Itchy Scalp

Reddened/flaky/itchy scalp is most commonly due to seborrheic dermatitis.  

Patients often have a diffusely reddened scalp.  Other reddened areas with flaking occur around the nose, on the cheeks, upper lip, eyebrows and behind the ears.  

The best treatment is an anti-fungal shampoo (e.g. Nizoral) or a shampoo containing selenium sulfide (e.g. Head and Shoulders, or Selsun Blue).  A mild topical steroid cream may be used in conjunction with the above such as hydrocortisone or triamcinolone.  Stronger topical steroids are discouraged because they may thin the skin.

Psoriasis, another cause of itchy scalp, is generally very red with overlying dried skin.  The discrete, localized nature of Psoriasis, as well as involvement of other body areas - 

• Elbows

• Knees

• Shins

• Forearms

 - helps to differentiate Psoriasis from the more generalized scalp involvement of seborrheic dermatitis. Patients with Psoriasis may also have arthritis and fingernail deformities.

A bump or nodule in the scalp that is itchy and usually painful may be a furuncle or carbuncle.  This is a localized infection of the hair follicle.  Patients may have enlarged lymph nodes near the site.  

Antibiotics may be needed if the bump is large or extends deeply into the underlying tissue.  For the majority of cases, avoidance of irritation (i.e. itching) and observation should suffice.

This section provided by LT Nathaniel Ruttig, MC, USNR, Naval Medical Center Portsmouth

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