Itchy Scalp: principal causes and treatments

The scalp on the top of the head consists of skin and millions of hair follicles. Unfortunately, certain conditions can make the skin rather dry and itchy. In this article, we shall briefly discuss some other clinical conditions that can affect the scalp and can cause an itchy scalp.

Causes of an itchy scalp

There are a number of different in conditions that can affect the scalp, resulting in reaching that can be rather annoying and frustrating. Below is a list of these conditions and a brief description regarding each of these.

1. Seborrhoeic dermatitis

Within the scalp tissue are present small glands known as the sebaceous glands. These secrete a thick, oily secretion that can keep the scalp tissue moist. However, in certain cases, the skin of the scalp can become cracked and inflamed and as a result can start to flake and become rather itchy. This condition is known as seborrhoeic dermatitis, commonly called dandruff. It is believed that dandruff can be caused by certain organisms and treatments must be targeted towards treating this.

Typically, dandruff can occur in phases with the periods when there is intense itching and flaking and periods when there is a completely clear scalp. As such, dry weather and the winter season are known to exacerbate dandruff. The opposite tends to occur during the summer months. On examination, there may be plaques and small areas of crusting along with small flakes of skin attached to the have follicles. On rare occasions, the skin over the eyelid may also be affected. Small areas of the trunk such as the middle of the chest and the back can also be affected simultaneously.

Seborrhoeic dermatitis can be easily diagnosed through clinical examination. In some occasions, a skin biopsy may be performed.

The treatment of seborrhoeic dermatitis is fairly straightforward and requires the use of medicated shampoos. A number of different products are now available at supermarkets and in pharmacies that tend to be rather effective. However, in some patients, seborrhoeic dermatitis may persist and in such cases a visit to a dermatologist is often warranted. Prescription shampoos and sometimes even steroids may be required.

2. Eczema

Eczema of the scalp is yet another condition that can cause dryness and itching. As such, the condition is common in infants and children though adolescents and adults seem to be affected as well. Patients may have eczema elsewhere on the body which helps differentiate this condition seborrhoeic dermatitis. Diagnosis is clinical and treatment often involves avoiding triggering factors such as soaps and shampoos. Stress is yet another triggering factor that should be managed. Steroids may be prescribed to certain patients in case of severe eczema.

3. Tinea Capitis

This is a clinical condition characterised by fungal infection of the scalp. It is often not limited to the scalp itself and can also affect the eyelids and eyebrows. The disease typically affects the hair follicles, causing loss of hair. On examination, there may be small patchy hair loss with lightening of the colour of the skin. Many a times, the condition is similar to seborrhoeic dermatitis and can present as flaky, itchy skin.

Complications can occur with tinea capitis, including the formation of abscesses which require treatment with antibiotics. These deep abscesses are called as kerions.

The treatment of tinea capitis is oral griseofulvin. The use of creams and ointments is often not effective. In the event that the above oral treatment does not help, patients may require alternative antifungal therapies.

4. Psoriasis of the scalp

Psoriasis is a skin condition characterised by the formation of silvery scales on an erythematous base. It has a multifactorial aetiology and is characterised by a great deal of inflammation and an increase in the growth of certain skin cells known as keratinocytes. There appears to be a genetic and environmental component to the clinical condition.

Psoriasis is often not limited to the scalp and can also affect the elbows and knees. On examination, the clinical lesions appear pink and elevated and have a silvery scale on the surface. Sometimes, there may be some itching and occasionally fever. Psoriasis of the scalp can cause flaking of the skin but closer examination will reveal a clear difference to seborrhoeic dermatitis.

Diagnosis of psoriasis is clinical. If required, additional tests may be performed depending on the part of the body that is affected by the condition. Psoriasis of the scalp can be clearly identified on examination of the affected area.

Treatment of psoriasis of the scalp involves the use of topical corticosteroids. In severe cases, coal tar shampoo and intramuscular steroids may be used. Topical retinoic acid is sometimes beneficial as well.

5. Allergic reactions

The use of hair dyes and shampoos can sometimes generate an allergic response which is typically characterised by itching of the scalp. In addition, patients may also notice a great deal of swelling of the affected area and facial puffiness on occasion.

An allergic reaction leading to scalp itching and swelling of the face requires urgent medical treatment. Patients are best treated in hospital with the use of antihistamine medication and steroids if required. Recovery is usually very good unless the triggering factor is still present.


Itching of the scalp can be a rather annoying problem. There are a number of different clinical conditions that can cause not just itching but also redness and dryness of the scalp. The environmental conditions and genetic factors must be taken into consideration when making a diagnosis. Treatment often requires the avoidance of triggering factors and maintenance of scalp health using different treatments prescribed by dermatologists. Dandruff appears be the most common scalp problem that is easily treated with the use of over-the-counter preparations

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