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Itchy Scalp Causes and Treatment

Itchy Scalp Causes and Treatment

Itching is the body's response to the presence of some harmful factor on the skin, and needs your immediate attention. There are a number of conditions involving the scalp that often lead to uncontrollable itching. Here are some conditions that cause itching of the scalp.
Anannya Saikia
Last Updated: Apr 23, 2018
The skin of the scalp is sensitive, and it is assailed by many conditions throughout a person's life. The scalp has quite a lot of hair follicles that are often involved in causing or aggravating those conditions. Also, unlike most of our skin, the scalp remains uncovered through most of the year. Even when it is covered, problems may crop up, e.g. helmet itch. The scalp is also affected in some conditions that are genetic in origin. Thus, intrinsic as well as environmental factors affect the skin of the scalp in different ways.
Seborrheic dermatitis
This condition usually results from an excessively oily scalp, although this may not always be the case, as some people have a familial predisposition to it. Many of the cases of seborrheic dermatitis are due to the fungus Malassezia furfur. Other conditions that may cause this are stress, HIV infection, season change, and certain neurological conditions. Plaques form on the scalp surface that look silvery-white and scaly. The skin itches and may turn red due to inflammation. When this condition occurs in infants, it is called seborrheic dermatitis, also called cradle cap.
Treatment depends on the cause and the severity of the condition.
  • Antifungal drugs are used when the condition is due to the fungus Malassezia, like Ketoconazole and Ciclopirox. These are available in the form of medicated shampoos that also contain ingredients for controlling the proliferation of skin cells. Some such ingredients are selenium sulfide, zinc pyrithione, coal tar and salicylic acid. Oral antifungals are also used when the infection is widespread.
  • Steroids are used to control the inflammation typical of seborrheic dermatitis. Some of these steroids are Hydrocortisone Desonide and Betamethasone.
  • In severe cases, immune suppressors like Tacrolimus and Pimecrolimus are used to reduce inflammation.
Tinea capitis
Tinea capitis is caused by some fungi known as dermatophytes. The infection shows up as small bald patches on the scalp, that itch and may turn red and inflamed by scratching. It is contagious, so it can be acquired by contact with people (or their belongings) who already have the infection. Since fungi grow well in a warm and moist environment, sweating can also be the cause.
Usually, the antifungals for tinea capitis are taken orally and in the form of medicated shampoos.
  • Itraconazole, Fluconazole, Griseofulvin and Terbinafine are usually used for treating the infection.
  • Shampoos containing antifungal drugs like Ketoconazole are used as part of the treatment. This may also be the only treatment used initially
Pediculosis capitis (Head Lice)
Head lice infestation is very familiar to us due to its prevalence in children, although older people get it too. The head louse called Pediculus humanus capitis, feeds on blood. It spreads easily with contact, but is easy to eradicate too. The scalp itch in those infested with head lice is caused by the saliva of the lice, which it injects into the scalp while feeding.
Head lice can be eradicated easily, but a vital part of the treatment is to eradicate the eggs as well, because even if the lice are killed, the eggs hatch fast and spread new lice.
  • Permethrin lotion (1%): It kills lice but not their eggs, so retreatment 9 days after the first one is essential for killing new lice. It cannot be used in children younger than 2 months of age.
  • Malathion lotion (0.5%): It kills lice and also their eggs, but the activity against eggs is partial, so a retreatment is essential to kill new lice. It cannot be used in children younger than 6 years of age.
  • Benzyl alcohol lotion (5%): It kills lice but does not kill the eggs, so retreatment is essential. It cannot be used in children younger than 6 months of age.
Discoid lupus erythematosus (DLE)
Like so many other skin conditions, DLE is a condition of unknown cause. It is a chronic condition in which red, scaly patches develop on the skin. The contours of the patches are often darker in color than their center. The patches are sensitive to sunlight, and may even be a result of it. People with systemic lupus erythematosus (SLE) are more likely to get DLE. However, other people who have DLE may have no systemic involvement at all.
  • Topical corticosteroids: These and other immune system-modulating drugs are used, as DLE is believed to be related to SLE, a disease caused by an out-of-control immune system.
  • Laser therapy: It can be used to remove skin cells of the DLE lesions. A burning sensation is often experienced after laser therapy.
  • Antimalarial drugs: Some drugs like Chloroquine, Hydroxychloroquine and Quinacrine are effective in treating DLE lesions. However, for those who smoke, these appear to be less effective.
Pityriasis amiantacea
Also known as tinea amiantacea, this condition affects the scalp causing very thick, white or yellowish scales, that adhere to the skin as well as the hair shaft. The scales are quite tenacious and hard to remove. This condition occurs as a complication of several others like psoriasis, seborrhoeic dermatitis, atopic dermatitis, tinea capitis, head lice, etc. It occurs more often in children than in adults.
The treatment involves resolving the condition of which pityriasis amiantacea is a complication. Other treatment options are aimed at removing the scalp scales.
  • Medicated shampoos: These are coal tar-based or salicylic acid-based or have antifungal drugs as major ingredients, if a scalp fungal infection is the cause.
  • Topical corticosteroids: These are used to deal with various inflammatory conditions of the scalp.
  • Oral antibiotics or antifungals are administered when a bacterial or fungal infection has occurred.
Prurigo nodularis
Prurigo nodularis (PN) is very similar to neurodermatitis in most of its features. However, in PN, small, hard lumps develop on the skin, that are the source of itching. The itching is severe, and to relieve it, the person may scratch to the point where he or she has done damage to the skin. Like neurodermatitis, irritated nerve endings are believed to play a role in the pathophysiology of PN. People who have an allergic skin condition are at a greater risk of developing this. Also, many other conditions like deficiency of iron, renal disease, HIV, and other allergic disorders can trigger PN. It is also believed by some experts working in this field that PN is not a separate disease but a consequence of scratching pruritic skin.
PN is difficult to treat. There is often no permanent resolution for this condition. The treatment options used are symptomatic in nature.

Topical Treatment
  • Topical corticosteroids: Steroids like Mometasone or Methylprednisolone can be used to suppress inflammatory flares.
  • Calcineurin inhibitors: Tacrolimus and other such drugs have proved successful in managing the symptoms of PN to a certain extent.
  • Other drugs: The other drugs used are Capsaicin, vitamin D3 analogues, Menthol and N-palmitoylethanolamine (PEA).

Systemic Treatment
Drugs are administered orally or by injection for managing PN, if topical treatment has failed to provide relief.
  • Antihistamines like Clemastine, Hydroxyzine, Levocetirizine, Loratadine, Desloratadine, and Azelastine are used to control an allergic reaction.
  • Cyclosporine: It has proved effective in controlling PN because it has wide-ranging immune-suppressing effects.
  • Other drugs: The other drugs that have been found effective in controlling PN are antidepressants, Naltrexone and Thalidomide.
Scalp dermatitis
This condition is due to an allergy to or an irritation from some substance or some object that has come in contact with the skin. Several chemicals, cosmetics, and skin- and hair-care products like shampoos, perfumes, detergents, or some objects like helmets, etc., trigger this kind of dermatitis. Any person can get an allergy to common hair dyes. The skin itches and becomes red after scratching, but usually goes away once the allergen is removed and the reaction to it has subsided.
Treatment involves nothing more than allowing the flare to resolve on its own. Topical corticosteroids may be applied if the flare does not subside. Subsequent exposure to the allergen should be avoided.
Sometimes, an intense itch develops, that causes the person to scratch the skin uncontrollably. Nothing seems to bring relief, and the individual is caught up in a cycle of itching and scratching, followed by more itching. Sometimes, the skin becomes hyperpigmented and scarred due to the constant scratching. It is believed that neurodermatitis develops when the nerve endings that innervate the skin become irritated. People who already have an allergic skin condition are at risk of developing neurodermatitis. Stress can also trigger this condition. Neurodermatitis is also known as Lichen simplex chronicus.
  • The treatment is symptomatic, as with many skin conditions. Corticosteroid creams and ointments are used to suppress inflammation. The strength of the steroid chosen depends upon the severity of the condition.
  • Antihistamines are drugs that control allergic reactions. They often prove beneficial in such cases.
  • Antibiotics are prescribed to deal with an infection that has developed due to constant scratching of the skin.
  • Drugs to control anxiety are also prescribed if the cause of the neurodermatitis is anxiety-related.
Actinic keratosis
This condition is often seen in white people who have spent a long period of time in the sun. Patches of rough, reddish skin develop on many areas exposed to the sun, including the scalp. If the patches begin to itch, a doctor should be consulted without delay, because these patches are considered precancerous, that is, there is a good chance that they may turn cancerous.
Patches are removed by either physical or chemical methods. Some creams and ointments are used to kill the cells by interfering with their metabolic processes.
  • Physical methods include cryotherapy, photodynamic therapy, dermabrasion and curettage.
  • Chemical methods include chemical peels and the use of creams containing 5-fluorouracil, imiquimod, etc.
This condition results from excessive proliferation of the skin cells causing reddish, scaly patches to develop on the skin. Many people who have this condition have a family member who is already suffering from it. Psoriatic patches are very itchy; frequent scratching can lead to a burning sensation and an infection.
The strategy for treating scalp psoriasis involves both applied medications and medicines taken internally.
  • Medicated shampoos and creams: The main ingredients of these are coal tar products, salicylic acid, Calcipotriene, and Tazarotene.
  • Some oral medicines taken for psoriasis are steroids, Methotrexate, Cyclosporine, oral retinoids, monoclonal antibodies, etc.
Atopic dermatitis
A large number of sufferers of this condition are children. People with this condition have skin that is more sensitive to environmental factors than that of other people. When exposed to such factors, it shows an allergic and inflammatory reaction. It becomes flaky and extremely itchy. The itching further aggravates the condition.
Many types of drugs are used to treat this condition. The main aim is to modify the activity of the immune system and control its unusual reactivity.
  • Applied medications: These include creams and ointments containing corticosteroids, calcineurin inhibitors and antibiotics.
  • Oral medications: These include oral antibiotics and oral antihistamines.
Skin Cancer
Basal cell skin cancer sometimes manifests itself on the skin of the scalp as itchy lesions that bleed upon scratching. These lesions appear shiny with the center turning into an ulcer. Exposure to the sun for long periods is often implicated in the development of this type of cancer. Sometimes, squamous cell carcinoma also causes itchy lesions on the scalp.
The treatment is based on which stage the cancer has attained at the time of diagnosis. Some treatments conventionally employed are:
  • Surgery: This is done to remove malignant lesions. If a large area of the skin is malignant, the skin is grafted onto the portion from where the lesion was removed.
  • Radiation therapy is used when it is not possible to operate on the skin lesions.
  • Photodynamic therapy: This treatment uses a substance to make the skin sensitive to the effects of light. A laser is then used to destroy the lesion.

There are many conditions that cause scalp itching, most of them due to the unusual reaction of the skin's immune system toward extrinsic factors. Several are genetic in nature. At present, most have only symptomatic treatment, though new research is sure to uncover permanent treatment methods for these conditions.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for professional medical advice.