What if scalp flora was involved in sensitive scalp onset?

Guichard A. et al. Int J Cosmet Sci. 2016 Aug;38(4):429-30.

In brief

Sensitive skin, which is the sensation of prickling, burning or tingling, is also more recently been described on scalp and could be related to a disturbed microbiome. The same triggering factors (pollution, heat, stress, antibiotics, hair washing, hair care products) can induce a sensitive skin sensations and microbiome disruption. Management of sensitive scalp should aim are balancing a healthy microbiome.

Introduction

Sensitive skin is a self-reported condition mostly associated with the face. Sensitive skin (or reactive or hyper-reactive skins) is defined as skin that exhibits an erythema and ⁄ or subjective symptoms (pricking, burning, pain, pruritus…) to stimuli which alone, are non pathogenic by themselves (wind, heat, cold, water, cosmetics, stress…). Sensitive skin is usually reported on the face but can occur in other localizations in decreasing order of frequency: hands, scalp, feet, neck, torso or back. Sensitive skin is probably a multifactorial syndrome involving the cutaneous nervous system.
Scalp sensitivity exists and occurs frequently, with numerous triggering factors. The symptoms appear to be different from those of facial skin sensitivity

Scalp sensitive skin and microbiota

Like the rest of human skin, scalp hosts a microbiome, a complex microbial ecosystem of fungi, bacteria, viruses and parasites, all interacting with each other, although much less diverse than on skin. With its important sebum secretion, favorable pH and numerous hair follicles, the scalp is a privileged location for microbiota growing.
Dysbiosis of cutaneous scalp flora could play a role in the pathogenesis of sensitive scalp. Indeed, skin microbiome disruption can be induced by the same triggering factors of sensitive skin : pollution, heat, stress, antibiotics, hairwashing, hair care products. As, well, anti‐microbial treatments improve sensitive skin symptoms.

Conclusion

The pathophysiology of sensitive scalp is still poorly understood but could be linked to increased sebum excretion, altered sebum quality, altered skin barrier function and pH.
Treatment of sensitive scalp could therefore rely on rebalancing scalp microbiome, with probiotics and maintenaning an acidic pH instead of using antibiotics, antiseptics and/or topical steroids.