Scalp

The scalp is the anatomical area bordered by the human face at the front, and by the neck at the sides and back.

Scalp
Layers of the scalp and meninges
Illustration depicting the layers of the scalp and meninges
Double cowlick
Details
Arterysupratrochlear, supraorbital, superficial temporal, occipital
Veinsuperficial temporal, posterior auricular, occipital
Nervesupratrochlear, supraorbital, greater occipital, lesser occipital
Lymphoccipital, mastoid
Identifiers
Latinscalpus
MeSHD012535
FMA46494
Anatomical terminology

Structure

Gray1196
Diagrammatic section of scalp
Blausen 0110 BrainLayers
Illustration of the scalp and meninges

The scalp is usually described as having five layers, which can conveniently be remembered as a mnemonic:[1]

  • S: The skin on the head from which head hair grows. It contains numerous sebaeceous glands and hair follicles.
  • C: Connective tissue. A dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
  • A: The aponeurosis called epicranial aponeurosis (or galea aponeurotica) is the next layer. It is a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
  • L: The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium. In scalping the scalp is torn off through this layer. It also provides a plane of access in craniofacial surgery and neurosurgery. This layer is sometimes referred to as the "danger zone" because of the ease by which infectious agents can spread through it to emissary veins which then drain into the cranium. The loose areolar tissue in this layer is made up of random collagen I bundles, collagen III. It will also be rich in glycosaminoglycans (GAGs) and will be constituted of more matrix than fibers. This layer allows the more superficial layers of the scalp to shift about in relation to the pericranium.
  • P: The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair. It may be lifted from the bone to allow removal of bone windows (craniotomy).

The clinically important layer is the aponeurosis. Scalp lacerations through this layer mean that the "anchoring" of the superficial layers is lost and gaping of the wound occurs which would require suturing. This can be achieved with simple or vertical mattress sutures using a non-absorbable material, which are subsequently removed at around days 7-10.

Blood supply

The blood supply of the scalp is via five pairs of arteries, three from the external carotid and two from the internal carotid:

  • internal carotid
    • the supratrochlear artery to the midline forehead. The supratrochlear artery is a branch of the ophthalmic branch of the internal carotid artery.
    • the supraorbital artery to the lateral forehead and scalp as far up as the vertex. The supraorbital artery is a branch of the ophthalmic branch of the internal carotid artery.
  • external carotid
    • the superficial temporal artery gives off frontal and parietal branches to supply much of the scalp
    • the occipital artery which runs posteriorly to supply much of the posterior aspect of the scalp
    • the posterior auricular artery, a branch of the external carotid artery, ascends behind the auricle to supply the scalp above and behind the auricle.

Because the walls of the blood vessels are firmly attached to the fibrous tissue of the superficial fascial layer, cut ends of vessels here do not readily retract; even a small scalp wound may bleed profusely.

Venous drainage

The veins of the scalp accompany the arteries and thus have similar names, e.g. Supratrochlear and supraorbital veins, which unite at the medial angle of the eye, and form the angular vein, which further continues as the facial vein.

The superficial temporal vein descends in front of the tragus, enters the parotid gland, and then joins the maxillary vein to form the retromandibular vein. The anterior part of it unites with the facial vein to form the common facial vein, which drains into jugular vein, and ultimately to the subclavian vein. The occipital vein terminates to the sub-occipital plexus.

There are other veins, like the emissary vein and frontal diploic vein, which also contribute to the venous drainage.

Nerve supply

Innervation is the connection of nerves to the scalp: the sensory and motor nerves innervating the scalp. The scalp is innervated by the following:[2]

The innervation of scalp can be remembered using the mnemonic, "Z-GLASS" for, Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve, Auriculotemporal nerve, Supratrochlear nerve and Supraorbital nerve.[2]

Lymphatic drainage

Lymphatic channels from the posterior half of the scalp drain to occipital and posterior auricular nodes. Lymphatic channels from the anterior half drain to the parotid nodes. The lymph eventually reaches the submandibular and deep cervical nodes.

Clinical significance

Infection

The 'danger area of the scalp' is the area of loose connective tissue. This is because pus and blood spread easily within it, and can pass into the cranial cavity along the emissary veins. Therefore infection can spread from the scalp to the meninges, which could lead to meningitis.

Hair transplantation

All the current hair transplantation techniques utilize the patient's existing hair. The aim of the surgical procedure is to use such hair as efficiently as possible. The right candidates for this type of surgery are individuals who still have healthy hair on the sides and the back of the head in order that hair for the transplant may be harvested from those areas. Different techniques are utilized in order to obtain the desired cosmetic results; factors considered may include hair color, texture, curliness, etc.

The most utilized technique is the one known as micro grafting because it produces naturalistic results. It is akin to follicular unit extraction, although less advanced. A knife with multiple blades is used to remove tissue from donor areas. The removed tissue is then fragmented into smaller chunks under direct vision inspection (i.e., without a microscope).

Disease

The scalp is a common site for the development of tumours including:

Scalp conditions

Society and culture

The scalp plays an important role in the aesthetics of the face. Androgenic alopecia, or male pattern hair loss, is a common cause of concern to men. It may be treated with varying rates success by medication (e.g. finasteride, minoxidil) or hair transplantation. If the scalp is heavy and loose, a common change with ageing, the forehead may be low, heavy and deeply lined. The brow lift procedure aims to address these concerns.

Scalping, the act of removing the scalp, is historically associated with the American West and the Indian Wars in particular, although the practice dates back to antiquity and has developed on each continent.

See also

References

  1. ^ MedicalMnemonics.com: 258
  2. ^ a b "Scalp: Nerve supply, Medical mnemonic". LifeHugger. Retrieved 2009-12-15.

External links

Alopecia areata

Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress may result. People are generally otherwise healthy. In a few cases, all the hair on the scalp or all body hair is lost and loss can be permanent.Alopecia areata is believed to be an autoimmune disease resulting from a breach in the immune privilege of the hair follicles. Risk factors include a family history of the condition. Among identical twins if one is affected the other has about a 50% chance of also being affected. The underlying mechanism involves failure by the body to recognize its own cells with subsequent immune mediated destruction of the hair follicle.There is no cure for the condition. Efforts may be used to try to speed hair regrowth such as cortisone injections. Sunscreen, head coverings to protect from cold and sun, and glasses if the eyelashes are missing is recommended. In some cases the hair regrows and the condition does not reoccur. In others hair loss and regrowth occurs over years. Among those in whom all body hair is lost less than 10% recover.About 0.15% of people are affected at any one time and 2% of people are affected at some point in time. Onset is usually in childhood. Males and females have the condition in equal numbers. The condition does not affect a person's life expectancy.

Aplasia cutis congenita

Aplasia cutis congenita is a rare disorder characterized by congenital absence of skin. Frieden classified ACC in 1986 into 9 groups on the basis of location of the lesions and associated congenital anomalies. The scalp is the most commonly involved area with lesser involvement of trunk and extremities. Frieden classified ACC with fetus papyraceus as type 5. This type presents as truncal ACC with symmetrical absence of skin in stellate or butterfly pattern with or without involvement of proximal limbs. It is the most common congenital cicatricial alopecia, and is a congenital focal absence of epidermis with or without evidence of other layers of the skin.The exact etiology of ACC is still unclear but intrauterine infection by varicella or herpes virus, drugs such as methimazole, misoprostol, valproate, cocaine, marijuana etc., fetus papyraceus, feto-fetal transfusion, vascular coagulation defects, amniotic membrane adherence, abnormal elastic fiber biomechanical forces and trauma are implicated. It can be associated with Johanson-Blizzard syndrome, Adams-Oliver syndrome, trisomy 13, and Wolf-Hirschhorn syndrome.

It can also seen with exposure to methimazole and carbimazole in utero. This dermatological manifestation has been linked to Peptidase D haploinsufficiency and a deletion in Chromosome 19.

Cutis verticis gyrata

Cutis verticis gyrata is a medical condition usually associated with thickening of the scalp. People show visible folds, ridges or creases on the surface of the top of the scalp. The number of folds can vary from two to roughly ten and are typically soft and spongy. These folds cannot be corrected with pressure. The condition typically affects the central and rear regions of the scalp, but sometimes can involve the entire scalp.

Hair loss can occur over time where the scalp thickens, though hair within any furrows remains normal. Thus far, due to the (apparent) rarity of the condition, limited research exists and causes are as yet undetermined. What is known, is that the condition is not exclusively congenital.

The condition was first reported by Jean-Louis-Marc Alibert in 1837, who called it cutis sulcata. A clinical description of the condition was provided by Robert in 1843 and it was named by Paul Gerson Unna in 1907. It has also been called Robert-Unna syndrome, bulldog scalp, corrugated skin, cutis verticis plicata, and pachydermia verticis gyrata.

Dandruff

Dandruff is a skin condition that mainly affects the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, is known as seborrhoeic dermatitis.The cause is unclear but believed to involve a number of genetic and environmental factors. The condition may worsen in the winter. It is not due to poor hygiene. The underlying mechanism involves the excessive growth of skin cells. Diagnosis is based on symptoms.There is no known cure. The typical treatment is with antifungal cream such as ketoconazole. Dandruff affects about half of adults. Onset is usually at puberty. Males are more often affected than females. Rates decrease after the age of 50.

Dermatophytosis

Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple areas can be affected at a given time.About 40 types of fungi can cause ringworm. They are typically of the Trichophyton, Microsporum, or Epidermophyton type. Risk factors include using public showers, contact sports such as wrestling, excessive sweating, contact with animals, obesity, and poor immune function. Ringworm can spread from other animals or between people. Diagnosis is often based on the appearance and symptoms. It may be confirmed by either culturing or looking at a skin scraping under a microscope.Prevention is by keeping the skin dry, not walking barefoot in public, and not sharing personal items. Treatment is typically with antifungal creams such as clotrimazole or miconazole. If the scalp is involved, antifungals by mouth such as fluconazole may be needed.Globally, up to 20% of the population may be infected by ringworm at any given time. Infections of the groin are more common in males, while infections of the scalp and body occur equally in both sexes. Infections of the scalp are most common in children while infections of the groin are most common in the elderly. Descriptions of ringworm date back to ancient history.

Dissecting cellulitis of the scalp

Dissecting cellulitis of the scalp, also known as dissecting scalp cellulitis, dissecting folliculitis of the scalp, perifolliculitis capitis abscedens et suffodiens of Hoffman, perifolliculitis abscedens et suffodiens, or folliculitis abscedens et suffodiens, is an inflammatory condition of the scalp that can lead to scarring alopecia, which begins with deep inflammatory nodules, primarily over occiput, that progresses to coalescing regions of boggy scalp. Boggy tissue has a high fluid level that results in a spongy feeling.

Isotretinoin proves to be the medicine of choice for the treatment of the disease.

Electroencephalography

Electroencephalography (EEG) is an electrophysiological monitoring method to record electrical activity of the brain. It is typically noninvasive, with the electrodes placed along the scalp, although invasive electrodes are sometimes used, as in electrocorticography. EEG measures voltage fluctuations resulting from ionic current within the neurons of the brain. Clinically, EEG refers to the recording of the brain's spontaneous electrical activity over a period of time, as recorded from multiple electrodes placed on the scalp. Diagnostic applications generally focus either on event-related potentials or on the spectral content of EEG. The former investigates potential fluctuations time locked to an event, such as 'stimulus onset' or 'button press'. The latter analyses the type of neural oscillations (popularly called "brain waves") that can be observed in EEG signals in the frequency domain.

EEG is most often used to diagnose epilepsy, which causes abnormalities in EEG readings. It is also used to diagnose sleep disorders, depth of anesthesia, coma, encephalopathies, and brain death. EEG used to be a first-line method of diagnosis for tumors, stroke and other focal brain disorders, but this use has decreased with the advent of high-resolution anatomical imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). Despite limited spatial resolution, EEG continues to be a valuable tool for research and diagnosis. It is one of the few mobile techniques available and offers millisecond-range temporal resolution which is not possible with CT, PET or MRI.

Derivatives of the EEG technique include evoked potentials (EP), which involves averaging the EEG activity time-locked to the presentation of a stimulus of some sort (visual, somatosensory, or auditory). Event-related potentials (ERPs) refer to averaged EEG responses that are time-locked to more complex processing of stimuli; this technique is used in cognitive science, cognitive psychology, and psychophysiological research.

Erosive pustular dermatitis of the scalp

Erosive pustular dermatitis of the scalp presents with pustules, erosions, and crusts on the scalp of primarily older Caucasean females, and on biopsy, has a lymphoplasmacytic infiltrate with or without foreign body giant cells and pilosebaceous atrophy.

Forehead

In human anatomy, the forehead is an area of the head bounded by three features, two of the skull and one of the scalp. The top of the forehead is marked by the hairline, the edge of the area where hair on the scalp grows. The bottom of the forehead is marked by the supraorbital ridge, the bone feature of the skull above the eyes. The two sides of the forehead are marked by the temporal ridge, a bone feature that links the supraorbital ridge to the coronal suture line and beyond.In Terminologia Anatomica, sinciput is given as the Latin equivalent to "forehead". (Etymology of sinciput: from semi- "half" + caput "head".)

Hair care

Hair care is an overall term for hygiene and cosmetology involving the hair which grows from the human scalp, and to a lesser extent facial, pubic and other body hair. Hair care routines differ according to an individual's culture and the physical characteristics of one's hair. Hair may be colored, trimmed, shaved, plucked or otherwise removed with treatments such as waxing, sugaring and threading. Hair care services are offered in salons, barbershops and day spas, and products are available commercially for home use. Laser hair removal and electrolysis are also available, though these are provided (in the US) by licensed professionals in medical offices or speciality spas.

Hair follicle

The hair follicle is a dynamic organ found in mammalian skin. It resides in the dermal layer of the skin and is made up of 20 different cell types, each with distinct functions. The hair follicle regulates hair growth via a complex interaction between hormones, neuropeptides and immune cells. This complex interaction induces the hair follicle to produce different types of hair as seen on different parts of the body. For example, terminal hairs grow on the scalp and lanugo hairs are seen covering the bodies of fetuses in the uterus and in some new born babies. The process of hair growth occurs in distinct sequential stages. The first stage is called anagen and is the active growth phase, catagen is the resting stage, telogen is the regression of the hair follicle phase, exogen is the active shedding of hair phase and lastly kenogen is the phase between the empty hair follicle and the growth of new hair.The function of hair in humans has long been a subject of interest and continues to be an important topic in society, developmental biology and medicine. Of all mammals, humans have the longest growth phase of scalp hair compared to hair growth on other parts of the body. For centuries, humans have ascribed esthetics to scalp hair styling and dressing and it is often used to communicate social or cultural norms in societies. In addition to its role in defining human appearance, scalp hair also provides protection from UV sun rays and is an insulator against extremes of hot and cold temperatures. Differences in the shape of the scalp hair follicle determine the observed ethnic differences in scalp hair appearance, length and texture.

There are many human diseases in which abnormalities in hair appearance, texture or growth are early signs of local disease of the hair follicle or systemic illness. Well known diseases of the hair follicle include alopecia or hair loss, hirsutism or excess hair growth and lupus erythematosus.

Hair loss

Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Typically inflammation or scarring is not present. Hair loss in some people causes psychological distress.Common types include: male-pattern hair loss, female-pattern hair loss, alopecia areata, and a thinning of hair known as telogen effluvium. The cause of male-pattern hair loss is a combination of genetics and male hormones, the cause of female pattern hair loss is unclear, the cause of alopecia areata is autoimmune, and the cause of telogen effluvium is typically a physically or psychologically stressful event. Telogen effluvium is very common following pregnancy.Less common causes of hair loss without inflammation or scarring include the pulling out of hair, certain medications including chemotherapy, HIV/AIDS, hypothyroidism, and malnutrition including iron deficiency. Causes of hair loss that occurs with scarring or inflammation include fungal infection, lupus erythematosus, radiation therapy, and sarcoidosis. Diagnosis of hair loss is partly based on the areas affected.Treatment of pattern hair loss may simply involve accepting the condition. Interventions that can be tried include the medications minoxidil (or finasteride) and hair transplant surgery. Alopecia areata may be treated by steroid injections in the affected area, but these need to be frequently repeated to be effective. Hair loss is a common problem. Pattern hair loss by age 50 affects about half of males and a quarter of females. About 2% of people develop alopecia areata at some point in time.

Pattern hair loss

Pattern hair loss, known as male-pattern hair loss (MPHL) when it affects males and female-pattern hair loss (FPHL) when it affects females, is hair loss that primarily affects the top and front of the scalp. In males, the hair loss often presents itself as a receding hairline, while in females, it typically presents as a thinning of the hair.Male pattern hair loss is believed to be due to a combination of genetics and the male hormone dihydrotestosterone. The cause in female pattern hair loss remains unclear.Management may include simply accepting the condition. Otherwise, treatments may include minoxidil, finasteride, or hair transplant surgery. Evidence for finasteride in women, however, is poor and it may result in birth defects if taken during pregnancy.Pattern hair loss by the age of 50 affects about half of males and a quarter of females. It is the most common cause of hair loss.

Scalp Trouble

Scalp Trouble is a 1939 Looney Tunes cartoon directed by Bob Clampett and starring Porky Pig and Daffy Duck. This cartoon was produced by Leon Schlesinger and released by Warner Bros..

Scalping

Scalping is the act of cutting or tearing a part of the human scalp, with hair attached, from the head.

This can either occur as part of war with the scalp being a trophy, or as an accident. Scalp-taking is considered part of the broader cultural practice of the taking and display of human body parts as trophies, and may have developed as an alternative to the taking of human heads, for scalps were easier to take, transport, and preserve for subsequent display. Scalping independently developed in various cultures in both the Old and New Worlds.

Seborrhoeic dermatitis

Seborrhoeic dermatitis, also known as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the scalp, face, and chest. It can result in social or self-esteem problems. In babies, when the scalp is primarily involved, it is called cradle cap. Dandruff is a milder form of the condition, without associated inflammation.The cause is unclear but believed to involve a number of genetic and environmental factors. Risk factors include poor immune function, Parkinson disease, epilepsy, and Down syndrome. The condition may worsen with stress or during the winter. It is not a result of poor hygiene. Diagnosis is typically based on the symptoms.The typical treatment is antifungal cream and anti-inflammatory agents. Specifically ketoconazole or ciclopirox are effective. It is unclear if other antifungals, such as miconazole, are equally effective as they have been poorly studied. Other options may include coal tar and phototherapy.The condition is most common in those around the age of 50, during puberty, and among those less than three months old. In adults about 2% of people are affected. Males are more often affected than females. Up to 40% of babies may be affected to some degree.

Storm Shadow

Storm Shadow is a British, French low-observable air-launched cruise missile, developed since 1994 by Matra and British aerospace, then manufactured by MBDA. Storm Shadow is the British name for the weapon; in French service it is called SCALP EG (Système de Croisière Autonome à Longue Portée – Emploi Général, meaning General Purpose Long Range Cruise Missile). The missile is based on the earlier MBDA Apache anti-runway missile, and differs in that it carries a warhead, rather than submunitions.

Tinea capitis

Tinea capitis (also known as "herpes tonsurans", "ringworm of the hair", "ringworm of the scalp", "scalp ringworm", and "tinea tonsurans") is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the Trichophyton and Microsporum genera that invade the hair shaft. The clinical presentation is 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.

At least eight species of dermatophytes are associated with tinea capitis. Cases of Trichophyton infection predominate from Central America to the United States and in parts of Western Europe. Infections from Microsporum species are mainly in South America, Southern and Central Europe, Africa and the Middle East. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus. The fungus can also exist in a carrier state on the scalp, without clinical symptomatology. Treatment of tinea capitis requires an oral antifungal agent; griseofulvin is the most commonly used drug, but other newer antimycotic drugs, such as terbinafine, itraconazole, and fluconazole have started to gain acceptance.

Yeti

The Yeti () or Abominable Snowman is a folkloric ape-like creature taller than an average human, that is said to inhabit the Himalayan mountains. The names Yeti and Meh-Teh are commonly used by the people indigenous to the region, and are part of their history and mythology. Stories of the Yeti first emerged as a facet of Western popular culture in the 19th century.

The scientific community has generally regarded the Yeti as a legend, given the lack of evidence of its existence. In one genetic study, researchers matched DNA from hair samples found in the Himalaya with a prehistoric bear from the Pleistocene epoch.

Head
Neck
Torso (Trunk)
Limbs

This page is based on a Wikipedia article written by authors (here).
Text is available under the CC BY-SA 3.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.