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Dermatology Library

H

Hair Health:

There are several hair conditions listed below.

DANDRUFF

What is dandruff?

Your skin continuously sheds layers, with the scalp shedding more than any other part of the body. Dandruff is an excessive amount of larger-than-normal flakes of scalp that stick to the shafts of the hair where they may accumulate a build-up of oil, dust and hair products. These flakes eventually fall on the collars and shoulders of clothes in large flakes. There may be associated irritation or itching.

Symptoms of dandruff

  • White scales and flakes on the scalp which fall onto the shoulders are clear signs of dandruff.
  • Some irritation or itch may be present.

What are the causes of dandruff?

  • The most common cause is the abnormal overproduction and shedding of dead skin from the scalp.
  • Seborrhoeic dermatitis is a red, scaly and itchy rash that causes the scalp to shed skin cells excessively. The cause of this condition is unknown at present.
  • Pityrosporum is a microscopic fungus that is normally present on oily areas of the skin. People who have dandruff often have an unusually large amount of pityrosporum.

What you can do

  • Massage your scalp for a few minutes each day to stimulate the circulation and loosen dead skin cells. This can then be followed by vigorous brushing to remove loosened flakes.
  • Wash your hair regularly with an anti-dandruff shampoo with fungicides.
  • Rinse well to eliminate any build-up of hair products. Many people find that regular washing is beneficial, however some people may find their scalp gets irritated by frequent washing.
  • Oily hair can often benefit from rinsing with fresh lemon juice or cider vinegar diluted in water.
  • A dry scalp can often benefit from a warm oil treatment used once a week.
  • Massage olive oil, castor oil or linseed oil into your hair and scalp and warm in a hot towel for at least 10 minutes (preferably a few hours) before washing.
  • Avoid the excessive use of hair products (including dyes) and change shampoo if it is not proving effective. An allergy-free product may be of benefit.
  • Stress and negative emotions have been known to play a significant part in skin conditions such as dandruff, so relaxation techniques may be of assistance.

When to see your doctor

Dandruff is usually more cosmetic than medical and is generally considered harmless. However, in some cases, dandruff may cause thinning of the hair and may be stress-related. Severe persistent dandruff may be a symptom of more serious conditions such as eczema, psoriasis or seborrhoeic dermatitis, and you should consult your doctor.

BALDNESS

Baldness in men

The most common type of hair loss starts in males from about the age of 30. It is known as androgenic alopecia or ‘male pattern baldness’. It is thought to be hereditary, and dependent on the male hormone, testosterone. How quickly or slowly baldness develops, and the pattern of hair loss, appear to be genetically determined. Although this type of baldness can also affect women, the pattern of baldness is different in males and females.

Other forms of baldness

Hair loss that is not hereditary may be caused by pregnancy, hormonal or other medicines, severe nutritional deficiencies, chemotherapy, auto-immune disorders, an under-active thyroid or scalp trauma, including reactions to hair care products and hair grooming methods.

How does hair grow?

The human scalp contains about 100,000 follicles. These anchor the hair to the skin and contain the cells that produce new hairs.

Normal hair grows in 3 phases:

  1. The anagen or follicle growing phase starts growing the new hair. This phase is genetically determined and can vary from 2 to 5 years (the average is just under 3 years).
  2. The catagen phase is a transition stage between the growing and resting phases.
  3. The telogen or resting phase is a mature hair with a root, which is held very loosely in the follicle. The telogen phase generally lasts about 3 months. About 100 telogen hairs are lost from the human scalp each day.

In hereditary hair loss, the follicle becomes smaller, the anagen phase is shorter and the telogen hairs are shed faster.

When should you seek medical advice?

You should seek medical advice for hair loss if:

  • you are a woman who has recently given birth.
  • you have been diagnosed with an auto-immune disorder such as systemic lupus erythematosis (SLE), nutritional deficiency or thyroid disease.
  • you have been recently treated with chemotherapy or have used a hormonal medicine; or
  • the hair loss cannot be explained by hereditary factors.

HEAD LICE

What are head lice?

Head lice (Pediculus humanus capitis), also known as nits (which are actually the eggs of the lice), live, eat and breed on the hair and skin of the human scalp. They are small, wingless insects, about 2.5 to 3.5 mm in length. Head lice cannot jump or fly, but they can roam the scalp by moving from hair to hair with strong claws. Healthy head lice can be very difficult to see on the scalp as they move quickly when the hair is disturbed.

Female lice lay about 6 to 8 eggs every day. Eggs are laid close to their food supply - the scalp. The eggs (nits), which are small whitish flecks, are often seen behind the ears and towards the nape of the neck. They are attached firmly to the hair and are very hard to remove or slide along the hair shaft. This is in contrast to dandruff which is easy to slide along the hair shaft. Eggs hatch about 7 to 10 days after being laid.

How are head lice spread?

Because they cannot fly or jump, head lice must come in close contact with another person's hair or head to spread. This can be done by sitting or lying next to a person with head lice, or using the same hairbrush, comb or hat. Head lice infestations occur most frequently in schoolchildren because they tend to be in close personal contact with each other and to share brushes and combs. Head lice are not associated with a lack of cleanliness.

Symptoms of head lice

Head lice may cause the scalp to itch, although often there are no symptoms. An active infestation of head lice is diagnosed by looking at the scalp and hair and either finding a live insect on the scalp or finding an egg (a nit) within 1.5 cm of the scalp (older eggs are found more than 1.5 cm from the scalp).

Wet comb technique to find lice

To help detect head lice, you can use the wet comb technique. Simply apply any brand of regular hair conditioner to dry, untangled (brushed) hair. This stuns the lice. Then comb the conditioner through to the ends of the hair using a fine-toothed lice comb. Wipe the combings onto a tissue; inspect the tissue for lice and eggs as you go (live eggs will ‘pop’ when squeezed between the fingernails). If any lice or live eggs are present you need to treat the infestation as described below.

How are head lice treated?

If you find lice or live nits in the hair or in the combings after using the wet comb tecnique, you will need to treat the infestation. Generally, a special shampoo or lotion is used. Follow the directions on the package carefully using a clock to time how long the shampoo should be left on. Speak to your pharmacist for advice about what treatment to use.

As no treatment kills the eggs as well as the lice, treatment must be repeated in 7 days to kill the newly hatched lice from eggs that have survived the first treatment. You can check the effectiveness of the treatment by using the wet comb technique to check for lice and eggs one week after the second application of lice treatment.

Don't worry about washing all the bedding and clothes, eggs will not survive away from their food source after hatching. Check for head lice on the scalps of family members and close contacts. Only apply treatment if an active infestation is found - there's no need to treat everyone who has been in contact with the person who has had head lice.

HIRSUTISM IN WOMEN

What is hirsutism?

Hirsutism is the name given to the problem of having too much hair on the face or body, a problem which mainly concerns women. For each woman, it is a matter of personal preference how much hair she considers to be too much.

Hair grows from tiny hair follicles. Men and women have the same number and distribution of these, although there is a difference between races. For example, Caucasians have more hair follicles than Asians, and people from the Mediterranean have more than those from Northern Europe.

In women, the hair on most parts of their bodies is very thin, pale and almost invisible. This hair is known as lanugo. Under the stimulus of male hormones (known as androgens) lanugo hair becomes coarser and darker, making it far more obvious. This is sometimes known as terminal hair.

What causes hirsutism?

All women have small amounts of androgens in their circulation, made primarily in the ovaries and adrenal glands. When androgens are produced in excess, hirsutism is likely to occur.

The usual cause of excess androgen production is a condition called polycystic ovary syndrome. Usually, women with this problem have irregular or absent periods and may experience difficulty becoming pregnant. Rarer causes are tumours of the ovary or adrenal gland and Cushing's syndrome, in which the adrenal gland is overactive.

In many cases, no abnormality of the hormones is found and it may be that in those people the hair follicle is more sensitive to normal amounts of androgen. Other family members are often affected.

How is it treated?

Treatment of hirsutism is through a combination of cosmetic measures and treatment of the hormone imbalance. Once the lanugo has developed into terminal hair it cannot change back. Cosmetic methods such as electrolysis, waxing and depilation are therefore needed to remove the excess visible hair. At the same time, those with an excess male hormone can be treated in a variety of ways to prevent further unwanted hair appearing.

Halo Nevus:

A halo mole (or halo nevus) is a mole with a white ring, or halo, around it. Halo moles are not uncommon and are usually seen in children or young adults.

Head Lice:

Head lice infestation (also called pediculosis) is a major problem in the United States, throughout Europe and Asia. The problem is particularly common in schoolchildren.

Also see: Head Conditions

Hemangioma:

Benign tumors of the vascular endothelium. Hemangiomas of infancy are the most common type of hemangiomas, characterized by a unique natural history of growth in early infancy, followed by slow involution over the next several years. Hemangiomas may be present at the time of birth as so- called precursor lesions in approximately half of the cases. Rarely are they fully- formed tumors at birth. In the remainder of cases, lesions become evident after birth, usually within the second and fourth weeks of life.

Herpes simplex:

The herpes simplex virus (HSV) causes blisters and sores around the mouth, nose, genitals, and buttocks, but they may occur almost anywhere on the skin or mucous membranes. HSV infections can be very annoying because they may reappear periodically. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal. There are two types of HSV - Type 1 and Type 2.

Herpes zoster (shingles):

Herpes zoster, also known as shingles or zoster, is a viral infection caused by the same virus that causes chicken pox. Anyone who has had chicken pox can develop herpes zoster. The virus remains dormant (inactive), in certain nerve cells of the body, and when it reactivates it causes zoster. About 20 percent of those people who have had chicken pox will get zoster. Most people get zoster only once.

Hidradenitis suppurativa:

Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several occurrences.

Causes: Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation. It's not known why this occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn's disease, herpes simplex or Grave's disease.

Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. There is no cure for hidradenitis suppurativa. But early diagnosis and treatment can help manage the symptoms and prevent new lesions from developing.

Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include:

  • Small pitted areas of skin containing blackheads, often appearing in pairs or a "double-barrel" pattern.
  • One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
  • Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.
  • Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Treatments and drugs: There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing. Treatments depend on the extent of the affected areas and whether the sores are painful or infected. Mild cases can be treated with self-care measures, including warm compresses and regular washings with antibacterial soap. Moderate cases may require medications, such as those you rub on the affected areas (topical medications) or those you take by mouth (oral medications). Possible medications include:

  • Antibiotics to treat infection. Antibiotics taken for a long time early in the disease may prevent future outbreaks or prevent the disease from worsening.
  • Oral retinoid medications to stop oil gland functions and to prevent the plugging of the hair follicle.
  • Nonsteroidal anti-inflammatory drugs to reduce pain and swelling.
  • Corticosteroids or immunosuppressant drugs.

For severe or persistent cases or for deep lesions, surgery may be necessary. Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.

The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:

  • Apply a warm washcloth or compress to help reduce swelling.
  • Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.
  • Wear loose fitting clothes and underwear to prevent skin irritation.
  • Avoid shaving the affected areas to prevent skin irritation.
  • Don't smoke. Smoking can worsen symptoms and trigger new outbreaks.

Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won't cure the disease, it may improve symptoms.

Submitted by: Elisa D. Endicott, P.A.-C.

Hives:

See: Urticaria

Hydrocortisone:

A less potent corticosteroid incorporated into creams, lotions and ointments used to treat skin inflammation.

Hyperhidrosis (excessive sweating):

Hyperhidrosis is a chronic medical disorder that results in the production of excessive sweat. A recent study determined that the condition - once thought to be rare - actually affects approximately 2.8 percent of the U.S. population, or 7.8 million people. Even more compelling, one out of three people surveyed with the condition said their sweating was intolerable or barely tolerable. Many sufferers said they were depressed and frustrated with daily activities, and they experienced interference with work and romance and had difficulty meeting people.

Hyperpigmentation:

Definition: Skin that has turned darker than normal is referred to as hyperpigmentation. Normal skin contains cells called melanocytes. These cells produce melanin. Melanin is the substance that gives skin its normal color. Too much melanin results in hyperpigmented skin.

Hyperpigmentation Description: Hyperpigmentation may occur in isolated areas or generalized areas. Darkened spots on the skin come in several varieties.

  • The most ominous is malignant melanoma, a very aggressive cancer that begins as an innocent mole. The majority of moles (nevus), however, are and remain benign (harmless). The average person has several dozen, and certain people with a hereditary excess may have hundreds.
  • Freckles are always flat and not as dark and are on sun exposed areas.
  • Keratosis consist of locally overgrown layers of skin that are dark primarily because there is more tissue than normal. These lesions are usually benign.
  • Melasma is a symmetrical patchy discoloration frequently seen on faces of pregnant women.

Causes:

  • Trauma such as cuts and burns
  • Certain medications
  • Conditions causing inflammation such as acne and lupus
  • Hormonal disorders such as Addison’s disease
  • Sun exposure

Diagnosis: Diagnosis can be made by visual examination, blood work, and biopsy. The pattern of discoloration is immediately visible to the trained dermatologist and may be all that is required to name and characterize the discoloration. Many of these pigment changes are signs of internal disease that must be identified. Pigmentation changes may also be caused by medication, and the drug responsible for the reaction must be identified and removed.

Treatment:

  • Avoid sun exposure
  • Always use sunscreen
  • Lightening creams
  • Laser surgery is an effective removal technique for many localized lesions
  • Because it spreads so rapidly, melanoma should be immediately removed, as well as some of the surrounding tissue to prevent regrowth.

Submitted by: Elisa D. Endicott, P.A.-C.