Rebecca Kazin, MD, FAAD is a Board Certified Dermatologist at the Washington Institute of Dermatologic Laser Surgery and is on faculty at the Johns Hopkins School of Medicine. Her company RKMD will launch a line of therapeutic hair care products in 2015.
HAVE YOU SEEN ANY TRENDS IN HAIR PROBLEMS OR HAIR CARE?
I have noticed in my clinical practice that many people experience some form of scalp irritation at one point or another especially if they are coloring or straightening their hair. These symptoms may be linked to the hair treatments patients are either performing at home or having done in salons. Patients often report scalp sensitivity, itching, and dryness, which signal inflammation in the scalp. This is important to recognize and treat because inflammation in the scalp can affect the normal growth of the hair in the follicle. This may cause the hair to be brittle and lack shine as the cuticle will not form properly.
There has been a trend toward recognizing that optimal growth and appearance of hair is based on a healthy scalp. I encourage patients to think about their hair care like it is “skin care for the scalp.” And if we keep this concept in mind, we can maximize the growth of beautiful healthy hair.
HOW DO YOU APPROACH SCALP INFLAMMATION?
If a patient has an irritated scalp, I typically first recommend that they use a shampoo that is sulfate free and sodium chloride free. There have been some concerns that sulfates are medically harmful, which largely have been dispelled. But we do think that the sulfates, which are a gentle type of surfactant, are harsh on the scalp and the hair. It's like using really harsh soap on your face. It strips your scalp and your hair of its natural oil, which gives hair its shine. We want the hair to have a little bit of natural oil to add shine without looking greasy. Anyone who treats their hair—coloring, straightening, etc. — is introducing chemicals and products that can compromise the health of the hair. If you then use a shampoo with harsh sulfates and sodium chloride, which depletes the protective scalp oils, the scalp becomes inflamed and affects hair growth. Hair becomes brittle, frizzy, and dry. Sulfate-free shampoos tend to be a little bit more expensive, because the sulfate surfactants are very cheap, but using the pricier shampoos will ultimately improve the appearance of the scalp and hair.
When I talk to people about sulfate-free shampoos, I warn them that most of them won't lather as much as standard shampoos, but that doesn't mean that your scalp and your hair are not getting clean. It's just getting used to a different amount of lather. Some sulfate-free shampoos lather more than others. I have found personally, because I use only sulfate-free shampoos, that you need to use a little bit more of the shampoo itself and you need to wet the scalp and the hair more than you typically do with regular shampoo. With that in mind, you can actually get a good bit of foaming and feel like you've actually done some cleansing.
WHAT ABOUT OTHER HAIR CARE PRODUCTS?
I tend to recommend that people who have treated hair, even if they don't typically feel like they need a conditioner, add one. Again for treated hair, the hair shaft and the cuticle that surrounds the hair shaft gets traumatized by the treatments. If you think of the cuticle as a ruffled feather, the conditioner helps lay those feathers down nicely and that's what makes your hair looks shiny and it helps decrease the appearance of split ends. I tell patients that even if they don't want to use a conditioner on the scalp because they feel like it makes their roots heavy and look greasy, then they should just use it on the ends and wash it out.
ARE THERE ANY TARGETED TREATMENTS YOU RECOMMEND FOR SCALP PROBLEMS?
If we are going to think about scalp care the way we think about skincare, then we also need to evaluate the scalp like we evaluate the skin. If patients have scalp symptoms like I talked about above—obvious irritation and inflammation— then in addition to sulfate free shampoo I have them use a shampoo that can alleviate some of their symptoms.
I developed a hair care line because I had trouble finding an over-the-counter sulfate-free shampoo that sufficiently addressed the scalp symptoms. In fact, many shampoos out there that effectively treat the scalp worsen the appearance of the hair, makes the hair dry, brittle, frizzy. The shampoos out there that effectively help your hair don't always effectively treat your scalp. There is a large treatment gap for this common scenario.
Current options include prescriptions to target scalp irritation. There are over-the-counter products available for scalp irritation from the major hair brands. Knowing that these may dry out patients' hair, I have them wash their scalp with it first—rub it into their scalp and then rinse. Then they should wash their hair with a sulfate-free shampoo and rinse that, and then use a little bit of conditioner on the ends to help counterbalance the dryness from the initial shampoo.
For patients with thinning hair, I recommend topical minoxidil, however, I do warn them that sometimes topical minoxidil can be irritating to an inflamed scalp. I advise them not to start minoxidil until we get the scalp irritation under control.
I have been pleased with the dry shampoos that have been out. Many women who are chemically treating their hair do not typically wash their hair every day. This is because of the drying sulfates as mentioned above and because they want to save themselves another blow out in which excessive heat damages their hair. The dry shampoos tend to come in a powder or in aerosol and I have tried both and I like both. Just applying dry shampoo to the roots gives a nice root lift because it decreases the oiliness right at the roots and I don't apply it to the rest of the hair because it can make the rest of the hair not look shiny.
WHAT ABOUT SUNSCREEN FOR THE EXPOSED SCALP?
This isn't usually a big concern for women, who tend to have enough hair to provide coverage and can easily wear hats and accessories for coverage. For men, if they just started thinning, it may be best to apply sunscreen directly to the scalp with a Q-tip so it does not make the hair look greasy. A patient who doesn't have much hair probably could use a spray sunscreen and not worry too much about the hair looking greasy.
Men with the U-shape hair distribution around the sides and not much on top have options. A translucent powder sunscreen is a good option. Some men would never think of putting a powder product on, but this is translucent, invisible, and it really gives a nice physical block because it's zinc and titanium based.
I use powder sunscreen every day on my face, and I think it's nice sometimes to use on other areas that people don't think about.
ARE SUPPLEMENTS OR OTHER THICKENING PRODUCTS WORTH RECOMMENDING?
Many patients ask about taking oral biotin. I think this product can strengthen the hair, but do not think that it grows hair.