Dandruff describes scaling and itching of the skin on the scalp. Dandruff causes white flakes on the scalp. Medicated or anti-dandruff shampoos can help. Seborrhoeic dermatitis has similar symptoms to dandruff. Cradle cap in babies is a form of seborrhoeic dermatitis. Psoriasis can also cause an itchy scalp.
Dandruff (pityriasis capitis) is the term used to describe simple scaling of the skin on the scalp. About 50 per cent of the population suffers from dandruff. Applying simple oils (for example, bath oil) to the scalp can be useful in the treatment of dandruff.
Why dandruff occurs
The top layer of the skin is constantly being shed and renewed. Although this usually goes unnoticed when it occurs on most areas of the body, it may become more visible on the scalp as the hair traps the scaling skin.
Itching scalp, with or without scaling, is a very common problem. It commonly occurs in middle-aged people, for no obvious reason. The usual response is to scratch, and this will often cause scratch marks and little crusty sores throughout the scalp. Dandruff can cause itching scalp. There are also a number of less common skin conditions that can present as itching in the scalp.
Seborrhoeic dermatitis can cause itching scalp
Seborrhoeic dermatitis is the name given to a red, itchy, scaly reaction in the scalp. It can be considered a more severe form of dandruff, except the scale is more marked and the scalp is often inflamed. It can be very itchy and can affect other parts of the body, including the face, eyebrows, beard and central chest area.
Symptoms of seborrhoeic dermatitis
Symptoms of seborrhoeic dermatitis develop gradually and may include:
- Dry or greasy diffuse scaling of the scalp. This is the most usual presentation.
- Yellow-red scaling on those areas of the body that are generally affected in severe disease – along the hairline, behind the hair, on the eyebrows, on the bridge of the nose, in the creases between the nose and the lips inside the ears, over the sternum (middle of the chest), on the underarms and groin hairy areas.
Why it occurs
Seborrhoeic dermatitis affects areas with high densities of large oil glands. The inflammation is caused by the body’s reaction to a yeast on the scalp and to products that break down oil produced by the oil gland.
Cradle cap is a form of seborrhoeic dermatitis that occurs in newborns. It may not be the same disease as in adults. It results in a thick, yellow-crusted scalp lesion. Other symptoms can include:
- Splits in the skin and behind the ears
- Red facial pustules
- Stubborn nappy rash.
Factors that can make seborrhoeic dermatitis worse
The incidence and severity of seborrhoeic dermatitis seems to be affected by:
- Other illnesses – for example, patients with neurologic disease (especially Parkinson’s disease, stroke and paralysis) or HIV may have severe seborrhoeic dermatitis
- Emotional or physical stress
- Genetic factors
- Seasonal – seborrhoeic dermatitis is usually worse in winter.
Psoriasis can cause itching scalp
Psoriasis is a relatively common skin condition that affects about three per cent of the population. It is often confined to the scalp, elbows and knees. While seborrhoeic dermatitis tends to involve almost all the scalp, psoriasis often occurs in small, localised patches of redness with quite prominent thick scaling. Because psoriasis may only occur on the scalp, it can be mistaken for a severe case of dandruff or seborrhoeic dermatitis. Psoriasis has a genetic link – there is often a family history of the condition. It may be triggered by some form of stress.
Medicated shampoos can help dandruff and itching scalp
Regular washing of the scalp with medicated soaps may be all that is required to relieve itching scalp. The most common anti-dandruff shampoos contain one or more of the following ingredients:
- Tar – shampoos containing tar have been used for years, usually for more severe scalp conditions. In the past, the scent of the tar-based shampoos made them less acceptable. However, newer preparations are well tolerated and simple to use
- Selenium sulphide
- Zinc pyrithione or zinc omadine
- Piroctone olamine – this is the most recent addition to the medicated shampoos. It is known as a 'second generation' anti-dandruff agent. It is less toxic than zinc pyrithione and is therefore safer for family use
- Antifungal agents.
How often to use medicated shampoos
How often you need to use medicated shampoos will depend on how severe your dandruff is and what treatment you are using. Always read the directions on the shampoo pack before using it. Some products are mild enough to be used every day, while others should only be used once a week. Over time, you will work out how often to use the shampoo to keep your dandruff under control.
Typically, those with a scaly scalp should be shampooing everyday. Infrequent shampooing may result in scale build-up and thus make symptoms worse. A medicated shampoo should be used about twice a week, leaving the lather in the scalp for several minutes to allow the active ingredient to work. On the other days, a mild, non-medicated shampoo can be used to prevent scale accumulation. A conditioner should always be used to prevent excessive drying from frequent washing.
Where to get help
- Your doctor
- Australasian College of Dermatologists.
Things to remember
- Dandruff affects about 50 per cent of the population.
- Itching scalp can be caused by a number of conditions, including dandruff, seborrhoeic dermatitis and psoriasis.
- Medicated shampoos can be used to treat dandruff and relieve itchy scalp.
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Australian College of Dermatologists
Fact sheet currently being reviewed.
Last reviewed: August 2011
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