The scalp is the environment in which every hair follicle lives, and its health has a direct bearing on the quality of hair growth. Conditions that affect the scalp — inflammation, seborrhoeic dermatitis, scalp psoriasis, and fungal infections — can impair follicle function and in some cases cause scarring that permanently damages follicles. Maintaining a healthy scalp is one of the most underappreciated aspects of hair health.
Seborrhoeic dermatitis — a chronic condition characterised by flaking, oiliness, and scalp inflammation — is associated with hair thinning in affected areas. The malassezia yeast that drives seborrhoeic dermatitis creates an inflammatory environment around the follicle that may accelerate miniaturisation in genetically susceptible individuals. Anti-fungal shampoos, particularly those containing ketoconazole, are the most effective treatment.
Scalp psoriasis produces plaques of thickened, scaly skin that can disrupt normal follicle function in the affected areas. It does not typically cause permanent hair loss, but active plaques left untreated for extended periods can. Management by a dermatologist, using topical corticosteroids and specialised shampoos, usually resolves the scalp component without permanent damage.
Folliculitis — infection of hair follicles — can cause localised scarring if severe or recurrent. Bacterial folliculitis is treated with topical or oral antibiotics; fungal folliculitis (tinea capitis) requires antifungal treatment. Both should be addressed promptly.
For patients planning a hair transplant, any active scalp condition should be assessed and treated before surgery. Operating on an inflamed or infected scalp significantly increases the risk of complications and may impair graft survival.
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