Dry Scalp Causes and Treatments

What to do about it and when to call the doctor

An itchy, dry, flaky scalp is a common complaint. A frequent cause of it is a condition called seborrheic dermatitis, also called seborrheic eczema, dandruff, or, in babies, cradle cap. It's not contagious, it doesn't indicate poor hygiene, and it doesn't cause serious damage to your hair or scalp.

The severity of seborrheic dermatitis varies from mild flaking and a little itchiness to an intense itch and thick, greasy scales encasing the hair. Treatment is often topical and may consist of over-the-counter (OTC) or prescription lotions or shampoos.

Dandruff flakes on a man's shoulder close up
AndreyPopov / Getty Images

Symptoms

Not everyone with seborrheic dermatitis will have symptoms, but many people with it have flaking and/or itching.

Flaking

At its mildest, this condition may just cause very small, thin flakes. When more severe, the flakes can be thicker, and are often yellowish or greasy as well.

If you have silvery scales on your scalp, it may be from an overlap with psoriasis, a condition sometimes referred to as sebopsoriasis.

Itching

Seborrheic dermatitis may or may not be itchy. When it does itch, it can be mild or intense. Some people say the itch bothers them the most at night, and some may wake up scratching.

Irritated, itchy skin may also be red, even if you haven't scratched it.

Other Areas

This rash can actually affect many areas other than the scalp, especially those that have a lot of sebaceous glands, including:

  • Over the eyebrows
  • Between the eyebrows
  • Sides of the nose
  • Chest
  • Groin

Rare, Life-Threatening Complication

In rare cases, seborrheic dermatitis can be widespread and affect the majority of the skin's surface. This is called erythroderma, and it's a severe, potentially life-threatening condition. Erythroderma is more common in people with compromised immune systems, such as from HIV/AIDS.

Seborrheic dermatitis on the scalp

DermNet / CC BY-NC-ND

Causes

Seborrheic dermatitis has many possible causes and triggers. Among the causes are:

  • Overgrowth of Malassezia yeast, which may trigger skin inflammation
  • Overactivity of sebaceous glands, leading to oily skin and possibly skin inflammation
  • Increased levels of androgen hormones
  • Immune system defects
  • High levels of stress
  • Nutritional deficiencies involving vitamin B2 (riboflavin), B6 (pyridoxine), niacin, and zinc
  • Genetics

Certain factors can trigger flare-ups of this condition, such as:

  • Alcohol-based skin products
  • Cold, dry air
  • History of rosacea, acne, psoriasis, or other skin conditions

When to See a Doctor

If you haven't been previously diagnosed with or treated for sebhorreic dermatitis or any other skin condition, you should see your doctor about an itchy, dry scalp if your symptoms:

  • Are severe
  • Impact your sleep or daily life
  • Spread beyond your scalp
  • Aren't improving with OTC treatments

If you're already being treated for it, you should talk to your doctor if your symptoms:

  • Get worse
  • Flare up after being under control for a while

Treatment

You have a lot of treatment options for seborrheic dermatitis. The first one many people turn to is OTC dandruff shampoos. Look for ones that contain ingredients that may help address the underlying cause(s) of the condition, including:

  • Zinc/pyrithione zinc: Believed to have beneficial effects on nutritional deficiency, fungus, inflammation, androgen hormones, immune function, and important cellular processes
  • Ketoconazole: An anti-fungal medicine that may kill Malassezia yeast
  • Selenium: Has anti-fungal properties that may kill Malassezia yeast
  • Salicylic acid: Has anti-inflammatory properties, dissolves oil plugs, and stops overactivity of the sebaceous gland
  • Tar: Helps slough off dead cells and slows the excess growth of skin cells; less popular than it used to be due to an unpleasant smell and possible cancer-causing effects of long-term use

If OTC shampoos don't work, you doctor may prescribe an anti-fungal shampoo, such as:

  • Nizoral (ketoconazole)
  • Loprox (ciclopirox)

In most cases, you'll use it a few times a week until your scalp clears up, then use it less often to keep symptoms from coming back. Your doctor can tell you the best treatment regimen for you.

In some moderate to severe cases, doctors prescribe shampoo containing topical steroids, which are powerful anti-inflammatories. Brands include:

  • Luxiq (betamethasone valerate)
  • Clobex (clobetasol)
  • Capex (flucinolone)
  • Synalar (flucinolone solution)

If you have a severe or stubborn case of seborrheic dermatitis, you may want to see a dermatologist.

Prognosis

Seborrheic dermatitis usually is considered chronic, meaning you may have occasional flares of symptoms throughout your life. However, it usually improves considerably with treatment and can be well-controlled for the long term.

Prevention

If you're prone to seborrheic dermatitis, you probably won't be able to prevent it entirely. However, you can reduce your risk of flares, and possibly of developing it in the first place, by:

  • Getting enough sleep
  • Managing stress in healthy ways
  • Avoiding intense or prolonged sunlight but getting a few minutes of sun exposure daily

Frequently Asked Questions

What is the difference between dandruff and dry scalp?

The main difference between dandruff and dry scalp is that dandruff is caused by excess production of oils on the scalp that causes skin cells to build up before they're shed, while in dry scalp, the skin gets irritated and flakes off.

A Word From Verywell

The visible flakes and itching from seborrheic dermatitis can be annoying and embarrassing. Fortunately, you have plenty of treatment options that are likely to control it pretty well, so don't think you just have to live with it!

It's simple to start working toward managing the condition, and if you need something more than what's available without a prescription, talk to your doctor.

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Article Sources
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