In the fleeting moments you spend scratching your head, have you ever stopped to wonder what may be causing your scalp to itch? Millions of people suffer from an itchy scalp and many are left without knowing what’s really going on. There are a number of conditions that may be causing you discomfort, so we caught up with Dr. Ingrid P. Warmuth, MD of the Warmuth Institute of Dermatology and her colleague, Lauren Hartman, MS, PA-C, to go over the most common causes of an itchy scalp, how to treat them and when to see your doctor.
What Causes It: According to Dr. Warmuth, seborrheic dermatitis is either caused by increased sebum or oil production in the skin causing an overgrowth of yeast, or from an irregular response in the immune system. “It can present in times of stress, with exercising or in cold and dry weather,” she says. It is commonly found on the scalp, and even the eyebrows, nose and ears.
How to Treat It: Dr. Warmuth advises ideal over-the-counter treatments or shampoos and moisturizers containing selenium sulfide, zinc pyrithione or salicylic acid, which help control the yeast. “If the condition persists or becomes worse,” she adds, “your doctor can write prescriptions with an antifungal ingredient to control the yeast and a topical corticosteroid to control the itch.”
Read More: How to Get Rid of Seborrheic Dermatitis
What Causes It: Hartman tells us psoriasis is a chronic condition of the immune system. “It presents with scaly plaques throughout the body, commonly found on the scalp and even the trunk, knees, palms and nails,” she says. Dr. Warmuth adds that there is often a strong genetic component to psoriasis, making family members more likely to develop it. Triggers such as stress, infections, environment and medications can cause the condition to flare up.
How to Treat It: “Over-the-counter shampoos containing coal tar or salicylic acid can help to soften the scales,” says Dr. Warmuth. “If the condition persists or gets worse, prescriptions such as topical corticosteroids or corticosteroid shampoos may be the next step in treatment. Biologics and laser treatment therapy have been proven effective.”
What Causes It: Head lice is found on the scalp and causes stress not only to our skin but our emotional state. Contrary to popular belief, lice prefer clean hair. Families must be cautious with young children in school and/or group activities. Dr. Warmuth claims it is “typical to see nits (tiny eggs) on the hair shaft because adult lice are harder to see.” She advises that all family members and close contacts should be checked after a diagnosis is made and pulling hair back into a hair tie can be an effective preventative measure. Common places that may itch from head lice are in the hairline along the neck, forehead and back of the head (where a higher ponytail might sit).
How to Treat It: Dr. Warmuth advises that over-the-counter treatment of lice includes shampoos that contain ingredients such as pyrethrin or permethrin, which are insecticides. Your doctor can prescribe medications such as benzyl alcohol lotion or ivermectin lotion to treat the lice infestation more aggressively.
What Causes It: Tinea capitis is a temporary infection of the skin and follicle. “The fungus extends into the hair follicle, which can lead to hair loss,” says Dr. Warmuth. “It can also have a black dot, ringworm-type appearance. It can affect the scalp, as well as the eyebrows or eyelashes since the hair follicle is involved.”
How to Treat It: Dr. Warmuth notes that over-the-counter anti-fungals are not effective on tinea capitis. After an appropriate diagnosis is made, your doctor can prescribe prescription-strength oral anti-fungals to treat the infection.
What Causes It: “Atopic dermatitis, or eczema, is characterized by itchy, dry and irritated skin” says Hartman. It is an inflammation of the skin and can be caused by an overactive immune system responding to irritants. Eczema can be triggered by stress, changes in weather and allergies. “It is common in patients with asthma and seasonal allergies,” she adds.
How to Treat It: Hartman suggests patients with eczema should take shorter, cooler showers; use moisturizing bar soap or cleanser and moisturize right after the shower. Patients with flare-ups should visit their doctor, who can prescribe a topical corticosteroid cream or ointment to calm the inflammation and help the itch.
Read More: What Are the Types of Eczema?
What Causes It: Hartman explains allergic reactions can be a common result of hair dyes, shampoos, conditioners and hair treatments.
How to Treat It: If anything is causing an allergic reaction, it is crucial to discontinue use entirely. “Allergic reactions can resolve on their own if you are able to determine the offending agents and avoid them, which is often very difficult,” says Hartman. “It is important to discuss with your doctor if you recently dyed your hair or had hair treatments, tried any new shampoos, conditioners, lotions or detergents in addition to any new medications.”
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Dr. Warmuth and Hartman advise that you should see your doctor if:
Your dermatologist can assess your scalp to determine which treatment will work best for you.