Scalp and scalp-related issues

What Is a Scalp?

Your scalp is made of three layers that cover the top of your skull. Beneath your hair are layers of skin, connective tissue with blood vessels and muscle. These layers are loosely attached to your scull by a type of connective tissue called the pericranium. In addition to covering and protecting your skull, you need your scalp for growing hair and creating facial expressions.

Hair — The scalp is covered in follicles that are responsible for growing your hair.

Skin — The skin on your scalp is one of the thickest sections of skin on your body. It is thickest at the back of your head and gradually becomes thinner

at the front. It has hair follicles, sweat glands and sebaceous glands that produce oil.

Connective Tissue — Beneath your scalp’s skin is a thin layer of connective tissue called the superficial fascia. This tissue, which is tightly attached to your skin by special fibres, houses blood vessels, fat, nerves and parts of the lymphatic system.

Muscle — Under your scalp’s blood vessels and nerves is a muscle called the occipitofrontalis. This muscle, which covers your whole scalp, is made of two attached segments called the occipitalis and the frontalis. These muscles contract to raise your eyebrows, wrinkle your forehead and contribute to facial expressions.

As published in On the Road… August 2015

The PRP Survival Guide is a repository of experiences and insights shared by PRP patients and their caregivers. Collectively, the PRP community possesses a wealth of practical knowledge about pityriasis rubra pilaris. We need to harvest that knowledge for those in need of enlightenment.
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The following discussion (edited) regarding recommendations for an itchy scalp was posted to members of the PRP Facebook Support Group. Remember: What works for one doesn’t work for all, but here are some treatments that worked for one or more.

Barbara Y — Winter Park, Florida

I had the crusty flaking plus lesions and a small amount of bleeding. I lost about 25 percent of my hair, which I prefer to believe I have mostly recovered since my PRP let up from the acute stage 6 months ago. My scalp was the last skin to clear for me. So maybe I should not be giving advice, but here is what I did:

(1) poured and sprayed Listerine to prevent infection;
(2) shampooed with TGel (horrible, tar-like, I don’t miss it) and used conditioner only on the ends;
(3) covered my scalp with baby oil at night to loosen the scales; and
(4) used a fine tooth comb to gently pull away dead skin.

BTW, my wonderful hair stylist did not abandon me and continued to dye my hair. I swear dyeing had no effect other than to keep my spirits up, because there is no way I want to see my real hair color at age 61, especially while I am also enduring PRP.

Anita R — Pearl, MS

What do you all recommend for itching scalp?

Jan T — Ringwood, NJ

For me, the prescription Clobetasol worked amazingly for the itch. Just did nothing for the dandruff. Now my scalp is about the only place that doesn’t really itch. And my scalp had been intensely itchy…Ketoconazole is an antifungal, so it probably would work for some types of dandruff. Clobetasol is in the corticosteroid category.

Bill M — Plano, TX

I was lucky that Ketoconazale 2% shampoo worked. Applied to scalp and left it there for 5 minutes. Then rinsed. Used ketbonazole for dandruff – the itch relief was just an extra. Used Clobetasol and urea lotion on palms and doles. again.
Like · Reply · 18 hrs · Edited

Anita R

What about over the counter shampoo? My dumb insurance won’t pay for prescription

Linda B — Oswestry, Shropshire, England, UK

Ketoconazole 2% w/w shampoo can be purchased over the counter in the UK. The brand name is Nizoral, but Boots produce their own version of this product which is slightly cheaper. Capasal Therapeutic Shampoo is also available over the counter.

Teresa S — Iowa City, IA

Utrogena T gel

Diane H —

I tried the medicated shampoos prescribed by the dermatologist, but they didn’t work. So, I went to Head and Shoulders Clinical strength and it has made a big difference. The other shampoos I tried changed the texture of my hair, this didn’t.

Anita R —

Head and Shoulders Max strength is not helping with the build up of dandruff. (Editor’s Note: What works for one doesn’t work for all)

Jan T —

Really, what is PRP doing to us? I have absolutely no natural oils or moisture in my scalp or hair, and my head is not sweating. It actually never “feels” dirty.

Mary H — Novato, CA

Utrogena T-sal shampoo.

Judy B — Melbourne, Victoria, Australia

I tried everything. Clobetesol worked best, but after 5 years in remittance my scalp is the only thing that hasn’t cleared. Just used to it now. Hang in there – it does get better.

Bill M  —Plano Texas

Here’s a link to the Nutrogena websiteTHIS IN NOT A PRODUCT ENDORSEMENT.

“Neutrogena® T/Gel® therapeutic hair care is a line of dermatologist-recommended shampoos formulated to treat flaky, itchy scalp, caused by conditions ranging from mild danduff to seborrheic dermatitis. Gentle and pleasant to use, T/Gel® products leave hair shiny and manageable and relieve itching for hours after rinsing. The complete T/Gel® line offers different active ingredients and benefits to help get rid of all kinds of scalp symptoms, and provide dry scalp treatment.” SEE MORE

Third-Part Websites

Canadian Dermatology Association

What causes dandruff?
How to control flaking

✽  An estimated 50 per cent of North Americans have dandruff.
✽  Dandruff is most common in younger people and usually resolves by middle age, although it can persist later in life.
✽  More men have dandruff than women, possibly due to hormones that produce more active oil glands and an oilier scalp.
✽  Medical conditions and certain medications can trigger or worsen dandruff and its variant seborrheic dermatitis.

This third-party website recommended by Murray R, Surrey, British Columbia, Canada.

Judi T — Montana (Post dated April 16, 2019)

I know I read of some things to help with your scalp but I sure cannot find them now. What do you use? Please. This itching is driving me insane.. Thank you. PRP Facebook Link

Vanessa — Portugal (Post dated March 24, 2019)

I’m about to start treatment with Acitretin, feeling quite nervous about all the side effects. Has anyone had a good experience with this medicine? Also, my scalp has been itching like crazy, and I’ve been struggling to keep it hydrated as it is a lot more difficult than doing it on the rest of the body (with all the hair and such), does anyone know of a good emollient for the scalp? Thanks! PRP Facebook Link

Anita R — Pearl, Mississippi (Post Dated: May 29, 2017

What do you all recommend for itching scalp? PRP Facebook link