Scaly Scalp Patient Information Fact Sheet

What is scaly scalp?
Scaly scalp is a common problem and usually causes flaking and itching.

What causes scaly scalp?
A number of different conditions can cause scaly scalp:

Dandruff. Skin cells are lost from everyone's scalp each day, but if more cells than usual are lost, they clump together to form white or grey flakes of dandruff. Dandruff affects men and women equally and can cause irritation and itching.

Psoriasis .This skin condition is very common and while people of any age can be affected, it usually begins between the ages of 15 and 35. Psoriasis often affects the scalp, where red areas covered in thick silvery scales appear under the hair. Scalp psoriasis can be stubborn and difficult to treat and may look unsightly, but it is not infectious.

Seborrheic eczema. This may also be called seborrheic dermatitis. In children and adults, seborrheic eczema causes itchy, scaly patches on the scalp. It can also affect the eyebrows, face, ears, and the upper parts of the body.

"Cradle cap". In babies this condition causes greasy, yellow scales to appear on the scalp, giving a crusty appearance. This can spread to the face and body.

How is scaly scalp treated?
The treatment will obviously depend on the cause of the problem. For psoriasis, your doctor may give you a steroid lotion or shampoo (eg, fluocinolone [Capex Shampoo] or clobetasol [Clobex Shampoo]). Anthralin, synthetic Vitamin D3 and Vitamin A are used in prescription topical treatments to help control psoriasis lesions. Your doctor may also refer you to a dermatologist. Seborrheic eczema may require treatment with a steroid preparation or sometimes with antibiotic tablets or cream. Recently, the FDA approved a new class of drugs, topical immunomodulators (TIMs), with two FDA approved non-steroid drugs: tacrolimus (Protopic) and pimecrolimus (Elidel). An antifungal shampoo containing ketoconazole (Nizoral Shampoo) or ciclopirox (Loprox Shampoo) can also be effective. Cradle cap is usually treated with simple shampoos but sometimes needs treatment with hydrocortisone cream or an antibiotic cream. Combination products that include the Vitamin D derivative calcipotriene in combination wtih the steroid betamethasone (Taclonex Scalp) may also be prescribed.

If you have mild dandruff or seborrheic eczema it will usually improve if you use a medicated shampoo once or twice a week. Medicated shampoos are available from pharmacies without a prescription. If use of a medicated shampoo is not successful the condition may respond to a preparation containing salicylic acid or coal tar, which will help to remove the scales—ask your pharmacist about this. Unfortunately the problem may return if treatment is stopped so you may need to continue one or more of these treatments for some time.

When should I see my doctor?
If your scalp problem does not clear up, you should see your doctor who will examine your scalp. If you have eczema your doctor will check that it is not infected. If you do have an infection your doctor may prescribe antibiotics.

Self-help measures

  • Do not use more than the recommended amount of prescribed cream or lotion or shampoo to reduce the risk of side effects.
  • Do not wash your scalp too frequently as this can dry your skin and encourage scaling and flakiness.
  • Be careful when using hair styling products as they can irritate your scalp and make your condition worse.
  • If your scalp is itchy, rub it gently. Your skin is delicate and can be damaged or become infected if you scratch it.
  • Tar-based products can stain, so use old sheets and pillow cases.
  • If you have blonde hair, avoid shampoos containing tar, which may discolor your hair.

Further information
National Eczema Association: www.nationaleczema.org
National Psoriasis Foundation: www.psoriasis.org

Last Reviewed: May 2013