Nothing is more uncomfortable or embarrassing than having an itchy or flaky scalp or thinning hair. Nearly everyone experiences — at one time or another — a hair issue. You can manage some conditions easily, but may need to consult a nurse practitioner or other healthcare provider to identify and treat other problems.
Dry, white flakes in hair and on clothing is dandruff. Dandruff can be a bother at any age, but it’s more common in teenagers and adults. The cause is dead skin cells that linger in the head. Sometimes a fungus called malassezia contributes to the lingering of the skin cells. This condition is known as seborrheic dermatitis, or seborrhea. Seborrhea can cause the scalp to be red, itchy and flaky.
According to the American Academy of Dermatology, dandruff is not caused by bad hygiene, but infrequent shampooing can make the flakes more obvious. Dandruff is harmless and treated easily with an over-the-counter (OTC) medicated or anti-dandruff shampoo. It contains zinc pyrithione, which stops the itch and loosens the dead skin cells on the scalp. Providers recommend using the shampoo according to the directions on the bottle. Some medicated shampoos can be used daily, while others should be used only a couple of times a week. They are safe to use in children of all ages.
If the dandruff flakes and itch do not clear up with the medicated shampoo, you should consult your provider. Other scalp conditions — such as psoriasis, eczema or seborrheic dermatitis — could be causing the itch, and specific treatment may be required.
Just the thought of lice can make one’s skin crawl. But it is important to remember that, as uncomfortable as it is, having a case of lice is not a medical emergency or a reason to stay home from school. Lice are caused by a louse (Pediculus humanus capitis) that is transferred by close contact with an infected person. The louse lays eggs, called nits, close to the scalp and tightly attached to the hair shaft, and the cycle continues. The American Academy of Pediatrics (AAP) states that a lice infestation is not a sign of bad hygiene, lice do not carry diseases and complete eradication of lice is, unfortunately, not likely.
You or your provider can identify a lice infection easily. Timely and optimal treatment, both safe and effective, is important to stop the spread of the lice and make your child’s scalp feel better. The Centers for Disease Control and Prevention states it’s important to remember that these shampoos are insecticides that should be used with care. Never use more shampoo than recommended, keep it out of the eyes, and never use more than one type of shampoo at a time.
It can be useful to ask your provider which treatment has been the most successful in killing the lice and nits in the area where you live. There are many OTC lice treatments as well as prescription shampoos. The shampoos are very easy to use and are usually successful in killing the lice and nits.
OTC lice treatments include permethrin 1% lotion and pyrethrins + piperonyl but oxide. Prescription lice treatments include malathion 0.5%, benzyl alcohol 5%, spinosad 0.9% suspension and ivermectin 0.5% lotion.
Very rarely, medicated shampoos can cause scalp irritation or redness, burning, tingling, stinging or numbness. Contact your provider if the symptoms do not resolve in a few days.
If your child has lice, all family members should be examined. Those with close contact to an infected child, such as family members sharing a bed, should be treated for lice even if the lice or nits aren’t seen yet. Wash bed sheets, recently worn clothing and hats and haircare items with hot, soapy water. Dry items such as stuffed animals in the dryer at 130° F to kill the nits. Vacuum furniture, carpets and car seats to remove the lice. Bag items that cannot be washed in plastic until the lice naturally die, usually in about two weeks.
Alternative treatment of lice can offer some relief, but complete clearing of the lice infection has not be proven. Occlusive treatments coat the hair with mayonnaise, petroleum jelly, butter, olive oil or herbal oils in hopes of smothering the lice. This can leave the nits alive to hatch later on, starting the cycle all over again.
Essential oils have been used with varying results. The food and Drug Administration does not control the quality of the oils, and different brands can vary in strength. In addition, the oils themselves can irritate your child’s scalp. Do not use a blowdryer to try to kill the lice because the windy air can actually cause the lice to become airborne and spread the infection. Highly flammable agents, such as gasoline or kerosene, or treatments intended for animals should never be used on humans.
Removing every lice and nit from an infected head by hand is not impossible, but it is tedious and requires many comb outs. Shaving the head would be very effective in ridding your child of lice, but it can be very distressing to both child and parent, and is, therefore, not recommended by the AAP. Fumigant sprays should not be used, as inhaling them can be toxic.
There are now several companies to help you treat your child’s lice infection. Many cities have professional salons, hair clinics and in-home services that specialize in lice removal.
It’s a good idea to teach your children how to prevent getting lice. They should not share their hair brushes, try on each other’s hats or sit with heads together if there is a known outbreak.
Most people lose up to 100 hairs a day. These hairs grow back in the same follicle in a timely manner. However, sometimes hair is lost in chunks and doesn’t grow back. This hair loss is called alopecia. Alopecia is an autoimmune condition of the hair follicle where hair is lost, most commonly on the scalp. It happens to both boys and girls of all races and ages and can be an inherited trait. Alopecia is not a contagious disease. Sometimes it is caused by severe stress. The hair loss can be a small patch on the scalp (alopecia areata), the whole head (alopecia totalis) or the whole body (alopecia universalis).
There is no effective prevention or treatment for alopecia. Watchful waiting is a reasonable option because the majority of patients have spontaneous regrowth of hair without treatment. However, it’s important to consider the psychosocial and emotional impact of the hair loss on your child. Alopecia can cause anxiety, embarrassment, low self-esteem or depression in kids, especially adolescents. Cosmetic camouflage with wigs, perms or scalp dying has been helpful in some children. The National Alopecia Areata Foundation is a great resource for parents.
Alternative treatments for hair loss are not usually harmful, but they have not been proven by research to promote hair growth. Massaging essential oils, garlic, green tea or coconut milk into the scalp are some alternative remedies. Aromatherapy, yoga, meditation and creative visualization may be effective in reducing stress.
There are some steroid treatments for those with extensive or long-term alopecia. According to the National Institute of Health, a provider may prescribe potent topical steroids for a child with a severe case of alopecia. Injecting steroids directly into the balding scalp is another option. Occasionally, topical minoxidil is used in combination with the topical or intralesional steroid. If these methods fail, topical immunotherapy may be used. The most severe cases may require daily systemic corticosteroids, phototherapy, laser therapy or immunosuppressive agents. Children do not tolerate these treatments well. Also, providers and parents must consider the side effects of the steroids — such as slower growth and lower immunity.
Other causes of alopecia include fungal infections (tinea capitas), trauma such as tight hair bands (traction alopecia) and habitual hair pulling (trichotillomania). Occasionally, nutritional deficiencies or chemotherapies are to blame for hair loss. Telogen effluvium is a type of hair loss after an illness, stress or surgery. These conditions each require a particular treatment, so it’s important that a provider examine your child. Keeping a healthy head is important for overall physical and emotional health.
Jennifer Uzzell, MSN, APRN, CPNP-PC, began her nursing career in the Neonatal ICU. A PNP since 2001, she enjoys parent education, addressing breastfeeding concerns and encouraging good nutrition.