Scalp psoriasis and Seborrheic dermatitis of the scalp remain relatively uncommon around the world. However, in recent years, there appears to be some increase in Seborrheic dermatitis cases in The Bahamas, according to specialist dermatologist Dr. Herbert Olander.
Scalp psoriasis can cause red patches to form on the skin; white scales to attach to the hair shaft; patchy scaling or thick crusting of the scalp that may bleed when removed; itching or soreness and patches that may extend beyond the hairline.
Seborrheic dermatitis of the scalp can cause itching in severe cases; yellow or white scales to form and attach to the hair shaft; red, oily skin covered with greasy white or yellow scales and patches that are usually confined to the hairline.
Olander, a specialist dermatologist at St Luke's Diagnostic Centre on Collins Avenue, said patients who display signs of psoriasis on the scalp tend to have symptoms of the disease elsewhere on their bodies, such as the elbows and knees.
Though both men and women are prone to both scalp psoriasis and Seborrheic dermatitis, Olander said St. Luke's mostly treats women when it comes to Seborrheic dermatitis.
"People tend to get the Seborrheic dermatitis, particularly women, quite frequently, simply because of the fact that they don't wash their hair frequently enough," he said.
"There is a tendency not to wash their hair frequently because of the fact that you have now permed the hair, and you do not wish to more or less cause the perm to wear off quickly.
"You tend to wash your hair once every three or four weeks and you would eventually end up with Seborrheic dermatitis, heavy dandruff and scaling of the scalp.
"That is common too because woman tend to put their hair in these styles, including gluing their hair to their scalps and therefore you cannot treat or clean the scalp."
Seborrheic dermatitis does not affect your overall health and is not contagious, though, as Olander pointed out, it can be embarrassing and, if left untreated, become quite severe.
In some cases, hair loss can occur when the disease becomes severe or the abuse of the scalp is extensive.
According to the European Academy of Dermatology and Venereology Journal compilation of 2009, the estimated population prevalence of psoriasis in Western Europe is two percent - and up to 80 percent of patients with psoriasis report some degree of scalp involvement.
According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis.
A brush with scalp psoriasis
Just a couple of months back, Sam Davis (named changed) said she noticed her forehead, especially around her hairline, becoming increasingly dry.
Despite attempts to moisturize and use grease, the condition became worse; and after several weeks her skin around her hairline began to discolor and scale.
Upon scratching, the skin would flake, Davis said, adding that there was not much itching but the skin was quite irritated.
Friends and family assured her the symptoms were the result of dry skin, and it was not until some dry scaled patches appeared around her face that Davis decided to visit a specialist.
Her diagnosis was scalp psoriasis.
"Everyone told me it was dandruff in my family, and I kept saying I don't have dandruff, I have never had dandruff, so I don't understand why would I have dandruff now," Davis said.
"The reason why I checked into it is because I originally thought it was dry scalp. I went to the hairdresser, and I was told to maybe use this, and use that, but it didn't work, and I kept self-medicating.
"The only reason I paid attention to it is because one of my friends had similar symptoms and her whole forehead was basically white and flaky, but I guess she had dermatitis.
"I said, maybe I have that. She told me it was because she really doesn't wash her hair a lot. Her hair is natural and she puts it in braids and stuff like that.
"I said maybe I have something different because I wash my hair all the time."
Noting that her condition was not severe, Davis said she was placed on a three-tiered treatment program, inclusive of a shampoo, cream and prescription medication.
Davis said some people referred to her scaled forehead as "growing dandruff", leading her to believe that many Bahamians with the condition go untreated or they self-medicate unsuccessfully.
"When I combined my dry skin treatment and my perm, I ended up burning my forehead," she said.
"It was not that serious but it was a little red, and it hurt a good bit."
Asked if there was a concern about a recurrence, Davis said she was advised that it could persist in years to come, but it can be contained with treatments.
Scalp psoriasis and Seborrheic dermatitis solutions
"You should shampoo your hair at least once a week, and if you can shampoo more than once a week, that is good," Olander said.
No special blood tests or diagnostic tools exist to diagnose psoriasis, but a dermatologist or other healthcare provider can diagnose psoriasis from the signs and symptoms by examining the entire skin surface.
A skin biopsy can also be taken and examined under the microscope to help differentiate between psoriasis and other disorders.
According to the World Health Organization, topical treatments, medications applied to the skin, are usually the first line of defense in treatment, slowing down or normalizing excessive cell reproduction and reducing psoriasis inflammation.
Steroids, being the most common treatment for psoriasis, are referred to as anti-inflammatory because they reduce the swelling and redness of lesions.
However, anthralin, synthetic vitamin D3 and vitamin A are also used in prescription topical treatments to control psoriasis lesions, according to WHO.
More moderate or severe psoriasis can be treated with prescribed drugs that work throughout the body, WHO says.
This route is the next step when patients do not respond or are unable to take topical medications.
Olander said in moderate cases, shampoos with tar components and salicylic acid work well, although those shampoos can be challenging to find.
The National Institutes of Health says sometimes scalp psoriasis will clear on its own, or it can remain on the scalp for long periods.
Scalp psoriasis can get worse if the scalp becomes infected with bacteria or yeast.
If crusting of the scalp along with scaling occurs and the lymph nodes in the neck become enlarged, antimicrobial treatment may be prescribed.

Click here to read more at The Nassau Guardian