The scalp is the anatomical area bordered by the human

face The face is the front of an animal's head that features the eyes, nose and mouth, and through which animals express many of their emotions. The face is crucial for human identity, and damage such as scarring or developmental deformities may aff ...

at the front, and by the

neck The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...

at the sides and back.

Structure

The scalp is usually described as having five layers, which can conveniently be remembered as a

mnemonic A mnemonic ( ) device, or memory device, is any learning technique that aids information retention or retrieval (remembering) in the human memory for better understanding. Mnemonics make use of elaborative encoding, retrieval cues, and image ...

: * S: The

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

on the head from which head hair grows. It contains numerous sebaceous glands and

hair follicle The hair follicle is an 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 ...

s. * C:

Connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

. 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 The epicranial aponeurosis (aponeurosis epicranialis, galea aponeurotica) is an aponeurosis (a tough layer of dense fibrous tissue). It covers the upper part of the skull in humans and many other animals. Structure In humans, the epicranial ...

) is the next layer. It is a tough layer of dense fibrous tissue which runs from the

frontalis muscle The frontalis muscle () is a muscle which covers parts of the forehead of the skull. Some sources consider the frontalis muscle to be a distinct muscle. However, Terminologia Anatomica currently classifies it as part of the occipitofrontalis muscle ...

anteriorly to the

occipitalis The occipitalis muscle (occipital belly) is a muscle which covers parts of the skull. Some sources consider the occipital muscle to be a distinct muscle. However, Terminologia Anatomica currently classifies it as part of the occipitofrontalis m ...

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 Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...

. 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 The emissary veins connect the extracranial venous system with the intracranial venous sinuses. They connect the veins outside the cranium to the venous sinuses inside the cranium. They drain from the scalp, through the skull, into the larger me ...

which then drain into the

cranium The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, th ...

. The loose areolar tissue in this layer is made up of random

collagen I Type I collagen is the most abundant collagen of the human body. It forms large, eosinophilic fibers known as collagen fibers. It is present in scar tissue, the end product when tissue heals by repair, as well as tendons, ligaments, the endomy ...

bundles,

collagen III Type III Collagen is a homotrimer, or a protein composed of three identical peptide chains (monomers), each called an alpha 1 chain of type III collagen. Formally, the monomers are called collagen type III, alpha-1 chain and in humans are encoded ...

. It will also be rich in

glycosaminoglycans Glycosaminoglycans (GAGs) or mucopolysaccharides are long, linear polysaccharides consisting of repeating disaccharide units (i.e. two-sugar units). The repeating two-sugar unit consists of a uronic sugar and an amino sugar, except in the case ...

(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 The periosteum is a membrane that covers the outer surface of all bones, except at the articular surfaces (i.e. the parts within a joint space) of long bones. Endosteum lines the inner surface of the medullary cavity of all long bones. Structu ...

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 The supratrochlear artery (or frontal artery) is one of the terminal branches of the ophthalmic artery. It arises within the orbit. It exits the orbit alongside the supratrochlear nerve. It contributes arterial supply to the skin, muscles and per ...

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 In human anatomy, the superficial temporal artery is a major artery of the head. It arises from the external carotid artery when it splits into the superficial temporal artery and maxillary artery. Its pulse can be felt above the zygomatic a ...

gives off frontal and parietal branches to supply much of the scalp ** the

occipital artery The occipital artery arises from the external carotid artery opposite the facial artery. Its path is below the posterior belly of digastric to the occipital region. This artery supplies blood to the back of the scalp and sternocleidomastoid musc ...

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: * Supratrochlear nerve and the

supraorbital nerve The supraorbital nerve is one of two branches of the frontal nerve, itself a branch of the ophthalmic nerve. The other branch of the frontal nerve is the supratrochlear nerve. Structure The supraorbital nerve branches from the frontal nerve mi ...

from the

ophthalmic division The ophthalmic nerve (V1) is a sensory nerve of the face. It is one of three divisions of the trigeminal nerve (CN V). It has three branches that provide sensory innervation to the eye, the skin of the upper face, and the skin of the anterior ...

of the

trigeminal nerve In neuroanatomy, the trigeminal nerve ( lit. ''triplet'' nerve), also known as the fifth cranial nerve, cranial nerve V, or simply CN V, is a cranial nerve responsible for sensation in the face and motor functions such as biting and che ...

* Greater occipital nerve (C2) posteriorly up to the vertex * Lesser occipital nerve (C2) behind the ear * Zygomaticotemporal nerve from the maxillary division of the

supplying the hairless temple * Auriculotemporal nerve from the mandibular division of the

The innervation of scalp can be remembered using the

"Z-GLASS" for Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve, Auriculotemporal nerve, Supratrochlear nerve, and Supraorbital nerve.

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: *

Actinic keratosis Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. . Actinic k ...

* Basal-cell carcinoma * Epidermoid cyst * Merkel-cell carcinoma *

Pilar cyst A trichilemmal cyst (or pilar cyst) is a common cyst that forms from a hair follicle, most often on the scalp, and is smooth, mobile, and filled with keratin, a protein component found in hair, nails, skin, and horns. Trichilemmal cysts are cl ...

Squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

Scalp conditions

Cutis verticis gyrata Cutis verticis gyrata is a medical condition usually associated with thickening of the scalp. The condition is identified by excessive thickening of the soft tissues of the scalp and characterized by ridges and furrows, which give the scalp a cer ...

– a descriptive term for a rare deformity of the scalp *

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 ...

– A common problem caused by excessive shedding of dead skin cells from the scalp *

Head lice The head louse (''Pediculus humanus capitis'') is an obligate ectoparasite of humans. Head lice are wingless insects that spend their entire lives on the human scalp and feeding exclusively on human blood. Humans are the only known hosts of thi ...

* Seborrhoeic dermatitis – a skin disorder causing scaly, flaky, itchy, red skin **

Cradle cap Cradle cap or cradle hat causes crusty or oily scaly patches on a baby's scalp. The condition is not painful or itchy, but it can cause thick white or yellow scales that are not easy to remove. Cradle cap most commonly begins sometime in the fir ...

– a form of seborrhoeic dermatitis which occurs in newborns *

Tycoon's cap Tycoon’s cap (also known as acne necrotica miliaris) is a human disease of the scalp, classified as a mixed alopecia, characterized by minute, itchy pustules within the scalp. See also * Skin lesion * Cicatricial alopecia Scarring hair loss, ...

, also known as ''

acne necrotica Acne necrotica presents with a primary lesion that is a pruritic or painful erythematous follicular-based papule that develops central necrosis and crusting and heals with a varioliform scar.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology i ...

miliaris'', characterized by pustules and itching

Society and culture

The scalp plays an important role in the

aesthetics Aesthetics, or esthetics, is a branch of philosophy that deals with the nature of beauty and taste, as well as the philosophy of art (its own area of philosophy that comes out of aesthetics). It examines aesthetic values, often expressed t ...

of the face.

Androgenic alopecia Pattern hair loss (also known as androgenetic alopecia (AGA)) is a hair loss condition that primarily affects the top and front of the scalp. In male-pattern hair loss (MPHL), the hair loss typically presents itself as either a receding front ha ...

, 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 Finasteride, sold under the brand names Proscar and Propecia among others, is a medication used to treat hair loss and benign prostatic hyperplasia (BPH) in men. It can also be used to treat excessive hair growth in women and as a part of h ...

minoxidil Minoxidil, sold under the brand name Rogaine among others, is a medication used for the treatment of high blood pressure and pattern hair loss. It is an antihypertensive vasodilator. It is available as a generic medication by prescription in or ...

) or hair transplantation. If the scalp is heavy and loose, a common change with

ageing Ageing ( BE) or aging ( AE) is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. ...

, the forehead may be low, heavy and deeply lined. The

brow lift A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep “worry” lines that run across the forehead. History The first docume ...

procedure aims to address these concerns. Scalping, the act of removing the scalp, is historically associated with the American West and the

Indian Wars The American Indian Wars, also known as the American Frontier Wars, and the Indian Wars, were fought by European governments and colonists in North America, and later by the United States and Canadian governments and American and Canadian settle ...

in particular, although the practice dates back to antiquity and has developed on each continent.

References

External links

* - "Integument: scalp, transverse" * - "Integument: scalp" * * http://www.dartmouth.edu/~humananatomy/figures/chapter_47/47-1.HTM {{Authority control Medical mnemonics