Itchy Scalp – Pictures, Causes and Treatment

1. Unwashed Hair

When the hair (especially oily hair) is not washed frequently enough, skin cells may build up on the scalp and cause itching and dandruff. Prevention is therefore by simply maintaining good hygiene and washing the scalp hair at least once a week.

2. Dry Scalp Skin

Dry scalp skin lacking the protective oil layer, is vulnerable to infections, and easily gets irritated. From the top of the head or hairline skin cells in the form of white dust (dry dandruff) may shed. Common causes of dry flaky scalp are:

  • Frequent hair washing with hot water and aggressive shampoos
  • Holding hair dryer close to the head
  • Cold windy weather in combination with dry air from indoor heating

Prevention is by using “shampoos for dry hair”.

3. Stress

Stress is a common cause of itch. Scalp, face, and neck are often affected.

4. Neurogenic Excoriation

Scratching from psychical reasons may cause itchy scalp scratches (neurogenic excoriations).

5. Dandruff, Caused by Fungi or Seborrheic Dermatitis

Dandruff are whitish, greasy, thin skin flakes, few millimeters in size, appearing in the hair and falling on shoulders. The scalp skin is itchy and may be reddened. The common cause is fungus Malassezia furfur (formerly known as Pityrosporum ovale) that normally lives on the scalp, but may overgrow on the greasy scalp, irritating it and causing scaling.

Dandruff may be related to seborrheic dermatitis, where irritated oil glands produce excessive amount of oil, resulting in an inflamed reddened scalp. Besides the  scalp, the eyebrows or eyelids, skin on the sides of the nose, behind the ears, and in the groin may be affected.

Dandruff usually does not appear before puberty, and it is more often in males, perhaps due to stimulation of oil glands by male sexual hormones. Diet poor in B vitamins, zinc, and essential fatty acids may also cause dandruff. Cold weather and indoor heating during winter may aggravate scalp scaling.

Treatment of Dandruff

Treatment of dandruff depends on the cause.

Mild dandruff can be controlled by regular hair washing with gentle shampoos to avoid greasiness. Hot water should be avoided and hair rinsed well after washing to prevent scalp irritating.

When regular shampoos do not help, over-the-counter medical shampoos can be tried (1):

  • In malassezia fungal infection, shampoos containing zinc pyrithione, selenium sulfide or ketoconazole are usually effective. Tea tree oil, a component of several ‘natural’ shampoos has antiseptic and anti-fungal properties
  • In seborrheic dermatitis, shampoos containing coal tar or salicylic acid may help

Several weeks of hair washing every day, and keeping shampoo on the hair for at least 5 minutes every time may be needed to get rid of dandruff.

Prevention of Dandruff

Alcohol based hair styling products should be avoided, since they dry up the scalp. Regular exposure to sun (but not sunbathing) may help in treating fungal infection. Learning to cope with stress and avoiding saturated fatty acids and trans-fatty oils may reduce oil glands secretion (2).

Diet in Dandruff

Nutrients to avoid:

  • Simple sugars like glucose, fructose, since they lower vitamin B6 level
  • Saturated fatty acids in meat and milk, since they increase oil gland secretion

Nutrients to consider (good for healthy scalp skin):

  • Omega-3 and omega-6 unsaturated fatty acids
  • Vitamins B (cabbage), A (carrots), and E, but not as supplements, if blood levels are normal

6. Cradle Cap in Infants

cradle capPicture 1. Cradle cap
(source: Wikimedia)

In infants, especially in newborns, crusting and scaling may appear on the scalp. Condition, called ‘cradle cap’, is caused by overactive oil glands, and usually disappears by the first year of age. Treatment is by applying mineral oil or baby oil after shampooing, and rubbing the scales off with a soft brush. Cradle cap is harmless and non-contagious, but may itch.

7. Scalp Sunburn

Scalp sunburn can burn or itch. Affected skin is red, tender and usually start to shed after few days. To ease burning and itching, first get out of the sun, and wear light protective hat when you can not avoid the sun. Apple cider vinegar, or after sun lotions applied on the scalp may ease burning. Cool shower may provide temporary relief. Painkillers as aspirin or ibuprofen help ease the pain. Lotions with anesthetics should be avoided since they may cause allergic reaction. In strong sunburn, oral corticosteroids may be needed to reduce swelling.

8. Acne

Acne on the scalp usually appear on the hair border. Acne vulgaris are treated with common anti-acne ointments.

9. Folliculitis

Folliculitis caused by bacterium Staphylococcus aureus causes red bumps with occasional pus-filled centers on the scalp. Common cause is auto-infection from other parts of infected skin. Treatment, if necessary is by over-the-counter antibacterial shampoos, or in severe cases with oral antibiotics by mouth. Several other types of folliculitis may affect the scalp.

10. Scalp Ringworm (Tinea Capitis)

Tinea capitis is fungal infection of the scalp mostly seen in pre-school children (3-7 years of age), but can also occur in adults. It is caused by group of fungi that normally live on the skin (dermatophytes) but may overgrow in certain circumstances. Tinea capitis may present as itchy, scaling area of hair loss, black dots (parts of broken hair in the scalp skin), yellow crusts (favus) or rough, thickened inflamed area (kerion). Lymph nodes on the sides of the back of the neck may be enlarged.

Tinea capitis is contagious, so other family members should be examined in suspected cases.

Therapy is by prescribed anti-fungals by mouth such as griseofulvin or terbinafine for 4-6 weeks (3).

Scalp Ringworm Pictures

Scalp ringworm - Tinea capitisPicture 2. Scalp ringworm (Tinea capitis)A mild but widespread infection by Tinea capitis. Inflamed areas are seen on the front, behind the ear and on the back of the neck.
Scalp ringworm - Tinea capitisPicture 3. Scalp ringworm (Tinea capitis) Multiple areas of hair loss; bumps are from inflammation within the skin
Scalp ringworm - Tinea capitisPicture 4. Scalp ringworm (Tinea capitis) Black dots are from broken hair
Scalp ringworm - Tinea capitis - kerionPicture 5. Scalp ringworm (Tinea capitis)Rough, thick scalp inflammation, known as a kerion (a lump can be felt on the scalp).

Source of images 2-5: Samuel Freire da Silva, M.D., atlasdermatologico

11. Tinea Amiantacea

Tinea amiantacea (Amia is a fish species with silvery skin) is another (rare) type of fungi that causes itchy scalp. Silvery skin scales are attached on the base of the hair thus gluing hair in tufts.

Picture of Tinea Amiantacea

12. Head Lice (Pediculosis capitis)

Head lice - Pediculosis capitisPicture 6. Head lice – Pediculosis capitis (source: Samuel Freire da Silva, M.D., atlasdermatologico)

Head lice may cause intense itch of scalp, neck, and shoulders due to allergic reaction to lice saliva. Adult louse is white or grey, about 2 mm long, and may be found on the hair by inspection and using a special lice-comb. Lice eggs (nits), are white, about 0.5 mm in size, and are firmly attached to the hair base.

Anyone with the hair can get head lice, but children are mostly affected.

Treatment of Head Lice

Over-the-counter anti-lice powders, lotions, or shampoos, containing pyrethrins or permethrine should be tried first. Head lice are highly contagious, so close head-to-head contact and sharing caps, headphones, and the like with infected persons should be avoided. Bed linen, clothes, and all items that were likely in contact with infected person should be washed, or if this is not possible, sealed for two weeks, what will kill the lice and eggs.

If over-the-counter products do not help, prescription lotions containing malathion or lindane should be used. Detailed instructions from CDC about treating head lice.

13. Chickenpox and Shingles (Herpes zoster)

Chickenpox in children may appear as itchy, red, crusting rash all over the skin, including the scalp.

Herpes zoster on the neckPicture 7. Herpes zoster – shingles affecting the shoulder, neck and scalp(source: Samuel Freire da Silva, M.D., atlasdermatologico)

Shingles represent reactivation of Herps zoster virus acquired during chickenpox, that remained dormant in roots of spinal or cranial nerves. Crusty, itchy or painful rash is typically confined to a course of affected nerve, usually only on one side of the head (or neck, arms, trunk or legs).

Chickenpox and shingles heal on their own in few weeks. Antiviral drugs and steroids by mouth speed up healing, though (5). Topical capsaicin or pain killers can be used to relieve pain.

14.Scalp Psoriasis

Scalp psoriasis may occur in isolation or as a part of generally affected skin. Condition may differ a lot in severity – from tiny scales to large thick yellowish patches on the reddened scalp skin.

Treatment of Scalp Psoriasis (6)

  • Shampoos against dandruff
  • Coconut oil ointment, containing coal tar, salicylic acid, and sulphur
  • Phototherapy with ultraviolet (UV-B) light

Treatment usually helps in several weeks, but it should be regular, since scalp psoriasis tend to reoccur.

15. Epidermal or Sebaceous Cyst

Epidermal cyst appears as a dome shaped, firm bump, o.5 – 2 cm in size, appearing on the scalp (or neck, upper trunk, armpits, or genitals) that may itch. It represent enlarged, oil-filled hair follicle or oil gland due to blockage of excretion. It may result from an injury, acne, or oil gland defect. Treatment options are: injection of steroids in the cyst, cyst drainage or complete surgical removal.

16. Contact Dermatitis

Shampoos or hair styling products can cause contact dermatitis of the scalp. Affected skin is itchy, reddish with papules or vesicles.

17. Allergic Dermatitis

Hair dyes containing PPD or other substances may cause hair dye allergy. Skin of the scalp (and often face and neck) suddenly becomes itchy, red and swollen. Reaction may last for several hours and then resolves on its own without consequences. Antihistamines or corticosteroids by mouth may speed up resolving the symptoms.

18. Lichen planopilaris

Lichen planopilaris is a type of Lichen planus (Latin lichen =plant growing on rocks and tree trunks; planus = flat), a skin inflammation of unknown origin, that (rarely) affects the scalp. It causes permanent scaring and partial hair loss. Treatment with steroids as ointment or by mouth may relieve itching (4).

Picture of Lichen Planus on the Scalp

Related Articles:

  • Itchy Face
  • Itchy Neck Rash
  • Itchy Skin Causes
  • Itchy Rash
  • Itch (Pruritus) – Diagnosis and Treatment
About Jan Modric (249 Articles)
Health writer
  • Dr. Chris

    Hi Raven

    You need to see a dermatologist who can examine the ares and diagnose the cause. This may just be excessively dry skin, dandruff, a fungal infection, psoriasis and so on. A dermatologist will be able to advise your further.

  • mano

    i take Griseofulvin 1000 mg in 4 divided dosage / day after meal
    i want to know
    if i take the first dose at 12 pm
    when should i take the second dose , third dose and fourth dose ????

    Good luck

  • Dr. Chris

    Mano,

    Please speak to your doctor or pharmacist about the dosage. It varies depending on your case and is prescribed for your needs specifically.

  • hyffy

    Hello

    is Tinea capitis cause stinging and burning the scalp ?

  • Dr. Chris

    Hi Hyffy

    It is usually itchy but with excessive scratching, you can break the skin (micro-tears) which can cause a stinging and burning sensation.

  • quickanswerrequired

    i’ve experience what I think is seborrhic dermatitus on my scalp according to my doctor and have been treating it for some time. It has in the past caused some hair loss which generally involves a hair coming out with a little hard bit attached to the end. I thought I was getting the better of it but occasionally do something silly that will dry my scalp out.

    here is my concern; this week, I don’t know what I could have done to have caused a flare up but for instance, I noticed a lot of dry skin shedding from my scalp. Some of the hairs coming off had little white bits on the end that were soft and came off and felt like skin…

    I noticed that these seem different to what I have previously considered follicles. Is this just some of the dry skin that is coming off attached to some of the daily hairs I lose or are these follicles.. it seems today that if they are I would have lost a large amont of hair, than I have ever experienced before.

    how do I tell what is a follicle and what is merely some dry skin?

    I am seriously panicking

  • Dr. Chris

    Hi Quickanswerrequired

    There is no way for you to say for sure without microscopic examination. Your doctor will need to examine it and will then be able to give you a more definite answer. Another possibility that should be considered here, from what you describe, is that this could be fungal in origin and would explain the white “bits” you are seeing at the end of the strand. It is best that you see a dermatologist to verify the exact skin condition. From what I understand, this has been ongoing for a long period of time and should not be the case. While treatment is currently aimed at reducing the severity of the symptoms (palliative), you need to find out why this is persisting for so long. Any underlying condition or predisposing factor has to be attended to.

  • Mary

    I am a hairdresser and have client who is an 80 year old lady who suddenly about 2 years ago started to get patches of broken hair(about 1mm).Patches are slightly raised and dry looking and are itchy ,more so at bedtime and quiet times.

    She had alot of stress in her life proir to and at the time of them appearing , there was also a sick cat around at that time.

    She has been to GP but they have had no success with daignosis and remedy yet.

  • Toor

    My doctor prescribed to me pills for treatment tinea capitis and a doctor told that many spices of fungal are resistant to oral antifungal now my symptoms are itchy – hair loss i would like to ask if i take the pills
    After how many days of treatment can i say this pills failed for treatment my lesion ???
    Do you have any idea ???
    Regards.

  • Dr. Chris

    Hi Toor

    It depends what medication your doctor prescribed. Most antifungals need to be used for 4 to 6 weeks before the infection will resolve. You should discuss this with your doctor and pharmacist.

  • Dr. Chris

    Hi Mary

    Your client needs to see a dermatologist. Skin scrapings may be examined under a microscope and can give a better idea of the possible skin disease. With the elderly, age, poor nutrition due to appetite changes and chronic medication can all play a part in thinning hair or hair loss. Telogen effuvium is a type of hair loss seen with physiological and emotional stress but a rash is not usually present to this extent and the hair growth restores after overcoming the stress. Skin diseases like psoriasis should also be considered here, as these lesions tend to be slightly raised, excessively dry and itchy. It could also be related to an infection, possibly fungal in origin, and therefore an assessment by a dermatologist or trichologist is necessary. As you can see, there are a host of possibilities and without professional assessment, it is difficult to assess. Excessive hair styling, use of hair care products, hair dyes and so on are all possible contributing factors.

  • mario

    i want to know How can we discriminate between scalp fungal and psoriasis of the scalp ??,what are the major signs and symptoms of both of those diseases of scalp ??? thanks for all

  • Dr. Chris

    Hi Mario

    There is a pronounced thickening of the skin that occurs in most cases of psoriasis as new skin cells grow but old cells are not shed. It is a raised lesion typically with reddish borders and a silvery-white appearance in the middle although sometimes this may not be evident (different types of psoriasis). Psoriasis will also not respond significantly to antifungals, unless a secondary fungal infection arose, but the primary lesions would remain unaffected or may even exacerbate slightly. This is the area of expertise of a dermatologist, so if you speak to your dermatologist, he/she can examine it, possibly take skin scrapings to confirm and make the final diagnosis.

  • clam

    i have swelling in the scalp caused by fungal infection my GP doctor prescribed o me oral antimycotic and oral prednisolone 40 mg/day , the pharmacist says that the daily dosage of prednsiolone is error and it is very danger now i confused and i ask what is the safe dosage to me ?? my weight 87 kg
    Regards

  • Dr. Chris

    Hi Clam

    We don’t respond to questions regarding dosages and treatment protocol. You do not have to do the homework to find what dosage suits you best. This is for your health care professionals with years of training to ascertain. You have to discuss this with your doctor and have him confirm with the pharmacist. Errors do occur but between both these professionals, you are in good hands.

  • soooitchy

    the back of my head is itching like crazy i cant stop itching its a fairly new thing maybe a couple months it does not itch all the time but at least every other day when i scratch i get thick sorta gooey white stuff under my nails and if i scratch long enough you can feel puss come out and eventually they will scab it never bleeds though i also have had some strange bumps behind my ears there not zits i cannot pop them they come and go a few have stayed but please you have to help me the itching is driving me insane

  • roman

    Hi
    i have tinea capitis kerion and confirmed the diagnosis by culture my doctor prescribed to me Antifungal tablets andTopical antifungal but kerion doesn’t improve within 3 weeks with the therapy ,, then he added oral cortisone in the third week of treatment he ays to me this will improve the cure really i asked another dermatologist about this medications he said that the addition of oral cortisone must be in the first week of the treatment with oral antifungal and oral cortisine must not use in the third weeks of treatment because it may be cause relapse the infection , or if we use oral cortisone it must be in the first week with oral antifungal ,, not is in the second or third week
    thus i returned to me doctor and said to him the recommendation which the another dermatologist told me ,, but he insist on the addition oral cortisone in the third week it will be help to cur the infection ,,, in the end i am very confused i would like to ask if patient tinea capitis kerion doesn’t improve within 3 weeks with oral antifungal can we add oral cortisne in the third weeks of therapy to be along with oral antifungal or it is mistake !!??

    can we add prednisolone therapy (1 week) ,

  • Dr. Chris

    Hi Soooitchy

    This could be various skin diseases like eczema (read more on the different types of eczema), psoriasis (possibly infected) or even a fungal infection of the scalp. It needs to be examined and assessed by your doctor, or preferably a dermatologist, and depending on the diagnosis, the appropriate treatment will be prescribed. Do not attempt to treat this on your own as you may be wasting time and it could lead to complications like hair loss or a spread of the infection. See your doctor immediately.

  • roman

    Hi
    i have tinea capitis kerion and confirmed the diagnosis by culture my doctor prescribed to me Antifungal tablets andTopical antifungal but kerion doesn’t improve within 3 weeks with the therapy ,, then he added oral cortisone in the third week of treatment he ays to me this will improve the cure really i asked another dermatologist about this medications he said that the addition of oral cortisone must be in the first week of the treatment with oral antifungal and oral cortisine must not use in the third weeks of treatment because it may be cause relapse the infection , or if we use oral cortisone it must be in the first week with oral antifungal ,, not is in the second or third week
    thus i returned to me doctor and said to him the recommendation which the another dermatologist told me ,, but he insist on the addition oral cortisone in the third week it will be help to cur the infection ,,, in the end i am very confused i would like to ask if patient tinea capitis kerion doesn’t improve within 3 weeks with oral antifungal can we add oral cortisne in the third weeks of therapy to be along with oral antifungal or it is mistake !!??

  • Dr. Chris

    Hi Roman

    We cannot comment on any treatment. This is your doctor’s perogative and you have already sought a second opinion. We would therefore not want to get involved as we are here only to guide readers on where to seek medical attention and not usurp the authority of your doctor. It is however still in the early stages and most fungal infections of the skin take at least 6 weeks to respond to antifungal medication.

  • roman

    Yes you are aright but i want an information about
    if the patient use oral cortisone(one week) in the third weeks of treatment ,, is it mistake ??? yes or not

  • Dr. Chris

    Roman, we will not answer this question because it is not for us to go against what your doctor is recommending. It can become a medico-legal issue.Speak to your doctor and seek a second or third opinion.

  • stephanie

    Hi..I have little bumps on my neck almost like bite from a mosquito an some on my arms of course. I hav also had a very ichy scalp for a couple weeks that comes and goes…I have been checked multiple times for lice and nothing..I have also been checking for bed bugs and nothing. I’m not real sure what the next step would be..its almost like I have little mosquito bits on my scalp as well but I can see any thing…theitch comes and goes through out the day getting worse when I’m hot or have worked out..

  • eddy

    hi, I was referred to a dermatologist and he said I have seborrheic dermatitis on my face, near mouth, sides of my nose, chin area. I was prescribed Ketoconazole cream. I used it for about 3 weeks. My skin would get red and oily a few hours after applying. Then I went back n he prescribed Desonide Lotion. Same thing occurred, redness after a few hours n it’ll also leave my skin oily. Every time I my face to dry after washing, it’ll leave the affected area dusty flaky looking. The flaky area would become visible when my face is stretched. Stretched by smiling, laughing, or getting dental work. So now I don’t know what to do. I saw the articles above and saw the coal tar or salicylic shampoo option and I was wondering if I can try rinsing my face with those products, of course without breaking out or anything. Is there anything else I should/could do for my S.B. ?

  • sonna

    Hi, my scalp will itch crazily at night. Its ridiculous. It gets to the point where I scratch so much it starts bleeding. I can’t wash my hair every day, so I wash it once a week, and I’ve been checking periodically for lice. Any Ideas?