4.3 Scalp Disorders & Unfavourable Reactions
Key Takeaways
- Common non-contagious scalp conditions include dandruff (pityriasis), seborrheic dermatitis, psoriasis, and dry scalp — services may proceed with adjusted products and care
- Tinea capitis (ringworm) is a contagious fungal infection and pediculosis (head lice) is a contagious parasitic infestation — both require refusing service, referring the client, and sanitizing tools and workstation
- Hairstylists must recognize and refer but must NOT diagnose or treat disease; that is medical scope of practice
- Unfavourable reactions to chemical services include scalp irritation, allergic reaction, and over-processing — stop the service, rinse, and refer for medical care when severe
- Alopecia has several types (androgenetic, areata, traction, postpartum); refer unexplained or sudden hair loss for medical evaluation rather than promising products will regrow hair
Recognizing Scalp Disorders & Unfavourable Reactions
Quick Answer: Hairstylists must recognize common scalp conditions — including dandruff, seborrheic dermatitis, psoriasis, ringworm (tinea capitis), and head lice (pediculosis) — but must not diagnose or treat disease. Contagious conditions require refusing service, referring the client to a physician, and sanitizing tools and workstation.
Scope of practice for a Red Seal hairstylist does not include medical diagnosis or treatment. Your responsibility is to recognize when something is wrong, decline or stop the service when needed, refer the client appropriately, and protect other clients through sanitation.
Common Non-Contagious Scalp Conditions
| Condition | Appearance | Likely Cause | Stylist Action |
|---|---|---|---|
| Dry dandruff (pityriasis capitis) | Fine, white, loose flakes on scalp and hair | Dry scalp, irritation from harsh products | Service OK; use moisturizing/balancing shampoo; avoid hot water and scalp abrasion |
| Oily dandruff (pityriasis steatoides) | Yellowish, greasy, sticky flakes | Excess sebum mixing with skin cells | Service OK; use clarifying/balancing shampoo; gentle scalp care |
| Seborrheic dermatitis | Greasy yellow scales with inflamed, reddened skin, often along the hairline | Chronic inflammatory condition related to yeast (Malassezia) on sebum-rich skin | Service OK with care; avoid irritating the scalp; recommend a medicated shampoo if appropriate; refer if severe |
| Psoriasis | Thick silvery scales over reddened plaques, often itchy | Chronic autoimmune skin condition | Service OK with extreme care; do not pick or abrade scales; refer if widespread |
| Dry scalp | Tight feeling, powdery flakes, no inflammation | Lack of moisture, weather, harsh products | Service OK; moisturizing scalp treatment |
These are not contagious. You may perform services, but you should adjust products and technique to avoid worsening the condition and should recommend the client see a physician if symptoms are severe or persistent.
Contagious Conditions — Refuse Service and Refer
Some conditions are contagious and require you to stop or refuse the service, explain the situation tactfully to the client, recommend medical care, and sanitize your workstation and tools.
| Condition | Cause | Signs | Required Action |
|---|---|---|---|
| Tinea capitis (ringworm) | Fungal infection of the scalp and hair shaft | Round, scaly, reddish patches; broken hairs at the patch; sometimes kerion (inflamed mass); may include hair loss | Refuse service; refer to physician; sanitize tools and station; do not apply any chemical or wet service |
| Pediculosis capitis (head lice) | Parasitic infestation; adult lice and nits (eggs) attached to hair shaft | Intense itching; nits (tiny white/gray oval eggs) firmly cemented to the hair shaft near the scalp, especially behind ears and at nape | Stop service immediately; tactfully inform client; refer for medical treatment; bag and launder all linens; sanitize all tools, capes, combs, brushes; do not resume service until cleared |
A hairstylist must never apply color, perm, relaxer, or any wet service over active ringworm or lice — the chemicals can worsen the condition and the infestation will spread to other clients via shared tools and capes.
Alopecia (Hair Loss)
Alopecia is the general term for hair loss. Common types a stylist should recognize:
| Type | Pattern | Likely Cause |
|---|---|---|
| Androgenetic alopecia | Thinning at crown and temples, receding hairline | Genetic and hormonal (pattern baldness) |
| Alopecia areata | Smooth, round, sudden patches of complete hair loss | Autoimmune; refer to physician |
| Traction alopecia | Hair loss along hairline and at tight ponytail or braid attachment points | Repeated tension from tight styles; reversible if style changes early |
| Postpartum / stress shedding | Diffuse thinning 2-4 months after a trigger | Telogen effluvium; usually self-resolving |
A stylist can advise on styling, gentle care, and avoiding traction, but unexplained or sudden hair loss must be referred for medical evaluation — do not promise products will regrow hair.
Unfavourable Reactions to Chemical Services
Even with proper analysis, a client may react adversely to a chemical service. Recognize and respond correctly:
| Reaction | Signs | Response |
|---|---|---|
| Scalp irritation | Burning, redness, itching during or after a service | Stop service; rinse product immediately with cool water; apply soothing rinse; do not proceed |
| Allergic reaction | Hives, swelling (especially face/eyes), breathing difficulty, widespread rash | Stop service; rinse; call emergency services if severe; recommend urgent medical care; document |
| Over-processing | Hair breaking, gummy/stretching when wet, discoloration | Stop service; rinse; apply protein reconstructor only if hair can tolerate it; do not continue; recommend restorative care |
A patch test (preliminary skin test) 24-48 hours before a color service is the standard protection against allergic reaction. Skipping it is unsafe practice and is a clear Red Seal exam topic.
Scope of Practice: Recognize, Refer, Do Not Treat
The hairstylist's scope is to:
- Recognize when a scalp or hair condition is abnormal or contagious
- Refuse or stop the service when contagious or when the scalp is broken, inflamed, or infected
- Refer the client to a physician for diagnosis and treatment
- Sanitize tools, capes, and workstation to protect other clients
You must not diagnose disease, prescribe medication, or apply products intended to treat disease. This boundary protects both you and the client.
A client presents with intense itching and tiny white oval nits firmly cemented to the hair shaft near the scalp, especially behind the ears. What is the correct action?
Which scalp condition is a contagious fungal infection that requires referral to a physician rather than a salon service?