The root of it all: Geriatric patients face hair, scalp concerns.

Key Points

High Point, N.C. - Aging alters the scalp and the structure of hair, leading to medical and cosmetic issues, according to Zoe Draelos, M.D., a clinical and research dermatologist in High Point, N.C.

Also, each strand of hair becomes thinner and lighter in color. Some follicles quit manufacturing new hair entirely. Graying is advanced in geriatric patients, although Asian races are slower to gray.

Seborrheic dermatitis

Seborrheic dermatitis (SD) is a common condition for many age groups, but especially for geriatric patients.

"The incidence increases with age," Dr. Draelos says, "because the immune system, which prevents fungal growth from overpopulating the scalp, is in decline."

Researchers speculate that sebum and Malassezia trigger an immune reaction and inflammation, causing the scalp to shed white flakes.

SD is a controllable, but chronic condition. The goal of treatment is to reduce excess sebum, decrease the fungal population, relieve inflammation and eliminate accumulated layers of skin and oil that are flaking off as dandruff.

For treatment and maintenance, Dr. Draelos says, "I have patients shampoo two-to-three times a week. I get them to rotate between a corticosteroid shampoo; something to alleviate scaling, such as a shampoo containing salicylic acid; and an antifungal shampoo containing zinc pyrithione."

SD is more common and more difficult to treat in black patients, according to Dr. Draelos.

"They need to use a conditioner containing zinc pyrithione, instead of frequent shampooing. I think the best approach to severe SD is applying a low-potency prescription topical corticosteroid ointment to the scalp once a week," she says.

Post-menopausal scalp

According to Dr. Draelos, geriatric women frequently show up in her office complaining of a fine, white powdery scale on the scalp that itches.

The condition is associated with dry skin caused by hormonal changes. As with SD, scratching is the typical, irrepressible response, but it exacerbates hair loss.

"It is possible to remove all of the cuticular scale off of a hair shaft with only 90 minutes of continuous scratching by the fingernails. This leaves the hair shaft weakened and permanently damaged," she says.

Treatment usually involves corticosteroid scalp products containing fluocinolone or clobetasol, beginning with milder preparations and moving toward stronger ones as needed. Some products can be applied overnight, covered with a shower cap and washed off in the morning.

Cosmetic issues

Dr. Draelos says people frequently turn to cosmetic solutions, such as permanents and coloring, to address graying and thinning, but these treatments cause even more hair damage.

"Hair is basically a textile. It looks best when new and degrades with age and use," Dr. Draelos says.

Brushing while using a hair dryer should be avoided, whenever possible. Those who don't use a hair dryer should also wait until the hair is dry before combing or brushing.

"Wet hair is more elastic than dry hair, meaning that vigorous combing of the moist fibers can stretch the shaft to the point of fracture," she says.

The best way to keep hair out of the face is with scarves or elastic bands that circle the entire head. Furthermore, pulling the hair back with clasps or braids can precipitate traction alopecia.

Disclosure: Dr. Draelos reports no relevant financial interests.