Question: I recently had Telogen Effluvium following a car crash a few months ago. I didn't use any treatment, I just waited for it to stop on its own and now my hair's stopped falling out but my scalp is flaking off in big chunks. It's all around the nape of my neck, my crown and hairline but I keep finding new patches all the time. It doesn't look like dandruff - it's more like chalk when it comes off under my fingernails and when I run my fingers through my hair my scalp feels scaly and like it has scabs on it. Sometimes they feel damp too even though my hair is dry. It's really horrible and I want to know what to do to make it go away please. When these scales come off they often have hairs still stuck in them so I'm worried they may scar and leave areas where my hair won't grow properly. Please help!
Answer: Hi Suzi. From your description this sounds could be a number of scalp conditions, and it's entirely possible that you could be experiencing more than one at the same time.
The first that comes to mind is Seborrhoeic Dermatitis. This can occur when yeast in the skin reacts with sebum - the oily substance our skin secretes in order to protect and 'waterproof' itself. The signs include a yellowing scaliness, redness of the scalp and itching. It can present anywhere on the scalp and may also affect other areas including in the eyebrows, at the sides of the nose and behind the ears.
Whilst part of your symptoms sound like Seborrhoeic Dermatitis, this is caused by an oily scalp and you mention a dry 'chalky' texture. Whilst - contrary to popular opinion - an oily scalp can still be prevalent even if your head feels dry to the touch and doesn't feel oily except where the scales are located, your description doesn't quite fit well enough for a confident diagnosis. This indicates a possible dermatological condition and these can be especially hard to diagnose remotely as the conditions often closely resemble one another.
As you mention the nape of your neck, this in conjunction with the white or silvery colour of the flaking you describe lends itself better to a diagnosis of either eczema or psoriasis. These are both 'dry' skin conditions which can cause pale flakes and an itchy scalp.
Psoriasis tends to cause raised patches of inflamed skin which can be covered in silvery scales which may extend beyond the hairline. Atopic eczema, meanwhile, can often present on the scalp - and other areas of the head including the neck or face - as cracked skin that appears to be flaking. When scratched - which, as it can be extremely itchy, is likely to happen - this can cause the skin to bleed which may be the reason for the scabs you mention.
As these are skin disorders rather than hair loss conditions, the best thing to do to confirm the precise reason behind your symptoms is to visit a dermatologist, or your GP. They will be able to help you with treatment too; usually this involves topical applications of prescribed steroid creams.
To help calm your scalp in the meantime you could try washing your hair every day with a medicated treatment shampoo that has been specially formulated to deal with scalp conditions. The B4 shampoo formula from Belgravia's range of shampoos and conditioners is a firm favourite with clients (and staff!) who have scalp disorders and is available for non-clients to purchase too. It is suitable for all hair types and can be followed with the conditioner of your choice or Belgravia's B7. It doesn't matter how long you leave the shampoo on for, what's more important is that you use it regularly.
Although we are unaware of any clinical data to confirm this, anecdotal evidence suggests that using dry shampoo may exacerbate scalp problems. As such, just to be on the safe side, we recommend sticking with the daily hair washing and avoiding using this in between washes.
Significant hair loss from the conditions listed above is rare although, in extreme cases, constant scratching can lead to Traction Alopecia. As you mention 'scabs', it may be the case that you have been scratching at your head unwittingly, which has led to these forming. When you scratch and pull bits of your flaky scalp out of your hair, you can also accidentally damage the hair, causing it to snap along the shaft. This leads to hair breakage which you'll be able to identify by checking to see if you notice shorter or slightly misshapen hairs around where the scabs or scaly patches are on your scalp.
I know it's hard but do try not to scratch your scalp as this can also lead to infection; once you start using the medicated shampoo any itchiness should subside. However, we do recommend you consult a skin specialist about the flaking and if you are still concerned about shedding hairs, it may be beneficial to visit a hair loss specialist for an assessment, even if it is just to put your mind at rest.
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