Itchy Scalp Problems: A Complete Dermatologist Guide

Are you facing itchy scalp problems? That scalp is the most important part of your hair. This is because the health of your scalp determines how healthy your hair grows out. Dr Teo Wan Lin, accredited Singapore dermatologist and author of the Haircare Bible: Dermatologist’s Tips for Haircare and Hair Loss, explains the latest research on scalp physiology.

Dermatologist Talks: Scientific updates on the scalp microbiome

The Skin and the Scalp Ecosystem encompassing the microbiome

A key area of interest is the skin and scalp microbiome. My white paper on maskne published in the Journal of the American Academy of Dermatology in October 2020 sets the stage for microbiome research. 

In the dermatology research arena, the skin microclimate affects the development of skin diseases.  These dermatological conditions are distinctly caused by microbiome imbalance. This is also know as dysbiosis. 

Microbiome and dermatological treatment

We understand more about the skin and scalp microbiome now than before. Dermatologists are moving away from treating skin and scalp conditions with topical or oral antibiotics. Antibiotic resistance itself can lead to greater harm and doesn’t always solve the problem at hand.

Itchy scalp problems are the commonest scalp and hair problem. Understanding the scalp microbiome is of interest. The incidence of seborrheic  dermatitis is increasing.

Also known as dandruff, this flaky scalp problem is common in the tropics. Scalp microbiome research is relevant. Flaky itchy scalp problems due to seborrheic dermatitis occurs becuase of overgrowth of a yeast known as Malassezia.  

The scalp microbiome is an important area of research that has advanced in the last five years. Dermatologists have determined that an imbalance of scalp bacteria and fungi can directly contribute to scalp disease. Untreated itchy scalp problems accelerates the hair cycle. Ultimately this leads to increased hair fall and poor quality of hair.

We hope you learnt something about the scalp microbiome and itchy scalp problems. 

Here are some of the common problems affecting your scalp, explained by board certified dermatologist Dr. Teo Wan Lin. 

Can I have scalp problems without knowing it?

Scalp problems can be without symptoms in early stages. By the time you observe symptoms, it is at least medium severity. Some of scalp symptoms tend to be mild and not noticeable. You may not have itchy scalp for example.

Usually by the time you observe itchy scalp symptoms, your condition has been going on for a while. 

Itchy scalp problem caused by dandruff

Dandruff is the commonest scalp problem observed.  Flaky scalp is embarrassing and irritating. For example,  flakes are visible on dark clothing.

Why does dandruff occur?  It is an increase in skin shedding. We know this is due to an imbalance in the scalp microbiome. The scalp microbiome, much like the skin microbiome, refers to bacteria and fungi. In dermatology, there is a condition known as seborrheic dermatitis. Seborrheic dermatitis is the term dermatologista use for dandruff.

What causes seborrheic dermatitis?

Malassezia FurFur is a type of fungus which lives on everybody’s skin. However, under the right conditions it overgrows. Itchy scalp problems is more common in individuals who produce a certain type of oil. Especially individuals who produce more oil than others. Hence the term seborrhea in seborrheic, meaning excess production of oil. 

Itchy dandruff on the scalp: is it eczema or seborrheic dermatitis?

Dermatitis is the term for eczema or flaking. Scalp “eczema” is often due to seborrheic dermatitis but can be due to true eczema. If you have a personal or family history of eczema, you can get itchy scalp problems due to eczema. 

Dermatitis describes flaking of the scalp. Dermatologists in Singapore often observe it is associated with an oily type of dandruff. This means that while the scalp appears dry and flaky, even together with an itchy scalp, it is not due to dryness. Rather there is an oily dandruff problem known as seborrheic dermatitis, caused by an imbalance.

Can Itchy scalp problems due to dandruff spread?

Dermatologists stress that dandruff is not contagious. This fungus lives on everyone’s skin. However, it only causes problems in certain individuals. There could be a genetic tendency such as a family history. It could also be due to tropical environments. If you live in Singapore where it’s hot and humid, you may be prone to develop itchy scalp problems. 

There is an increased risk of developing seborrheic dermatitis when you sweat more and produce oil. Thus, itchy scalp problems due to dandruff tends to affect teenagers rather than children. Seborrheic dermatitis is the most common itchy scalp problem diagnosed after puberty. 

Itchy scalp problems in babies and children 

There is a special form of dandruff that affects babies and infants. This is also known as cradle cap. Cradle cap affects infants in the first six months. Itchy scalp problems in an infant shows as greasy yellow crusts on the scalp. It may look quite alarming. Usually, before the child turns one years one year old, it will clear up. Olive oil to remove the crusts may be sufficient.

Pityriasis amiantacea in children and teenagers 

This is a type of thick dandruff that affects older children and sometimes adults. We do not know why it happens. However, it appears as localised area of thick scales on scalp. It may be associated with hair loss. Treatment is with medicated shampoos and lotions. 

Itchy scalp problems in children

The other common type of scalp problem is head lice. Head lice is contagious and can be spread amongst school children. Head lice is treated with medicated lotions and using a fine tooth comb. Medicated solutions such as those containing permethrin are prescribed by dermatologists. 

How does head lice cause itchy scalp problems?

 Lice feed on blood and the females will lay their eggs on their hair it is important to prevent this common scalp problem in children after completing treatment. This prevents recurrence.  Ensure that there is complete eradication in the surrounding furniture and bedding. 

Itchy scalp problem due to ringworm

Another type of scalp problem is actually ringworm. Ringworm can be spread amongst children. Sometimes it can be caught from an infected animal such as a dog or cat. It leaves scaly round patches of hair loss on the scalp. Oral medication is required to kill the fungus. Oral antifungals are usually taken for a period of three months for treatment of ringworm of the scalp.

Scalp psoriasis: an immune genetic cause of itchy scalp problems

Scalp psoriasis is another type of scalp problem that can cause scalp redness and flaking. What is the difference with dandruff? In scalp psoriasis, flakesis are thicker and bigger scales with underlying redness. It also affects the hairline. 

Psoriasis is immune-genetic condition. This means that it occurs in individuals who have a family history. If you have a family member who has psoriasis, you have a higher chance of developing psoriasis. 

Itchy scalp pimples due to scalp folliculitis

Scalp folliculitis is another type of scalp problem. It presents as pimples on the scalp. Scalp folliculitis can cause scratching and squeezing, causing secondary infections. When folliculitis is severe it can lead to a type of hair loss known as scarring alopecia. If you suspect you have scalp folliculitis, seek the care of an accredited dermatologist because it requires oral medications for treatment. Scalp pimples could also be the early sign of a more serious condition known as folliculitis decalvans and are dissecting cellulitis of the scalp. Both of which causes serious permanent hair loss and scarring. If you have a scalp problem, it is important to get diagnosed by a board certified dermatologist. 

How to treat itchy scalp problems 

The treatment for scalp problems such as seborrheic dermatitis can be via over the counter shampoos that contain medicated active ingredients. Itchy scalp problems due to excess growth of fungus, known as malessezia furfur, is treated with antifungal shampoos. Salicylic acid can help to increase shedding of dead skin cells so medicated solutions can penetrate the scalp better. Antifungal agents such as zinc pyrithone is from our Deep Cleanse Shampoo range by our dermatology pharmacy helps. You can also use hair oils with natural antifungal and antibacterial properties to help improve the scalp microbiome. If it is more severe, you may get a prescription ketoconazole shampoo when you visit a dermatologist. 

Regular scalp cleansing to treat and prevent itchy scalp problems 

If you live in Singapore, you should shampoo daily. Compared to temperate climates, your scalp will produce more oil and encounter a change in bacteria balance in tropical climates. Daily shampooing in tropical climates is recommended to maintain a healthy balance of the scalp microbiome.  Our skincare pharmacy carries a range of over the counter haircare, serums and shampoo to treat itchy scalp problems.

If your itchy scalp problem does not improve with over the counter remedies, visit an accredited dermatologist. If you are looking for a dermatologist in Singapore, always check the doctor’s accreditation on the system. If you’re living in Singapore, you can always check the Dermatological Society of Singapore’s list of dermatologists to look for a board certified dermatologist.