1. DR.TARUN KUMAR DWIBEDI
PG SCHOLAR SHALAKYA TANTRA
SJG AMC & H, KOPPAL.
THE SCALP, HAIR & IT’S APPLIED
ANATOMY

2. THE CONTENT…
THE SCALP
• EXTENTEND
• LAYERS
• SKIN
• CONNECTIVE TISSUE (DENSE)
• APONEUROTIC LAYER /GLEA
APONEUROTICA
• LOOSE CONNECTIVE TISSUE
• PERI-CRANIUM
• MUSCLES
• BLOOD SUPPLY
• LYMPHATIC DRAINAGE
• NERVE SUPPLY
THE HAIR
• PARTS
• LAYERS
• GROWING CYCLE OF HAIR
• ANAGEN
• CATAGEN
• TELOGEN

3. APPLIED ANATOMY
1. SCALP AVULSION
2. SEBASEOUS CYST
3. TELOGEN
EFFLUVIUM
4. NEVUS
5. DISCOID LUPUS
ERYTHEMATOSUS (D
LE)
6. DISSECTING
CELLULITIS OF THE
SCALP
7. NON SCARRING HAIR
LOSS
8. TRICHOTILLOMANI
A (TTM)
9. KERION
10. ALOPECIA
UNIVERSALIS
11. ALOPECIA TOTALIS
12. ALOPECIA AREATA
13. TRACTION
ALOPECIA
14. FOLLICULITIS
DECALVANS
15. ACNE KELOIDALIS
NUCHAE
16. ACTINIC
KERATOSIS (AK)
17. DERMATITIS
HERPETIFORMIS
18. TRICHORRHEXIS
NODOSA
19. SCALP ECZEMA
20. LICHEN SIMPLEX
CHRONICUS
21. SCALP PSORIASIS
22. HEAD LICE
INFESTATION
23. MALE PATTERN
HAIR LOSS
24. LICHEN PLANNUS
SCALP
25. CRADLE CAP
26. PREMATURE
GREYING OF HAIR
27. TRICHORRHEXIS
INVAGINATA
28. INGROWN HAIR
29. MONILETHRIX
30. HAIR CASTS
31. FOLLICULITIS
32. TINEA CAPITIS
33. SEBORRHOIC
DERMATITIS
34. DANDRUFF

4. THE SCALP
• Extend from top of the forehead to the superior nuchal line
behind.
• Laterally up to the zygomatic arch and external acoustic meatus

5. LAYERS OF SCALP
• 5 layers
• S -skin
• C –connective tissue (dense)
• A –aponeurotic layer / glea aponeurotica
• L –loose connective tissue
• P –peri-cranium / osteum

6. THE SCALP

7. SKIN
• Thick & hairy
• ADHERANT TO THE EPICRANEAL APONEUROSIS / GLEA
APONEUROTICA (a tough layer of dense fibrous tissue) THROUGH
THE DENSE SUPERFICIAL FASCIA.
• Numerous sebaceous gland.

8. CONNECTIVE TISSUE (DENSE)
• More Fibrous And Dense In The Center Than Periphery Of Head
• Provides Proper Medium To The Nerves And Vessels Of The Skin .

9. APONEUROTIC LAYER / GLEA
APONEUROTICA
• Freely Movable On Pericranium
• On Each Side It Is Attached To The Superior Temporal Line
• It Receives The Insertion Of Frontalis And Occipital Bellies
Posteriorly.

10. LOOSE CONNECTIVE TISSUE
• Extends anteriorly into the eye lids
• Posteriorly to the highest and superior nuchal lines and on
each side to the superior temporal lines.

11. PERI-CRANIUM
• Loosely attached to the surface of the bones but firmly to the sutures
.

12. MUSCLES OF SCALP
OCCIPITALIS
• Origin –Superior
nuchal line of
the occipital
bone and mastoid
process of
the temporal bone
• Insertion- glea
aponeurotica
• Posteriorly
• Pulls scalp back,
anchors aponeurosis.
TEMPOROPARIETALIS
• Origin –auricularis
muscle
• Insertion- glea
aponeurotica
• On both sides
• Tenses scalp, moves
ear.
FRONTALIS
• Origin- glea
aponeurotica
• Insertion-orbicularis
oculi
• Anterior part of scalp
• Raises eyebrows and
wrinkles forehead
OCCIPITOFRONTALIS
• Origin- Two occipital
bellies and two
frontal bellies
• Insertion- glea
aponeurotica
• It consists of two parts
or bellies: The occipital
belly, near the occipital
bone, and the frontal
belly, near the frontal
bone.
• Wrinkle the
forehead, widen
the eyes, and
• raise the ears

15. BLOOD SUPPLY
Arterial supply
• Branch of external carotid artery
• Supratrochlear
artery
• Supraorbital artery
• Superficial temporal
artery
• Posterior auricular
artery
• Occipital artery
Venous supply
• Branch of EJV AND IJV
• Supratrochlear
veins
• Supraorbital veins
• Superficial temporal
vein
• Posterior auricular
vein
• Occipital vein

16. BLOOD SUPPLY

17. LYMPHATIC DRAINAGE
• The part of the scalp that is anterior to the auricles is
drained to the parotid, submandibular, and deep
cervical lymph nodes.
• The posterior part of the scalp is drained to the
posterior auricular (mastoid) and occipital lymph nodes.

18. NERVE SUPPLY TO THE SCALP
• Supratrochlear nerve
• Supraorbital nerve
• Zygomaticotemporal n.
• Auriculotemporal n.
• Greater auricular n. (C2, c3)
• Third occipital n.
• Greater occipital nerve (c2)
Posteriorly up to the vertex.
• Lesser occipital nerve (c2)
Behind the ear.

19. THE HAIR
• It’s a protein filament grows from hair follicle in
dermis of skin.
• Keratin is the protein found in hair.
• Pigments of hair is responsible for its color.

20. ARRECTOR PILLI
MUSCLE

21. PARTS OF HAIR
IT HAS 3 PARTS
1. ROOT –PART OF HAIR ELOW THE SURFACE OF
SKIN, Widest Part--follicle
2. SHAFT- The body
3. TIP– The End Of Hair , The Narrowest
Part.

22. HAIR BULB
• Part of root
• The hair bulb is the bulb-shaped structure at the base of
the hair follicle
Each hair bulb includes:
• The area of cells that produces new hairs by mitosis is the
GERMINAL MATRIX
• PAPLLA is the area that contains many blood
vessels which supply nutrients to nourish the growing hair

23. ROOT SHEATH
Two layers :- surrounded by an outer sheath of connective tissue.
• External epithelial root sheath :- Consists of several layers of
cuboid epithelial cells visible when stained with H&E stain,
a histology stain
• Internal epithelial root sheath :- consists of three layers:
1. Henle's layer
2. Huxley's layer, and
3. Cuticle of inner sheath.

25. LAYERS OF HAIR
It has 3 layers
1. Cuticle- outer covering with over lapping
scales
2. Cortex – PROTEIN RICHED,
ARROUND THE MEDULLA HAVING
PIGMENTS (melanocytes).
3. Medulla – the central core part

26. GROWING CYCLE OF HAIR
There are cycles of hair growth & loss during which the
follicle presents different appearance
It has 3 growing stages
1. Anagen
2. Catagen
3. Telogen

27. ANAGEN
• It’s the growing phase of the follicle.
• Maximum development of hair takes place
• Mitosis occurs during this stage
• ~90 % hairs are in this stage
• Lasts for 2-6 years
• Growth 1-1.5 cm / month.
• Hair bulb is rounded, full and contains melanin

28. CATAGEN
• It’s the transition stage ~1-2 % of hairs are
at this stage
• Lasts for 1-2 weeks
• Mitosis stops hair =>growth ceases.
• Germinal matrix shrinks away from the
papilla

29. TELOGEN
• The resting stage ~8-9% of hairs
• Lasts for 3-4 weeks
• Follicles has shrunk away from the papilla
• The inferior segment of follicle is absent in this
phase and this is succeeded by the next anagen
phase.
• Hairs fall out ~50-80 hairs / day

31. • The ‘danger area of the scalp’ is the area of loose connective
tissue. As pus and blood spread easily within it, and can pass
into the cranial cavity along the emissary veins. Hence
infection can spread from the scalp to the meninges, which
could lead to meningitis.
• Scalp laceration bleeds profusely as elastic fibres of
underlying glea aponeurotica prevent initial vessel retraction.
• Hence significant blood loss which may lead to clinical
shock

32. • So it is essential to control all bleeding points before
suturing the lacerations.
• Failure to control the bleeding points can leads to
hematomas.
• Repair of scalp require full thickness tension sutures
because the glea aponeurotica will otherwise gape as
the occipital and frontal bellies contract.
• Scalp flaps can be used in craniofacial surgery for
correction of congenital deformity,

33. SCALP AVULSION
• Avulsion - body structure is forcibly detached from its
normal point of insertion
• The inner smooth surface of avulsed scalp is first placed
on a spherical vessel or container. The long hairs is then
clipped and shaving commence from front to back and
side to side .The eye brows are not shaved.

34. • After the completion of shaving the scalp is washed
thoroughly in running tap water. Then the scalp is taken off
from the container. The scalp is prepared without any hairs in
the inner part of it.
• All patients has acceptable recovery of sensation of forehead
and scalp by 6-9 months after replantation.
• There will be satisfactory hair growth

36. SEBASEOUS CYST
• Due To The Presence Of Numerous Sebaceous Gland
The Scalp Is Commonest Site Of Sebaceous Cyst.
• The Sebaceous Gland Produces The Oil Called Sebum
That Coats Our Hair And Skin.
• Cysts Can Develop If The Gland Or Its Duct, The
Passage Where Oil Is Able To Leave, Becomes
Damaged Or Blocked. This Usually Occurs Due To A
Trauma To The Area.
• Treatment:-
Surgical Removal
Of The Cyst.

37. TELOGEN EFFLUVIUM
• Thinning or shedding of hair resulting from the early
entry of hair in the telogen phase.
• Emotional or physiological stress may result in an
alteration of the normal hair cycle and cause the
disorder, with potential causes including eating
disorders, fever, childbirth, chronic illness,
major surgery, anemia, severe emotional disorder, crash
diets, hypothyroidism, and drugs
• Vitamin d ” levels may also play a role in normal hair
cycle

38. NEVUS
• Visible, Circumscribed, Chronic Lesion Of
The Scalp Skin.
• Can Be Either Congenital Or Acquired.
Management
• Chemical Peels
• Cryotherapy
• Dermabrasion
• Electrodessication
• Laser Ablation

39. DISCOID LUPUS ERYTHEMATOSUS (DLE)
• It’s A Chronic Skin Condition Of
Sores With Inflammation And Scarring
• These Lesions Develop As A Red,
Inflamed Patch With A Scaling And
Crusty Appearance.
• The Centre Areas May Appear Lighter
In Color With A Rim Darker Than The
Normal Skin.

40. DISSECTING CELLULITIS OF THE SCALP
• Pus-filled Lumps Develop On The Scalp, Resulting In
Scarring And Permanent Hair Loss Over The Area
Affected.
• Most Likely Due To Blocked And Ruptured Hair Follicles,
Resulting In Significant Inflammation And Secondary
Bacterial Infection.
Management:-
• Avoid Picking And Squeezing The Lumps As This Can
Worsen The Problem
• Avoid Oil-based Hair Products And Use An Antiseptic
Shampoo Regularly

41. • Antiseptic Washes (Eg Chlorhexidine) And
Shampoos Can Be Useful As Well As Topical
Antibiotics Such As Clindamycin Lotion.
• Doxycycline, Erythromycin Or Clindamycin.
• A Combination Of Clindamycin And Rifampicin
• Steroid - Prednisolone Can Be Used For Short Term
• Large Cysts And Abscesses
Can Be Incised And Drained
Or Excised.
• Skin Grafting May Be
Required In Some Cases.

42. NON SCARRING HAIR LOSS
• Loss Of Hair Without Any Scarring
Causes
• Alopecia Areata
• Anagen Effluvium
• Androgenetic Alopecia
• Dermatopathia Pigmentosa Reticularis
• Telogen Effluvium
• Trichotillomania (Trichotillosis)
Treatment :-
According To Their Causes

43. TRICHOTILLOMANIA (TTM)
• Hair Pulling Disorder
• It Is An Impulse Control Disorder
Characterized By A Long Term Urge That
Results In The Pulling Out Of One's Hair.
• The Head And Around The Eyes Are Most
Common Site.
• The Disorder May Run In Families. Women
Are More Commonly Affected Than Men
• It Occurs More Commonly In Those
With Obsessive Compulsive Disorder.
Episodes Of Pulling May Be Triggered
By Anxiety.
Treatment
• Cognitive Behavioral Therapy With
Clomipramine
• Psychotherapy Is Useful In This Case

44. KERION
• Raised, Spongy Lesions, And Typically Occurs
In Children
• Host's Response To A
Fungal Ringworm Infection Of The Hair
Follicles Of The Scalp That Can Be
Accompanied By Secondary Bacterial
Infections
• Painful Inflammatory Reaction With Deep
Suppurative Lesions
Treatment
• Antifungals:-griseofulvin Or Terbinafine For 6-
8 Weeks

45. ALOPECIA UNIVERSALIS
• Loss Of Hair All Over Body Including
Eyebrows And Eye Lashes.
• In Any Age Group
• An Autoimmune Disorder, In Which A
Person's Immune System Attacks The Hair
Follicles.
Treatment
• Immunomodulatory Agents Such
As Imiquimod.
• Tofacitinib Citrate May Also Have Benefits.

46. ALOPECIA TOTALIS
• Loss Of All Skull And
Facial Hair
• Believed To Be Autoimmune
TREATMENT
• Methotrexate And Corticosteroids

47. ALOPECIA AREATA
• Spot Baldness,
• A Condition In Which Hair Is Lost From Some Or All Areas Of
The Body.
• Often Few Bald Spots On The Scalp, Each About The Size Of A
Coin
CAUSE
• Autoimmune Disease
• Failure By The Body To Recognize Its Own Cells With Subsequent
Immune Mediated Destruction Of The Hair Follicle

48. TREATMENT
• Corticosteroids Clobetasol Or Fluocinonide , Corticosteroid Injections, Or
Cream.
• Minoxidil, Elocon (Mometasone) Ointment (Steroid Cream), Irritants (Anthralin
Or Topical Coal Tar), And Topical Immunotherapy Ciclosporin, Sometimes In
Different Combinations
• Alopecia Areata Is Associated To Celiac Disease , The Treatment With A Gluten-
free Diet Allows Complete And Permanent Regrowth Of Scalp And Other Body
Hair In Many People, But In Others There Are Remissions And Recurrences.
(May Be Due To The Normalization Of The Immune Response As A Result
Of Gluten Withdrawal )

49. TRACTION ALOPECIA
• Gradual Hair Loss, Caused Primarily By Pulling Force
Being Applied To The Hair
• Results From The Sufferer Frequently Wearing Their Hair
In A Particularly Tight Ponytail, Pigtails Or Braids

50. FOLLICULITIS DECALVANS
• An Inflammation Of The Hair Follicle That Leads
To Bogginess Or Induration Of Involved Parts Of
The Scalp Along With Pustules, Erosions, Crusts,
Ulcers, And Scale
TREATMENT
• Rifampin 300 Mg Twice Daily
And Clindamycin 300 Mg Twice Daily For 3-5
Months.

51. ACNE KELOIDALIS NUCHAE
• Destructive Scarring Folliculitis That Occurs Almost
Exclusively On The Occipital Scalp Of People Of African
Descent

52. ACTINIC KERATOSIS (AK)
• A Pre-cancerous Patch Of Thick,
Scaly, Or Crusty Skin.
• These Growths Are More Common In
Fair-skinned People And Those Who
Are Frequently In The Sun.
• They Usually Form When Skin Gets
Damaged By Ultraviolet
(UV)radiation From The Sun Or
Indoor Tanning Beds.
• Aks Are Considered Potentially Pre-
cancerous; Left Untreated, They May
Turn Into A Type Of Cancer
Called Squamous Cell Skin Cancer.

53. TREATMENT
SURGICAL
TECHNIQUES
• Dermabrasion
• Laser Therapy
• Chemical Peels
• Shave Excision
And Curettage
• Surgical Excision
• Fluorouracil Cream
• Imiquimod Cream
• Ingenol Mebutate Gel
• Diclofenac Sodium Gel
• Retinoids
• Photodynamic Therapy

54. DERMATITIS HERPETIFORMIS
• An Itchy, Blistering, Burning Skin Rash
• This Rash Likely Indicates Gluten Intolerance,
Which May Be Related To A More Serious
Underlying Condition Known As Celiac
Disease
TREATMENT
• Gluten-free Diet
• Dapsone Is Most Effective But Have Many
Side Effects.

55. TRICHORRHEXIS NODOSA
• Defect In The Hair Shaft Characterized By
Thickening Or Weak Points (Nodes) That Cause The
Hair To Break Off Easily
• Hair Loss, Lack Of Growth, And Damaged-looking
Hair
MANAGEMENT
• Harsh Chemicals Such As Hair
Straightening Compounds And Permanents Should
Be Avoided.
• The Hair Should Not Be Ironed.
• Excessively Harsh Shampoo Should Be Avoided.
• Hair Conditioners Should Be Used.

56. SCALP ECZEMA
• Irritated, Red, And Itchy Skin On
The Scalp, Which Causes The
Flakes Known As Dandruff, Is
Called Scalp Eczema.
MANAGEMENT
• Antidandruff Shampoo Or Medicines Which
Are Made Up Of Salicylic Acid, Coal
Tar,zinc,resorcinol,ketoconazole,seleniumsulfi
de,corticosteroids, Ciclopirox, Sulfacetamide
Sodium, Protopic (Tacrolimus) Or Elidel
(Pimecrolimus)are Usefull.

57. LICHEN SIMPLEX CHRONICUS
• A Skin Disorder Characterized By
Chronic Itching And Scratching.The Constant
Scratching Causes Thick, Leathery, Darkened,
(Lichenified) Skin.
• More Common Between Ages 35 And 50 And Is
Seen Approximately Twice As Often In Women
Compared To Men.
MANAGEMENT
• Steroid Cream
(Suchas Triamcinolone Or Betamethasone)
Applied To The Affected Area Of The Skin.
• Nighttime Scratching Can Be Reduced With
Sedatives And Antihistamines.

58. SCALP PSORIASIS
• Red Scaling, Slightly
Raised Bumps(papules) That Merge To
Form Plaques
• Loss Of Scalp Hair, Which Usually Will
Return If The Disease Can Be
Controlled
MANAGEMENT
• Salicylic Acid
• Coal Tar
• Dovonex For Scalp Psoriasis
• Taclonex
• Tazarotene Which Is Alternative Of
Vitamin A
• Calcipotriene, Which Is A Unique Form
Of Vitamin D

59. HEAD LICE INFESTATION
• Infection Of The Head Hair And Scalp By The Head
Louse(pediculus Humanus Capitis)
• Itching From Lice Bites Is Common.
• During A Person's First Infection, The Itch May Not
Develop For Up To Six Weeks.If A Person Is Infected
Again, Symptoms May Begin Much More Quickly

60. MANAGEMENT
• Combs, Shaving, Medical Creams, And Hot Air Can Be
Used
• Dimethicone,ivermectin ,Permethrin, Malathion, Benzyl
Alcohol Are Effective In This Case

61. MALE PATTERN HAIR LOSS
• Hair Loss That Primarily Affects The
Top And Front Of The Scalp
• Hair Loss that Primarily Affects The
Top And Front Of The Scalp
MANAGEMENT
• Minoxidil, Finasteride
• Hair Transplant Surgery

62. LICHEN PLANNUS SCALP
• Inflammatory Condition That Results In
Patchy Progressive Permanent Hair Loss
SYMPTOMS
• Itch, pain, tenderness, discomfort, burning,
TREATMENT
Topical Tacrolimus, hydroxychoroquine
Tetracycline,doxycycline,acitretin,methotrexate,ciclosporin,
mycophenolate

63. CRADLE CAP
• A Yellowish, Patchy, Greasy, Scaly And
Crusty Skin Rash That Occurs On
The Scalp Of Recently Born Babies
• The Rash Is Often Prominent Around
The Ear, The Eyebrows Or The Eyelids
• Massage Baby's Scalp With The Fingers
Or A Soft Brush To Loosen The Scales

64. • Oil Remedies Can Be Used By Rubbing A Small Amount
Of Pure, Plant-derived Oil (Coconut Oil, Pure Olive Oil,
Almond Oil) On The Baby's Scalp And Leaving It On For
15 Minutes. After 15 Minutes, Gently Comb Out The
Flakes With A Fine Tooth Comb Or Brush. Be Sure To
Wash Out All Of The Oil To Avoid Making The Cradle
Cap Worse
• Clotrimazole , Miconazole Can Be Applicable

65. PREMATURE GREYING OF HAIR
• Also Known As Canities
• Hair Is Said To Have Greyed Prematurely If It
Occurs Before The Age Of 20 Years In Whites,
Before 25 Years In Asians, And Before 30 Years
In Africans.
• Topical Antiaging Compounds That Are Currently
Under Investigation Include Photoprotectors, Such
As Cinnamidopropyltrimonium Chloride And
Solid Lipid Nanoparticles As Carriers For Uv
Blockers, Oral Supplementation With L-
cystine And L-methionine, And
Topical Melatonin.[Temporary Hair Colorants Are
Used Worldwide.

66. TRICHORRHEXIS INVAGINATA
• Also Known As "Bamboo Hair
• A Distinctive Hair Shaft Abnormality That
May Occur Sporadically, Either In Normal
Hair Or With Other Hair Shaft Abnormalities,
Or Regularly As A Marker For Netherton's
Syndrome
• The Primary Defect Appears To Be Abnormal
Keratinization Of The Hair Shaft In The
Keratogenous Zone, Allowing For
Intussusception Of The Fully Keratinized And
Hard Distal Shaft Into The Incompletely
Keratinized And Soft Proximal Portion Of
The Shaft

67. INGROWN HAIR
• A Condition Where Hair Curls Back Or Grows
Sideways Into The Skin
• Most Prevalent Among People Who Have
Coarse Or Curly Hair
MANAGEMENT
• Removed With Tweezers
• Electrolysis
• Twice Daily Topical Application Of
Diluted Glycolic Acid
• Applying Salicylic Acid Solution Is Also A
Common Remedy For Ingrown Hairs Caused
By Waxing Or Shaving

68. MONILETHRIX
• Also Termed As Beaded Hair Is A
Rare Autosomal Dominant Hair Disease That
Results In Short, Fragile, Broken Hair That
Appears Beaded.
• It Comes From The Latin Word
For Necklace (Monile) And The Greek Word For
Hair

69. HAIR CASTS
• Also Known As "Pseudonits“
• Represent Remnants Of The Inner Root Sheath,
And Often Occur In Great Numbers And May
Mimic Nits In The Scalp

70. FOLLICULITIS
• Hair Follicles Become Inflamed
• Caused By A Bacterial Or Fungal
Infection
• Look Like Small Red Bumps Or
White-headed Pimples Around Hair
Follicles
• Itchy, Sore, Permanent Hair Loss And
Scarring.
• Some Folliculitis Are Known As Hot
Tub Rash, Razor Bumps And Barber's
Itch.

71. TINEA CAPITIS
• Ringworm Of The Hair Or Ringworm Of The Scalp
• Is A Cutaneous Fungal Infection (Dermatophytosis) Of The Scalp
• Typically Single Or Multiple Patches Of Hair Loss, Sometimes With
A 'Black Dot' Pattern (Often With Broken-off Hairs), That May Be
Accompanied By Inflammation, Scaling, Pustules, And Itching.
• Uncommon In Adults, Tinea Capitis Is Predominantly Seen In Pre-
pubertal Children, More Often Boys Than Girls.

72. MANAGEMENT
• Griseofulvin, Terbinafine, Itraconazole, And Fluconazole
Provides Effective Results.

73. SEBORRHOIC DERMATITIS
• Red, Itchy Rash On Your Scalp That
Has Flaky Scales Could Be Seborrheic
Dermatitis, Or Seborrhea.
• It's A Common Skin Disease That
Looks Similar To Psoriasis, Eczema,
Or An Allergic Reaction.
MANAGEMENT :-
• Proper Skin Care
• Antifungal Medications Provides
Better Results

74. DANDRUFF
• Flaking And Sometimes Mild Itchiness
• It Can Result In Social Or Self-
esteem Problems.
TREATMENT
• Ketoconazole (Nizoral) Shampoo
• Zinc Pyrithione And Selenium Disulfide