What Is A Scalp Yeast Infection

Introduction

Yeast is a single-celled microorganism which belongs to the fungi kingdom. There are more than 1,500 species of yeast, out of which Candida Albicans is the most found yeast type in your body. It is generally present in the throat, mouth, intestines, and genitalia in small quantities. If it overgrows then it causes an infection called Candidiasis. If this fungal overgrowth takes place on the scalp, then it is called a Scalp Yeast Infection. Normally yeast is present in

• Gastrointestinal Tract: Mouth, on the tongue, gums, and inside of your cheeks, oesophagus, and intestines.
• Genitalia: Genital area of both man and woman. Overgrowth of Candida causes penile yeast infections in men and vaginal yeast infections in women.
• Skin: It can be present on the skin, especially in areas where there are folds so thus a higher possibility of moisture accumulation, such as under the breasts, in the groin, and between the toes.
• Nails: overgrowth of Candida on nails can cause nail discolouration, thickening, and brittleness
• Scalp: The scalp is one of the most common areas where fungal overgrowth can take place leading to scalp yeast infections.

Types of fungal overgrowth

Candida

This is a genus of Ascomycota fungi that causes fungal infection candidiasis in humans. Candida is a normal part of the skin's microbiota that naturally resides on the skin of humans. An overgrowth of Candida on the scalp can lead to "candida scalp infection" or "scalp yeast infection” which shows symptoms like:

• Mild to intense itching causing discomfort is the most common symptom of scalp yeast infections.  
• The skin on the scalp becomes dry, flaky, and scaly. The flakes are typically more persistent and may be larger than dandruff flakes. 
• Inflammation of hair follicles causes localised or widespread redness, small, raised bumps or pimple-like lesions. 
•  Painful Pustules or Blisters filled with pus.
• Tender or Sensitive Scalp leading to discomfort when brushing hair.  
• In severe and chronic scalp yeast infection it can lead to hair loss and thinning in the affected area.

Malassezia

This is a genus of Basidiomycota found in higher numbers in cases of dermatitis and dandruff in humans.¹ Malassezia is a type of yeast or fungus which is a normal part of skin microbiota that naturally resides on the skin of humans. The yeast’s interaction with the body’s immune system is thought to be the cause of flaking itching and redness.

• Dandruff: This is a common condition in which dead skin cells shed from the scalp which looks like white or yellow flakes.
• Seborrhoeic Dermatitis: This is a severe condition which involves red, scaly, and itchy patches on the scalp and can spread to the face, neck, and back.
• Pityriasis Capitis: This is a rare and specific type of scalp condition caused by Malassezia, which involves scaly patches on the scalp, along with hair loss and redness.

Factors contributing to infection

• It is common in young children, mainly between ages 3 and 7 as their immune system is still developing but it can occur in people of all ages.
• Scalp yeast infections can spread through direct contact with contaminated surfaces or objects. It also occurs more where people are in close contact with each other, such as in schools, day-care settings, and team sports along with places where bad hygiene practices of sharing personal items like combs or hats, towels, and beddings are followed. Fungal spores may remain viable on these surfaces for months further increasing the chance of spread.²     
• Warm and humid environments are favourable for fungal overgrowth.
• Individuals with thicker or coarser hair which can hold moisture for a longer time are more prone to scalp yeast infections, as the fungus thrives in moist and warm environment^.3
• Patients with weakened immune systems as in cancer, diabetes, HIV and those who are taking antibiotics for a longer time are also more prone to scalp yeast infections⁴      

Diagnosis of scalp yeast infection

Physical examination

The most common and usually sufficient way of diagnosing Yeast infection of the scalp is by physical examination. Your healthcare provider will examine your scalp and look for any redness, inflammation, flakiness, or pustules. They may also enquire about your medical history and symptoms like itching or any pain at the site of infection. If your healthcare provider is unsure of the type and cause of the infection, some lab tests may be required.

Microscopic Examination

• Skin Scraping: Here your doctor may take a small sample of skin or flakes from your scalp for microscopic examination. This can help to confirm the presence of yeast or any other microorganisms.
• Culture: A culture involves collecting a sample from the affected area and growing it in a laboratory to identify the specific type of fungus causing the infection. This helps to decide the treatment which is most effective for that type of yeast.
• Wood's Lamp Examination: sometimes doctors can take the help of ultraviolet light to highlight fungal infections This is called Wood's Lamp Examination.
• Biopsy: In rare cases, a skin biopsy is needed to obtain a deeper tissue sample for examination under a microscope.  

Treatment

Shampoos and cleansers

• Ketoconazole Shampoo: Ketoconazole is one of the widely used antifungal agents which helps reduce itching and flaking.⁵
• Selenium Sulfide Shampoo: It works by reducing the growth of yeast and eliminating flakiness. Selenium sulfide shampoos are available to purchase over the counter.
• Ciclopirox Shampoo: Ciclopirox is another antifungal shampoo which can be used for treating scalp yeast infection under the guidance of healthcare professionals.

Gently massage the shampoo into your scalp, especially on affected areas and leave it on for the duration recommended before rinsing it off.

Antifungal medications

1. Topical antifungals

If the condition is severe, antifungal cream or ointment containing ingredients like clotrimazole, miconazole, or terbinafine can be prescribed by your healthcare professional.

• Clotrimazole Cream: It can be applied to affected areas on the scalp to control the overgrowth of yeast and associated symptoms.
• Miconazole Cream: It can be applied topically to the affected areas on the scalp and is available over the counter.

2. Oral antifungals

Oral antifungals like fluconazole, itraconazole, or ketoconazole can be taken under the guidance of a healthcare provider.6

3. Topical steroids

In some cases, if the inflammation and itching are severe then your healthcare provider may recommend a mild topical steroid cream for local application.

Home remedies and lifestyle change

1. Maintaining good hygiene

• Regularly wash your hair and scalp, and use a medicated or antifungal shampoo as directed by your healthcare provider.
• Make sure to completely dry your hair and scalp after washing, swimming or exercising to avoid moisture build up.
• Do not share combs, brushes, hair accessories, or towels which are potential means of spread.

2. Avoiding irritants

• Avoid tight-fitting hats, headbands, helmets, or wigs that can trap moisture.
• Avoid scalp irritants like strong hair products with harsh chemicals and perfumes which can contribute to yeast overgrowth.
• Avoid frequent use of hot styling tools and tight hairstyles which results in dryness and irritation.
• Make your hairdresser or stylist aware of your scalp condition to ensure they consider it before any hair treatments.

3. Dietary considerations

Yeast feeds on sugar so limiting the consumption of sugary and processed foods can help to reduce fungal overgrowth.

Complications

Spread to other areas

• Untreated infection may extend to the forehead, face, or neck areas causing redness, itching, and the appearance of red, scaly patches.
• The infection that has spread to the ears shows symptoms like itching, discomfort, and development of red or flaky skin on the external ear.
• The presence of yeast on the scalp may lead to the spread of yeast spores onto clothing and bedding. Thus, spreading the infection on the neck, back and shoulders and in body skin folds such as the groin, armpits, and under the breasts.
• In rare cases, the yeast infection spreads to eyebrows and eyelashes, causing itching and redness.

Secondary infections

When the scalp is infected with yeast overgrowth, it becomes more susceptible to bacterial or fungal infections as a complication of a primary scalp yeast infection.

• Common bacterial infections that can occur along with yeast overgrowth include folliculitis (inflammation of hair follicles) and cellulitis (skin and soft tissue infection). Increased redness, warmth, tenderness, and the presence of pustules or abscesses. It needs to be treated with either oral or topical antibiotics, depending on the severity of the infection.

Emotional impact

Like any health condition,  a scalp yeast infection can create emotional and psychological distress.

• Itchiness and Discomfort: The physical distress caused by itchiness and discomfort may make it difficult to concentrate on daily tasks and can lead to frustration and irritability.
• Self-Esteem and Confidence: For self-conscious individuals, theirself-esteem and confidence can be affected by hair loss, flakes in hair and redness on the skin which affects appearance. 
• Anxiety and Depression: Living with a chronic or recurrent scalp yeast infection can cause social isolation due to concerns about their appearance and thus anxiety and depression for some individuals. T
• Poor quality sleep: Itching and discomfort can disrupt sleep patterns, leading to fatigue, mood disturbances, and further emotional stress. 

 FAQ’s

What causes scalp yeast infection?

Warm humid overcrowded conditions, bad hygiene practices like sharing combs, hair tools and other personal items, poor hair cleaning practices, leaving hair damp, and wearing tight-fitting headwear can cause moisture buildup. All of these are conducive to yeast overgrowth resulting in scalp yeast infection.

How does yeast infection on the scalp look like?

It looks like localised or widespread redness, cracks, or patches on the skin. White or yellow flaky scales or shedding. oft, moist areas on the scalp with white, pus-filled pimples along with pain and itchiness.

Can Candida yeast cause hair loss?

Yes, a Candida yeast infection on the scalp can cause hair loss. If the infection is severe or left untreated, the hair follicles become damaged because of the crust from infection further weakening the hair shaft, resulting in hair loss.

Who is at risk of scalp yeast infection?

Generally, it is more common in children as their immune system is still developing but anyone can have a scalp yeast infection. People with weakened immune systems, cancer, HIV, and organ transplants may be at greater risk. Also, people who take antibiotics may have a higher risk.

Summary

Yeast is a single-celled microorganism from the fungi kingdom. Candida is the most common type of yeast that grows on the scalp normally. When there is an overgrowth of this yeast it leads to scalp yeast infection with symptoms like redness, itchiness, flakes, and inflammation. If severe or left untreated it can cause inflammation of hair follicles or pustules and blisters filled with pus. It becomes painful to brush or style your hair as the scalp becomes tender or sensitive. If left untreated complications like secondary infections and hair loss can occur. Due to concerns about appearance, it can also cause social isolation, anxiety and depression

Scalp yeast infection is more common in school-age children, people living in crowded, humid conditions, and in patients with weak immune systems. Shampoos containing antifungal agents like ketoconazole and selenium sulfide, or topical antifungal ointments like clotrimazole cream and miconazole cream are available for treatment over the counter or under the guidance of healthcare professionals. In severe cases, oral antifungal agents can also be prescribed to get the infection under control. Along with prompt medical treatment and proper hygiene practices like avoiding sharing combs and towels, washing hair regularly, and drying them completely after shower to avoid moisture buildup can help in quick recovery and minimal chances of recurrence and complications.