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What is itchy scalp?
Many people suffer from chronic itching of the scalp, a problem that can profoundly impact quality of life. Itchy scalp does not have one cause. The most common causes are: seborrheic dermatitis, psoriasis, contact dermatitis, and neuropathic itch.
What else can cause an itchy scalp?
Less common causes of itchy scalp include tinea (ringworm) infections, eczema (atopic dermatitis), and infestations (e.g. scabies). Other possibilities include lichen planopilaris, central centrifugal cicatricial alopecia, skin cancer, and dermatomyositis.
How is itchy scalp diagnosed?
Often a visual assessment is sufficient to make the diagnosis. Tests might include culture for fungal infection, metabolic tests to rule our renal disease, diabetes, or HIV, an MRI of the neck to rule our soina stenosis or nerve impingement, and a scalp biopsy when warranted.
How is itchy scalp treated?
Treatment of itchy scalp depends on the cause.
Seborrheic dermatitis. Scalp itch from seborrheic dermatitis usually responds to more frequent hair washing, shampoos containing selenium sulfide, zinc pyrithione, or coal tar extracts, and topical steroids.
Psoriasis. Itchy scalp due to psoriasis will usually be treated with topical steroids and vitamin D analogues, sometimes in conjunction with a salicylic acid gel to remove scale. In cases with generalized psoriasis, biologics (e.g. Humira, Stelara, Cosentyx) might be used.
Atopic Dermatitis. Scalp itch associated with atopic dermatitis is frequently treated with topical steroids.
Allergic Contact Dermatitis. Allergic contact dermatitis of the scalp is often caused by hair dye, fragrance or preservatives. Avoidance of hair dye and any new shampoos and conditioners is the first step. Patch testing for specific allergies is sometimes helpful. Topical steroids can relieve the itch.
Neuropathic Scalp Itch. Neuropathic scalp itch is difficult to treat. Identifying and, when possible, treating and nerve impingement is important. Topical analgesics can be helpful, (e.g. compounded 10% Ketamine, 5% amitryptyline, 5% lidocaine). Oral Gabapentin can also provide relief.
Treatment of other causes of scalp itch are directed at the underlying disorder, such as correcting metabolic disease or eradicating tinea.
What is the prognosis for scalp itch?
Many cases of itchy scalp or caused by chronic problems. Treatment can be provided to reduce the itch and discomfort, but if treatment is not maintained it is likely that the itch will return.
Who treats scalp itch?
Contact a board-certified dermatologist to treat your scalp itch.