The most common causes of itchy scalp
Itchy scalp. The words alone trigger a desire to hop into the shower and scrub, scrub, scrub. I’d wager that pretty much everyone has experienced an itchy scalp before, be it the effect of a healing sunburn, momentary lapse in proper hygiene, or something that goes beyond that.
I am admittedly not an expert on itchy scalps. In fact, when someone approaches me for the 411 or asks for advice on their current condition, I always redirect them to a doctor who specializes in that sort of thing. Today, friends, I’m bringing the doctor to you.
With a lot of help from Dr. Fayne L. Frey, a NYC-based dermatologist with over 20 years of experience, you’re going to learn about the common causes of chronic itchy scalp, as well as their respective treatments. Saddle up!
The term “mycotic” sounds like fancy pants derma-jargon, but it essentially boils down to diseases caused by either funguses or yeasts-run-amok. The below are caused by a lipid-dependent yeast called malassezia (which is not a new Italian luxury brand, but rather a yeast commonly found on your scalp).
Did you know that up to 50 percent of the population experiences dandruff? Yup. “Dandruff is usually seen in individuals from adolescence to about age 50, when the sebaceous glands are most active,” explains Dr. Frey. It presents itself as “fine white or gray scales that are found diffusely in the scalp,” typically accompanied by an itching sensation.
“This itchy scalp lasts beyond 50 years of age and is usually chronic and recurring,” says Frey. “Red patches with large, yellow, greasy scales that may form crusts commonly occur in the scalp, on the face–eyebrows, nasolabial folds, and eyelid margins–ears, armpits, groin, and mid-chest.” Frey says that mild itching is common and that this particular form of itchy scalp is prevalent “in immunocompromised patients and in patients with neurological illnesses like Parkinson’s and stroke patients.”
Treatment: Frey recommends anti-fungal shampoos with the following ingredients: pyrithione zinc, selenium sulfide, ciclopirox, and ketoconazole. You can find these over the counter and online, but if you’ve got a more severe case, consider a prescription shampoo.
Within the “mycotic diseases” category also lies itchy scalp caused by dermatophytes, or the less glamorous term: ringworm.
The fungal organisms of tinea capitis may affect the hair, while others infect the follical, explains Frey. It is most commonly seen in pre-pubescents, but anyone may fall prey to the ol’ ringworm.
“It is spread by contact with people, animals, and found in soil. Sharing pillows, hairbrushes, and clothing may spread the condition. There are both inflammatory (with pustules and abscesses, lymph node swelling) and non-inflammatory (round patches of hair loss with fine scaling) infections.”
Treatment: Prescription oral medication, including Griseofulvin, Itraconazole, and Terbinafine are best. Anti-fungal shampoos will help as well. A good rule of thumb is to stop sharing stuff and get your pets checked for infection.
Don’t freak out at the word “parasite.” OK, you can freak out a little bit. The truth is, though, it’s not terribly uncommon for parasites to cause an itchy head.
Frey says that parasitic conditions are most commonly seen in school-age children and that the form that emerges most often is, of course, lice and their eggs (nits).
“These are frequently seen in the scalp area behind the ears and lower areas of the scalp,” says Frey. “Lice and nits can be seen with the naked eye, and nits usually attach to the hair shaft close to the scalp.”
Fact: lice prefer straight, caucasian hair to curly hair. They also transfer easily from one person to another via shared clothing, hair products/tools, and pillows
Treatment: Shampoos, lotions, and creams that contain permethrin or malathion should be applied once and repeated weekly. Nits can be removed with a fine-tooth comb. Bedding should be washed in hot water, clothing that has been worn should be washed, and all family members should be inspected for possible infestation.
“The most common cause of inflammatory scalp itching is psoriasis, a chronic, recurring condition that affects two percent of the population–half of whom [experience itchy scalp],” says Frey. She says this presents as red areas with silver-gray scaly patches that may appear anywhere on the scalp, but especially along the hairline.
Treatment: Says Frey, “This condition is often difficult to treat. Mild cases may improve with tar shampoos. Keratolytics (salicylic acid) shampoos are often helpful at removing scales, though topical steroids are the mainstay of treatment. In severe cases, oral medication (methotrexate, cyclosporine) is helpful. Injectable immunobiologics are also an option for patients with severe psoriasis.”
Less “Severe” Causes
I hope all the above information didn’t scare you. If you’ve got an itchy scalp and you don’t suspect it’s due to a disease or skin condition, these factors may be to blame.
Amp up the conditioner, especially during the winter and fall when the air is particularly dry.
Not Washing Enough
When you don’t wash your hair regularly, you can experience a buildup of oil and dead skin cells that causes both flaking and discomfort.
Not Exfoliating Enough
When you wash your scalp, exfoliate. Use your fingers or an exfoliating tool and break up that buildup.