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Season 4: What Healthy Scalp Means and How Effects Develop

The Scalp as a Biological System

Dr. Manfred Groeppel, Prof. Dr. Alexander Steinkasserer 28.05.2026 02:38

In summary

  • A healthy scalp needs an intact skin barrier, a neutral pH level, and a balanced microbiome of bacteria, fungi, and viruses. 
  • If the microbiome becomes imbalanced, dandruff, redness, and eventually hair loss can follow. 
  • Androgenetic hair loss affects around 3 billion people worldwide and is caused by dihydrotestosterone (DHT), which is toxic to hair follicles and triggers cell death. 
  • Alopecia areata is an autoimmune disease where the immune system attacks hair follicle cells and can begin as early as infancy.
FAQ

The Scalp as a Biological System

What role does the scalp play in healthy hair growth?
A healthy scalp with an intact skin barrier, a neutral pH level, and a balanced microbiome is what makes healthy hair growth possible. If any of these factors becomes disrupted, hair growth is affected.
What is the scalp's microbiome?
The microbiome is the ecosystem on the scalp, consisting of bacteria, fungi, and viruses. It keeps the pH level neutral, strengthens the scalp, and supports hair growth. An imbalance leads to dandruff, redness, and ultimately hair loss.
What does a healthy scalp look like from a scientific perspective?
A healthy scalp shows no dandruff, no excessive sebum production, and has an intact skin barrier. Greasy hair or redness are signs that the balance has been disturbed.
What are the main causes of hair loss?
There are two main forms. Androgenetic hair loss affects around 3 billion people worldwide and is caused by dihydrotestosterone, which damages follicle cells and triggers inflammation. Alopecia areata is an autoimmune disease where the immune system attacks the hair follicle cells directly.
Have the causes of hair loss been scientifically researched?
Yes. Androgenetic hair loss is driven by hormonal and genetic factors, which is why different treatments work differently for different people. Alopecia areata is well documented as an autoimmune disease.

Description

Healthy hair growth does not start at the hair, but at the scalp. An intact skin barrier, a neutral pH level, and a balanced microbiome determine whether the scalp is in good shape. The microbiome is the scalp's own ecosystem, made up of bacteria, fungi, and viruses. When that balance is disrupted, dandruff, redness, and eventually hair loss follow. 

The two main forms of hair loss have different origins. Androgenetic hair loss affects around 3 billion people worldwide. It is caused by dihydrotestosterone (DHT), a breakdown product of testosterone that is toxic to hair follicles, triggers cell death, and sets off an inflammatory reaction. Because genetic factors vary between people, different treatments work differently for different individuals. 

Alopecia areata is an autoimmune disease: the immune system attacks hair follicle cells. It can begin as early as infancy and, in extreme cases, lead to complete hair loss across the entire body.

Experts

Dr. Manfred Groeppel
Dr. Manfred Groeppel
Prof. Dr. Alexander Steinkasserer
Prof. Dr. Alexander Steinkasserer
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