“When dealing with sensitive issues such as hair and scalp health, it’s important to build a rapport with customers and create trust. These conditions should not be trivialised, as a patient’s mental health could be massively affected by them,” says Jacquie Lee, Numark’s information pharmacist.

SEBORRHOEIC DERMATITIS

This common skin disorder affects up to 5 per cent of adults, and 42 per cent of babies up to three months old. “It is thought to be linked to the increase in the production of Malassezia yeast, resulting in increased cell turnover, scaling and inflammation in the epidermis,” says Jane Martins, consultant trichologist at Philip Kingsley. “It tends to run in families and variations in the severity of flaking occur with stress, hormonal fluctuations and even the frequency of shampooing or type of shampoo used.” 

Signs include patches of flaking skin, with white or yellow scales. An itchy scalp is common. In adults it’s a chronic condition often necessitating long-term treatment.

Treatment “For cradle cap in babies, simple measures include application of a mineral oil, left on for a few hours to loosen the scales, followed by removal with a soft baby brush. For adolescents and adults with mild sebhorrhoeic dermatitis, an antifungal shampoo such as ketoconazole 2% should be applied to the scalp and left on for five minutes. Use twice weekly for two to four weeks and then once a week,” says Dr Naila Dinani, consultant dermatologist and British Skin Foundation spokesperson. “For more severe cases where there is inflammation and itch, a topical steroid can be used alongside the shampoo, applied once daily for up to two weeks. If the condition is very scaly, then preparations containing salicylic acid can be recommended.”

Self-help tips “Shampooing regularly and thoroughly with the right shampoo is important,” says Ms Martins. “Stress is a factor, so encourage customers to incorporate exercise and relaxation to help reduce it”. “Some patients find that after a while a treatment shampoo is no longer as effective, so it might be useful to rotate to a different shampoo,” says Dr Dinani. “For very scaly dermatitis, a preparation containing coconut oil and salicylic acid can be applied and left on overnight, then washed off in the morning.” 

SCALP PSORIASIS

Some 45-56 per cent of people who have psoriasis also get scalp psoriasis, says Dr Dinani. It’s a chronic condition that needs ongoing treatment. It can make the scalp feel itchy and tight and causes a build up of thick, scaly skin which flakes like dandruff.

Topical treatments include coal tar, dithranol, salicylic acid, steroid creams and vitamin D-based treatments. It’s important to talk to customers about correct application – to the scalp, not the hair. “The first step is topical treatment, with the aim of removing thick scale from the scalp so the inflammation underneath can then be treated with topical anti-inflammatories. If this is not successful, the patient should be referred to a dermatologist,” says Dr Dinani. “The most effective treatment is topical steroids. Combination treatment with a vitamin D analogue is more effective than corticosteroid monotherapy. Salicylic acid is a helpful adjunctive treatment.” 

It’s important to remind customers that the condition is long-term. If treatment stops, the psoriasis will relapse. “Often, a maintenance regime is needed. Adherence is one of the largest barriers to topical therapies and it’s important that pharmacists remind patients of the importance of compliance,” says Dr Dinani.

HAIR LOSS AND THINNING HAIR WOMEN

According to a survey by hair and scalp specialists Philip Kingsley, 42 per cent of women experience hair loss and thinning hair and 75 per cent are worried about it happening in the future. 

“Hair loss in women has always been a problem, but the problems have been exacerbated over the last few years because of immense psychological and physical stressors including Covid,” says Philip Kingsley brand president and trichologist, Anabel Kingsley.

Androgenetic alopecia is the most common form of hair loss in women, affecting up to 50 per cent, and more commonly after menopause. Women rarely go completely bald as not all hairs are equally affected. It usually appears as a thinning around the crown and front of scalp and a widening of the central parting. 

The only licensed treatment is topical minoxidil, available as 2% solution or 5% foam. “It must be applied daily, and it will be at least four to six months before thickening of the hair is noted,” says Dr Dinani. “Patients often worry as when they first start using it, they notice hair shedding. This is a normal part of the process and will subside. It’s important to warn them about this. They also need to be told that the benefits only last as long as treatment is maintained. An important area for pharmacists to be aware and advise patients on is camouflage. Pigment fibres and sprays are available, as well as scalp micropigmentation wigs and hair pieces.”

“Hair loss is a very sensitive subject,” says Ms Martins. “There may be an underlying cause, so patients should be encouraged to seek the advice of a specialist, such as a trichologist, who will be able to discuss factors which may be influencing the hair loss.” 

HAIR LOSS AND THINNING HAIR MEN

Androgenetic alopecia is the most common form of hair loss, affecting up to 80 per cent of men. There is a strong genetic factor. An improvement should be noticed after four to six months’ use of one of the two licensed treatments available – topical minoxidil 5% solution or scalp foam, applied twice daily. Stopping treatment will cause hair shedding. Oral finasteride 1mg is available on private prescription or PGD. It takes around six months to notice an improvement. 

Category management

“This category is mostly led by anti-dandruff and hair growth products. There hasn’t been a huge amount of recent development, but there is a focus on caffeinated products to help boost hair growth,” says Cathy Crossthwaite, OTC business development executive at Numark. “There has also been a movement towards more natural products.” 

At Alphega Pharmacy, Vinay Patel, pharmacy services and contract pharmacist, says: “Some customers are reluctant to seek help as they have accepted their condition may not improve, while others seek help to delay the progression of hair loss. Pharmacy staff should approach customers sensitively and normalise the condition.” 

As for tips to improve your hair and scalp category:

• We recommend a focused section containing hair treatments, making use of point of sale materials to guide customers. They may need bespoke advice for treating symptoms and choosing the most appropriate products, so staff should ensure they are equipped with appropriate knowledge,” says Ms Crossthwaite.
• “Cross shopping across formats is high, so retailers can win in this category by creating a dedicated hair health area that is clearly visible in-store. Signage must be educational, but should not include wording that could prevent consumers from approaching and exploring further,” says Jenny Holmes, Viviscal senior brand manager, Church & Dwight.

Product news

Density is a new range of products from from Philip Kingsley designed to improve the condition and quality of hair, with a focus on improving thinning hair. There are nine products in the range, which claim to thicken hair, help prevent hair loss and stimulate the scalp to support healthy hair growth, including preserving scalp drops, thickening shampoo, preserving scalp foam and thickening protein spray, as well as two oral supplements designed to improve hair quality.

Viviscal is being supported with a digital campaign across social media and YouTube. The brand has recently announced a new panel of experts, including trichologist Hannah Gaboardi and celebrity stylist Halley Brisker.

Views of the P3pharmacy category panel

“Acute scalp conditions are common. Customers will ask how effective hair loss treatments are, and what they can do to prevent oily hair/scalp. Top sellers for us include Head & Shoulders and Neutrogena T/Gel. Alternatives to steroids, such as coal tar and coconut oil, are requested. Ensure you counsel patients on use – many don’t realise you have to leave certain products on the scalp for several minutes before rinsing and repeating to maximise benefit.”

Marisa Maciborka, Well Pharmacy, Tonteg, South Glamorgan

“We get no demand for hair loss products, but requests for scalp condition products are fairly regular; we get most queries about itchy scalp conditions like psoriasis, dermatitis and eczema. Nizoral, Selsun, T/Gel and Alphosyl are popular. Customers with these conditions tend to know what they’re looking for, although they may want to try a different product if the one they’re using isn’t effective enough. We display these alongside the regular hair care range.”

Hardik Desai, Ticehurst Pharmacy, East Sussex

“We get a lot of queries about hair loss. Regaine and Nourkrin both do well, and we’ve had an increase in requests for Viviscal recently. We give lots of information as there are issues customers need to be aware of before use. Scalp products are popular too – best sellers are Nizoral, Neutrogena and Capasal shampoo. A haircare brand ambassador comes to our pharmacy every two to three weeks. Her head examinations are very popular.”

Sarina Mughal, Day Lewis, Knightsbridge