Your Scalp Itches — Is it Eczema?

You’re relaxing at home halfway through your favorite show and find yourself scratching your scalp again. You can’t figure out why. You’ve tried anti-dandruff shampoo, various creams and have even thrown away that beloved old baseball cap. Nothing helps. To better understand the causes of an itchy scalp, and whether or not it’s eczema, we connected with Dr. Jeff Yu, board-certified dermatologist at Massachusetts General Hospital.

1. Allergic contact dermatitis

Dr. Yu shared that an itchy scalp might be caused be “allergic contact dermatitis to hair treatments/products, like hair dyes (including high/low-lights), shampoos/conditioners, gels/mousse, blowouts, etc.” Did you recently try any new hair products or styling gels? An allergic reaction may be the cause of your itchy scalp, and it may be time to reassess your hair care routine. NEA’s Eczema Product Directory includes over-the-counter products that are suitable for care of eczema or sensitive skin.

2. Seborrheic dermatitis

You may have another common condition, seborrheic dermatitis. Seborrheic dermatitis is a form of eczema and a common chronic inflammatory skin disease. It’s often found in places where there are oil glands such as your scalp, upper back and nose. NEA Ambassador Turquoise Peart lived with an itchy scalp for more than 10 years before she received a diagnosis of seborrheic dermatitis. Turquoise identified a few indicators that might mean you have this condition: 

• Uncontrollable itch, or an abnormally incessant desire to scratch your scalp;
• Dry flaky scalp; a shade or two lighter than your complexion and very dry in nature;
• Scale that’s yellow, greasy and adherent;
• Involvement in the ears, face and upper chest;
• Gray areas around the hairline from flare ups; also a shade or two lighter;
• Hair loss and scabs onto the scalp from scratching at night;
• Raw flesh and oozing from the scalp from constant itching.

There are a few scalp treatment options you can pursue. Turquoise advised trying medicated shampoos as a part of your hair care routine as well as more general wellness tips to improve your scalp condition. Medicated shampoos such as T-Gel or Head and Shoulders are available over-the-counter. Consider searching the NEA Product Directory, too.

3. Scalp psoriasis

If you’re noticing a thick build up of scaly patches, you may have a skin condition known as scalp psoriasis. Dr. Yu advised that “psoriasis can look a lot like dandruff or seborrheic dermatitis but usually shows up as a well-demarcated plaque on the scalp with thick, silvery scale. The scale can also bleed easily if you try to peel it off; This is called “Auspitz Sign.” This is unlike dandruff or seborrheic dermatitis in that it can be much more diffuse and appear more greasy. You can read more about the differences between psoriasis and eczema here.

4. Lice

Dr. Yu noted that if your scalp itches, and if you’ve ruled out eczema, you may have lice. Lice first present as nits, or small white dots found on the hair shafts. The American Academy of Pediatrics has the most up to date information on how to diagnose and treat lice, and they note that it is vital in diagnosis to not confuse the nits with dandruff or hairspray on the hair shaft.

5. Neurogenic or neuropathic causes

With Dr. Yu’s help you’ve probably eliminated a few reasons why you might be scratching your head. Still looking for an answer? It’s possible that your scalp itches for a reason unrelated to dermatology. Dr. Yu pointed out that, “Some people itch due to an incorrect stimulation of nerves that control the itch/pain sensation of the scalp. These nerves come from the spinal cord in the neck and send a message to the brain to be interpreted as an itch/pain sensation. Arthritis in the neck, for example, can pinch these nerves causing a sensation of itch without an obvious rash.”

If you feel that you may have any of the other conditions above, reach out to your dermatologist and they can provide a diagnosis and guide you on the best course of action to manage your symptoms.