About two years ago, disaster struck and forced me to get scalp tips beyond a casual Google search. More specifically, I noticed it was a bit…out of whack. There was excessive dandruff, a bit more skin sensitivity, and less-than-favorable-scent. (Prior to this, I could wash my hair every other week and still not smell a thing). So the jig was up. I knew there was something going on. And as someone who prefers to get to the root cause of all problems and take the necessary actions to make whatever it is, right, I immediately sought out assistance.
My first stop was the trusted hairstylist who’d been slaying my presses for a couple of years. She immediately suggested I see a dermatologist. “Even though I don’t see anything wrong with your scalp” she urged, “they have this shampoo that they prescribe and some of my clients use it. Whatever it is, can be put to bed with that cleanser.” So off to the dermatologist, I went. The first appointment took a mere three minutes. The MD inquired about my symptoms, took a very swift glance at my hair and scalp and voila! the mystical shampoo prescription and a topical lotion landed in my lap.
The doctor recommended using the shampoo (Ketoconazole 2%) daily; more specifically, leaving the formula on my scalp for 3-5 minutes before rinsing. As a black woman, part of me knew that daily cleansing just wasn’t going to work. And as for the topical lotion that was to be applied to my scalp every day…“Manageable,” I concluded. Or so I thought. The shampoo ended up wreaking havoc on my strands.
So I took the prescriptions back to my hairstylist and her suggestion was to use the Ketoconazole first and then follow up with a moisturizing shampoo and conditioner. This worked for about a year. However, I still didn’t understand the source of the scalp issue, and it was clear that the prescriptions were only bandages. I didn’t like not knowing what was going on internally. So instead of going back to that specific dermatologist, I set up an appointment with a trichologist to see if she could help me get to the bottom of my sandy surface.
“The relationship between the trichologist, dermatologist, and hairstylist is one of the most necessary relationships as it pertains to you having a healthy scalp and hair,” explained CJ Dunford, trichologist, hair restoration expert, creative director and education specialist for Team Sheer Lace at the Beauty Boutique in Brooklyn New York. “You want to reach out to all of them and have them collaboratively helping you.”
Now that I’ve done just that, here are the correct steps to follow if you notice a change in your scalp health too.
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1. Start With Your Hairstylist
Hairstylists should have expertise that goes beyond basic styling. They can help determine the problem and at least point you in the right direction. “I have found some hairstylists have done the work in studying trichology in hair and scalp analysis. They can give you an effective solution until you can get to your dermatologist” Dunford tells. “Or you might even arrive at a solution before then.”
A good stylist is also going to respect your own knowledge of your hair. So before you seek any professional help, keep a record and list of identifiable symptoms that you can share. For instance, “If you’re shampooing at home in the shower or sink when you comb through, look at how much hair is coming out. Take a photograph of it. Track if you’re experiencing any shedding or breakage from week to week, and if that amount is varying.”
Dunford also recommends tracking your diet and any new products purchased. Taking a photograph of the ingredients list could also help speed up the process. Ideally, a hairstylist should be able to tell you if any of them are contributing to your scalp issues.
2. Seek a Dermatologist
If you aren’t able to solve your problem after that first stop, it’s time to see a dermatologist. I was referred to Dr. Shari Hicks-Graham, board-certified Columbus dermatologist, a fellow of the American Academy of Dermatology, and founder of LivSo. Most people understand dermatology as the branch of medicine dealing with the structure of skin but fail to realize that the scalp is included. Often times, whatever is happening on your face is happening on your scalp too.
“If our face gets oily throughout the day, the same thing happens in our scalp,” said Hicks-Graham. “The Ketacolozone shampoo 2% is an anti-fungal shampoo. It does a nice job of removing fungus and yeast that can sometimes play a role, especially when we’re wearing protective styles and if you have an active lifestyle.” After looking at my Instagram, Graham concluded that I was a workout queen though I hadn’t worked out in over a year. However, this reminded me that my scalp issues did start around the end of 2017 when I was on a cardio kick.
“When you lead an active lifestyle, there are some trade-offs that we have to account for” she continued. “The sebaceous gland that makes oil, that naturally coats our scalp to help keep it from breaking down; it provides shine to our hair and dumps right into the hair follicle. That’s how it gets out on the surface of the skin. When we are perspiring, there are sweat glands that make perspiration. There are glands that make odor and scent. All of them have a particular function. We might appreciate that or we may not appreciate that. Really it’s there to keep us healthy and fight off unwanted bacteria.”
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All of those side-effects are exaggerated when we’re active. In this case, an uptick is cleansing should keep your scalp in check. This is something I neglected to do when I was in workout mode. I thought once a week was enough, but clearly looking back and dealing with what I have now, I probably should have done it more often.
“My recommendation for my patients who have very active lifestyles is to certainly shampoo more than once a week. That seems wild to most of us in the textured hair community, or certainly us with curly hair or people of color. It’s a lot of work and we worry about whether that can be good for the health of our hair because we worry it’s going to dry it out,” said Hicks-Graham. Fortunately, there are products formulated specifically for this, including my personal favorite: LivSo.
Not only are the ingredients gentle; they also help to reduce yeast levels using an active ingredient called Xylitol. It’s not a substitution for a prescription but it can be used successfully as an adjunct once your scalp is in great shape.
3. Find a Trichologist
Finally, if your derm-subscribed products aren’t working, it’s time to let a trichologist decide if another bodily issue is tied to your scalp problems. Simply put, trichology is the medical branch that deals directly with the hair and scalp. A qualified trichologist will diagnose your scalp based on a holistic view of the entire body. Ideally, the one you choose should have an obvious education, as well as a successful practice with returning clients. According to Dunford, a referral is the best way to find one. That along with a hairstylist and dermatologist will ensure that you finally figure out what’s wrong and get the help you need.
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So after submitting my history, and chatting on the phone with Dunford and Graham, I went into the Beauty Boutique to start treatments. The first step was a hair and scalp analysis that uses a magnifier to look at the hair on a microscopic level. “We can see the scalp, the hair, the follicle, and if there’s any obstruction,” said Dunford. “If there’s any sign of fungus, it’s usually pointed out by some discoloration on the scalp or an excessive skin build-up or skin cellular multiplications where the skin has started to layer and harden.”
There wasn’t any discoloration or anything to make her think fungus on my scalp. However, I was still dealing with flaking, so Dunford concocted a cleansing routine based on her analysis. After applying a cocktailed pre-poo of essential oils, she shampooed with the LivSo shampoo, Xylitol, and a dose of the exfoliant glycolic acid. Next came the conditioner on the scalp, which was applied using a greasing method, pulling it through from root to tip. Later, we used LivSo moisturizing lotion directly on the scalp and then transitioned into all Monat anti-aging hair products. After blow-drying my strands, Dunford used a high-frequency laser comb on my hair and scalp to regenerate skin cells and attend to any inflammation or discomfort on the skin and scalp. I was then braided up and unit-blessed.
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The Verdict
Ultimately, I learned that failing to adjust your beauty routine to your lifestyle choices (like an increased workout schedule) can actually wreak havoc on your scalp. The longer you let the problem persist, the longer it takes to cure. One of my biggest concerns was that I would have to use the Ketoconazole shampoo and topical solution forever. Dr. Graham’s answer was “well, maybe.” In other words, I may have to use it intermittently, like every other month or once every couple of washes. So it’s good to keep on hand either way.
I also ended up with some regrowth issues, even after seeing all three experts. I noticed that I was having a harder time regrowing my frontal perimeter than in the past and sort of blamed this entire process. As it turns out, I’m just being impatient. “Remember to give it time! It is not uncommon for it to take months, even years, to see a substantial improvement. Be encouraged, however, because there are additional treatments like platelet-rich plasma injections and other medications that have been helpful for regrowth of hair under these circumstances” Graham told me.
We’ll see how it goes. For now, I remain hopeful.