Download Protection of the scalp

Protection of the scalp
Prof. Dr. med. Ralph M. Trüeb, Dermatologische Praxis und Haarcenter
Professor Trüeb, Zentrum Wallisellen, Bahnhofplatz 1A, 8304 Wallisellen
www.derma-haarcenter.ch
A sensitive scalp is a frequent problem in the physicians practice and quite often it
represents a real challenge for the dermatologist. In particular, patients with hair loss
and alopecia frequently complain also about scalp problems, and these must be taken
into account if a treatment program is to be successful. The main complaint relates to
a sensitive scalp, for which various causes can be taken into consideration: an atopic
predisposition of the skin, with a tendency to sebostasis, irritation and eczema, a Type
IV hypersensitivity to certain shampoo ingredients such as cocamidopropyl betaine and
preservatives, age-related dryness of the skin (senile sebostasis), intensive chemical hair
treatment, as well as other specific dermatological scalp afflictions such as seborrhoic
eczema, psoriasis or treatment sequels, especially those due to the prolonged use of
corticosteroid-containing topicals.
One condition, characterised by reddening of the
scalp, irritation, itching and burning sensations, that
does not respond to the usual anti-eczematous or anti-seborrhoic treatment, and for which there is no clear
nosocomial attribution to a specific dermatological disease, is often referred to as the Red Scalp Syndrome
(Fig. 1a,b). On the one hand, one observes the apparition of the unpleasant symptoms of the sensitive scalp,
such as itching, sensations of burning and of tension,
as seen after the application of hair-restoring products
and due to the drying out and irritating effect of the alcohol and/or of the propylen glycol solvent contained in
these preparations. On the other hand, the Red Scalp
Syndrome typically occurs in case of a vertex alopecia,
in the area maximally exposed to UV radiation and is
then considered as a chronic UV-caused lesion of the
scalp, a rosacea-like affection from the pathogenic
point of view.1 There is also increasing evidence that
exposition to UV radiation, apart from the skin lesions
also exerts a negative effect on hair growth,2 presumably by generating reactive oxygen radicals and in par-
Fig. 1 a
allel to an increase of the sensitivity of the hair papilla
fibroblasts to oxidative stress.3
In the presence of a specially irritable and sensitive
scalp, that seems not to tolerate any external stimuli
anymore, the term Burn-Out Syndrome of the scalp is
used. A burn-out generally designates a condition of
emotional exhaustion and can be considered as the
final state of a course that starts with idealistic enthusiasm and ends in disillusonment, depression and agressivity, after going through a whole series of frustrating
experiences. Again and again one observes such
patient careers in relation to the condition of the scalp
and its treatment by various therapeutic approaches.
Just as the well-known burn-out syndrome, which is
not recognised scientifically as a disease, but rather,
according to ICD-10, is a problem of mastering ones
life,4 the burn-out of the scalp must not be considered
as a distinct entity, but rather as a question of coping
with a problem.
Fig. 1 b
Fig. 1 a, b. Red Scalp Syndrome, before and after 6 months of treatment with a hamamelis-containing shampoo (Erol® Energy Shampoo)
It is a matter of protecting the scalp against further
negative environmental, medical and cosmetic impacts,
of acting towards its appeasement and restoration and
at the same time of regaining the trust of the patient.
The first step in the treatment and prevention of
the irritated scalp consists in an optimisation of the
hair-washing frequency. Persons with fatty hair should
wash their hair often, sometimes even daily, persons
with dry hair less often. This is why a mild shampoo
must be chosen, to avoid ingredients with a high irritation potential, or containing known contact allergens.
Of particular interest in this context are the anti- and
abirritative active principles found in the traditional phytomedicine, such as camomile (Marticaria chamomilla),
balloon plant (Cardiospermum halicacabum), peony (Paeonia lactiflora), and the Virginian Witch Hazel
(Hamamelis virginiana).
When Europeams encountered Native North
Amercians for the first time, the groups dwelling in the
Northeastern region used about 275 plants for medicinal purposes. Hamamelis virginiana (Fig. 2) was
among the most important of those plants, and was
used for the treatment of superficial skin wounds and
skin inflammations. From the middle of the nineteenth
century onwards, hamamelis finally became a constituent of the official European and American medicine.
The foliage leaves (Hamamelidis folium) as well as the
Fig. 2. Hamamelis twig (usable parts of the plant: bark and leaves)
have been specially developed for the care and treatment of the sensitive scalp. The shampoo is composed
of extracts of Hamamelis virginiana and a shampoo
base of mild tensidic character, free of cocamidopropyl
betaine and parabens.
Over a period of six months, from October 2009 to
March 2010, an observational study was carried out
Medicinal drug:
Preparation:
Ingredients:
Application:
Hamamelis water
(Hamamelidis aqua)
Water-vapour distillate of
freshly cut or partly dried
twigs and leaves.
Essential oil
Hamamelis water is used for the treatment
of wounds and in cometics.
Hamamelis bark
(Hamamelidis cortex)
Water-vapour distillate of the
dried, chopped up bark of
stems and twigs.
Tannins (ca. 8–12 %), such as
Hamamelitannin and free gallic acid.
Also essential oil, ellagitannin and
flavonic glacosides.
Used for inflammations of the gum and
mucous membrane of the mouth and for
light skin lesions, hemorrhoids and varicous- vein complaints. Component of
numerous creams, onguents or other medicinal finished products.
Hamamelis leaves
(Hamamelidis folium)
Water-vapour distillate of
dried hamamelis leaves.
Tannins (ca. 3–8 %), especially
hamamelitannin as well as single
and oligomeric proanthocyanidins,
essential oil, (Ionon, safrol), flavonoids and caffeic acid derivatives.
Used for slight skin lesions, local inflammation of the skin and mucous membranes, hemorrhoids and varicous-vein
complaints.
bark (Hamamelidis cortex) of the native Northamerican
Virginian witch hazel are used. Today, the following
commercially used medicinal preparations are obtained
from Hamamelis, with the corresponding ingredients
and applications, as listed in the table:5
Quality plays an important role. Commonly used
hamamelis distillate (HMM-Water) elicits only low peaks
for the active-principles. To achieve a rapid regeneration of the scalp and a positive course of the entire
therapeutic process, the use of high-grade active principles, from hamamelis obtained from wild stocks and
sustainable production, is therefore essential. The Erol®
Energy hair care products, based on Virginian witch
hazel, with the botanical name Hamamelis virginiana,
at the Dermatologic Clinic of the University Hospital
Zurich, during which the hamamelis products Erol®
Energy Shampoo and Tonic were dispensed to patients
complaining about subjective irritation symptoms of the
scalp, with or without objectiveyl observable alterations
such as reddening, squames, papules and excoriations. Many patients had previously used various medicinal shampoos, mainly against seborrhea and dandruff, as well as corticosteroid-containing topicals, but
without success. After a period of application of four
weeks, the majority of patients reported an improvement of the subjective manifestations of irritation, and
after the end of the application they rated the tolerance
of both products as good to excellent. Overall, the majority of the patients were satisfied with the products.
The documented efficacy can be attributed chiefly to
Hamamelis virginiana. The main active principles are
the flavonoids and tannins contained in hamamelis, as
a natural source of antioxidants and radical captors.6
Furthermore, the vegetal ingredients additionally contained in Erol® Energy Hair Tonic promote the metabolism and blood flow (rosemary, field horsetail), inhibit
the proliferation of propionibacterium (rosemary), are
active against dandruff (rosemary), strengthen the connective tissue (field horsetail) and stimulate healthy hair
growth (birch, stinging nettle).
Since that time, in the period between August 2010
and December 2013, Erol® Energy Shampoo has been
applied successfully in 1‘373 patients (1‘233 women
and 140 men) at the dermatological practice and Hair
Center Professor Trüeb, to treat a irritable scalp conditions or as a concomitant treatment to a minoxidil therapy for androgenetis alocepia. Durin g this period, 369
(26.9%) have received the Erol shampoo more than
once. Experience has shown that the local application
of topical minoxidil products (2 to 5%) in an alcohol
and water base for the treatment of androgenetic alopecia often leads to irritation of the scalp, which can
have a negative impact on patience compliance. The
complaints of the patients and the reddening of the
scalp can be misinterpreted as a seborrheic eczema
and treated with irritaton-causing anti-dandruff shampoos or topical corticosteroids in alcoholic bases (scalp
applications), and thus only aggravate the problem. As
a concomitant therapy for topical minoxidil in androgenetic alopecia, treatment with a mild shampoo with
reduced irritative potential, based on Hamamelis, is
therefor a much more suitable option.
References
1. Oberholzer PA, Nobbe S, Kolm I, Kerl K, Kamarachev J,
Trüeb RM. Red scalp disease--a rosacea-like dermatosis
of the scalp? Successful therapy with oral tetracycline.
Dermatology 2009;219:179-81
2. Trüeb RM. Is androgenetic alopecia a photoaggravated
dermatosis? Dermatology 2003;207:343-8
3. Bahta AW, Farjo N, Farjo B, Philpott MP. Premature
senescence of balding dermal papilla cells in vitro is associated with p16(INK4a) expression. J Invest Dermatol
2008;128:1088-94
4. ICD-10: Z70-Z76 auf DIMDI
5. Willibald Pschyrembel: Pschyrembel Naturheilkunde und
alternative Heilverfahren. 3rd edition. De Gruyter, Berlin
2006, ISBN 3-11-018524-5
6. Reuter J, Wölfle U, Korting HC, Schempp C. Which plant
for which skin disease? Part 2: Dermatophytes, chronic
venous insufficiency, photoprotection, actinic keratoses,
vitiligo, hair loss, cosmetic indications. J Dtsch Dermatol
Ges 2010;8:866-73
Detailled information under www.hamamelis.ch
Conclusion
The choice of suitable hair-care products represents
an important aspect in the treatment plan for the sensitive scalp. Hair washing is the most common form of
scalp and hair treatment. In this context, a shampoo
must accomplish more than just cleanse. It should
additionally be adapted to the specific requirements
of the different hair types, to age and to washing routines. But most importantly, it should have a positive
influence on problematic scalp conditions. With the
Erol® Energy hair-care products, the advantages of
Hamamelis are now also available for the treatment of
the scalp, especially in the context of the problems associated with the Red Scalp Syndrome, the burn-out of
the scalp and the topical minoxidil treatment for androgenetic alopecia.
Products
Pharmacode
Main active principle
Particulars
Erol® energy Hair
Shampoo Hamamelis
3589275
200 ml
EAN 7640126460109
Hamamelis virginiana as a distillate
with increased active-principle
content.
Hamamelis distillate Apomedica from wild
stocks without pesticide residues and additives.
Erol® energy Hair Tonic
Hamamelis
3589252
200 ml
EAN 7640126460116
Hamamelis virginiana as a distillate
with increased active-principle
content.
Hamamelis distillate Apomedica from wild
stocks without pesticide residues and additives. In case of dandruff, reddening, and
itching; favours hair growth.