminated water, combs, pillow covers, salon equipments and unbelievable as it may sound, even through soap nut powders and henna leaves. Helmets are also a leading cause of scalp infections. The person wearing the helmet tends to profusely sweat on the head. The inner sponge lining of the helmet soaks up all this sweat and becomes a breeding ground for organisms, thereby causing scalp infections.

Like many other infections, scalp infections can also be airborne. For example, if a piece of bread is allowed to stay on the table for two days, there will be fungal growth on it. Fungal infections can often run a chronic course. Some people are found to have fungal infections for as long as 20-30 years at a stretch.

There is a very interesting story of fungal infections and the Pharaoh’s tomb in Egypt. In the 1920’s when the Pharaoh Tutankhamen’s tomb was broken into by the archaeologists, they were warned by the natives, that there is curse on them and they would soon die. Being men of science they naturally did not believe in this, but strangely enough some of them did die, within the next few years. For a long time it was unexplained, until recently when it was found that they suffered from fungal infections of the lungs. Its seems the pharaohs tomb was airtight for 2000 years during which there was plenty of fungal growth in the tomb and the first few people who entered the tomb inhaled the contaminated air and died from it. That’s how tenacious fungal infections can be.

Stress

When the body experiences stress it increases the secretion of certain hormones like Cortisol which in turn causes excess sebum production on the scalp. The sebum secretion is full of fatty acids and a rich source of food for the various organisms which then grow and flourish on the scalp. Stress also causes lowering of the body’s immune system and its ability to fight diseases. Which is why people under stress often fall sick more easily, then those not under stress.

A CEO of an IT company suddenly developed multiple boils on his scalp in a short span of 3-4 days. His company was going through bad times and he was given the task to lay off 100 odd employees from his company. He was found to be under tremendous mental stress figuring how he would break the news and how he would pick the employees to be laid off.

Diagnosis is usually done through the following methods

1) Observation of the symptoms

2) Visual inspection of the scalp condition under UV light

3) Collection of scalp scrapings for laboratory analysis

4) Tricho Analysis which can help to differentiate between the various types and show the severity and extent of infection and how much it has affected the hair roots.

    a) Avoid scratching the head

    b) Avoid sharing personal items

    c) Clean helmets regularly

    d) Do not skip on hygiene

    e) Use the right shampoo

Avoid scratching the head

Some people have an itchy scalp or tiny pimples on the head which make them scratch the head repeatedly. Some have the habit of finger-combing their hair all the time.

Most of these things are done by reflex, not realizing that the hands are a big source of germs. For example we touch door knobs, keyboards, cell phones, shake hands with other people, exposing our hands to contamination. And then we pass it on to the scalp each time we scratch the head.

Avoid sharing personal items

Combs, pillow covers, helmets, hair bands are things which come in touch with your scalp, some of them for long periods of time. If they are contaminated, they can easily transfer the infection to your scalp.

This is especially true for people who stay in the same house or room-mates who share the house and belongings and end up eventually sharing their scalp infections too. A similar thing occurs in frequent travelers. Even the best of hotels fall short on laundry standards. For instance, a sting operation carried out by a popular news channel sometime back, showed high fungal growth in pillow covers and beddings of some of the top-notch hotels in India.

Clean helmets regularly

Clean the outside and inside of the helmet regularly. Wear a cotton scarf before wearing the helmet.

The scarf absorbs most of the sweat and can be put for washing daily, something that can’t be done with helmets. Also avoid sharing helmets.

Do not skip on hygiene

During winters, a lot of people simply stop washing their heads. This is especially true for people who need to leave their homes early in the morning like BPO workers and school children.

While it is completely understandable and there are genuine concerns of catching a cold in this weather, some level of hygiene is essential. Consider washing the scalp in the afternoon when it is relatively warmer.

Use the right shampoo

Fungal infections develop from a combination of excess sebum on the scalp and exposure to contaminated objects. One of the easiest ways to prevent scalp infections is to follow a correct hair care which keeps the sebum in check and prevents the growth of various bacteria and fungi on the head.

The cornerstone of such hair care is regular washing with the correct shampoo. A correct shampoo is one which gives enough detergent action enabling the locking and removal of sebum molecules from the scalp. Thus contrary to popular belief that detergent based shampoos are harmful, it is these shampoos that provide enough cleansing action and help in preventing fungal infections from developing.

Treatment varies depending on the type of infection and the organism involved. Depending on the severity, oral medications or external applications or both are advised. Treatment may involve shaving off the head for better accessibility and absorption of the medication.