There are many early signs of hair loss – hairline recession, crown thinning, and brittle strands of hair. But did you know that an itchy scalp can also be a symptom, and even part of the cause?
The good news is that an itchy scalp isn’t always a sign of permanent hair loss.
In this post, we’ll explore the five main causes of an itchy scalp.
We’ll then discuss how each one might relate to hair loss, and what you can do to treat the condition.
The Five Most Common Causes of Itchy Scalp
Let’s take a look at the five most common signs of an itchy scalp so you can be on your way to treating the problem.
Dandruff is perhaps the most common scalp condition in the United States and throughout the world.
In fact, it’s believed that dandruff combined with its more severe form, Seborrheic Dermatitis (SD), affects more than half of the adult population (1).
What Causes Dandruff?
Dandruff is a scalp condition characterized by itching and white-to-yellow flakes. But what is its cause?
It’s mistakenly believed that an unhygienic scalp is the sole reason for dandruff. While hygiene can certainly contribute to the proliferation of dandruff, it’s not the cause.
Instead, that award goes to the fungus Malassezia.
The malassezia fungus is commonly found on the skin of humans and animals.
In fact, it’s present in about 30 percent of adults according to a 2014 research study (2).
However, an overgrowth of the fungus can cause an imbalance which triggers the development of dandruff and seborrheic dermatitis.
This is likely why 84 percent of individuals with clinical dandruff have levels of Malassezia present in their scalps.
In addition to the usual itching, dandruff is also accompanied by:
- White to yellow flaking;
- Scaling; and
- Redness at the site of itching
In more severe cases of dandruff, known as seborrheic dermatitis, you may also suffer from facial scaling.
Seborrheic Dermatitis: How It Differs from Dandruff
When discussing the difference between dandruff and seborrheic dermatitis, it helps to think of each scalp condition on opposite ends of a spectrum.
Generally speaking, dandruff is on the lesser end of the spectrum while SD is on the more severe end. But the lines are often blurred between the two, and it can be difficult to tell them apart.
So, how can you know if you suffer from dandruff or seborrheic dermatitis?
The conditions share symptoms, including itching, flaking, and redness.
They differ in where they present on the body, though.
Dandruff is found strictly on the scalp. You will often find it along the hairline and in other places where sebum concentrations are higher.
Seborrheic dermatitis, on the other hand, can also be found on the face, behind the ears, and even on the upper chest (3).
And just like dandruff, the severity of seborrheic dermatitis can also differ from person to person.
Perhaps the greatest difference between these two ends of the spectrum, though, is that dandruff is not accompanied by inflammation while seborrheic dermatitis is (4).
Can Dandruff Cause Hair Loss?
If the question is whether dandruff is a direct cause of hair loss, the answer is no.
But if left untreated, the scratching that is sure to accompany the itching may cause problems.
Mechanical actions such as scratching can dislodge the hairs from the follicles. This can result in thinning and, if it happens frequently enough, miniaturization of the follicle.
The best way to avoid hair loss as a result of dandruff? Treat the problem at the source.
How to Treat Dandruff
There are many treatment options for those with dandruff.
The most common are medicated shampoos, such as Nizoral (ketoconazole).
Ketoconazole is an active ingredient that interfereces with the organic molecule ergosterol. The lack of ergosterol then leads to destruction of the cell membrane of yeast and fungi.
This means the organisms are no longer able to reproduce which stops the progression of dandruff and SD.
But ketoconazole may not be successful in all cases. Or it may need to be used alongside other treatments.
Just how effective are these options?
The zinc shampoo was shown to drastically reduce dandruff and even regrow hair in patients with pattern hair loss.
The tar-based shampoo didn’t do too bad, either. After all, greater than 70 percent of participants in the study saw positive results during treatment.
2. Scalp Psoriasis
A condition that is often confused with seborrheic dermatitis, scalp psoriasis is a condition all its own.
It does mimic a few symptoms of dandruff and SD but, as you’ll see below, the causes and treatment options are quite different.
What Causes Scalp Psoriasis?
Scalp psoriasis is a multi-faceted condition, so let’s just jump right into it.
According to a comprehensive review of the topic published in 2015, psoriasis is “a chronic, multisystem inflammatory disease with predominantly skin and joint involvement (7).”
This simply means that the condition is autoimmune in nature.
As with many autoimmune conditions, the reasons for susceptibility are unknown. However, genetics and environmental factors are thought to play a large part (8).
Scalp Psoriasis Symptoms
The most well-known aspect of scalp psoriasis is likely the ‘plaques’ that build up on the skin.
These plaques are often silvery or red, and they can build up on any part of the skin, including the hands, feet, trunk, arms, and legs.
But if you’re suffering from scalp psoriasis, you’ll be all too familiar with scaling seen on the hairline and behind the ears.
The most common symptoms associated with the condition are:
- Reddish patches on the scalp;
- Dandruff-like flaking;
- Dry scalp that may crack and bleed;
- Itching; and
- Temporary hair loss.
These symptoms can sometimes be difficult to distinguish from other scalp conditions, like seborrheic dermatitis. However, the presence of silvery scales and the location of the patches can help to point you in the right direction.
Can Scalp Psoriasis Cause Hair Loss?
Unlike dandruff and SD, scalp psoriasis can actually cause hair loss.
This is because scalp psoriasis is, at its core, a condition triggered by inflammation.
Inflammation at the follicle can lead to miniaturization, which can prevent the follicles from producing healthy hair strands.
The good news, though, is that hair loss caused by scalp psoriasis is often temporary.
Scalp psoriasis, like many other autoimmune conditions, can resolve on its own. This is known as remission.
However, triggers such as diet or illness can cause a flare-up.
During periods of remission, it’s likely that the affected hair follicles will heal and new hair will grow.
You can increase the odds of hair regrowth by treating the condition and avoiding anything which you know to cause flare-ups.
How to Treat Scalp Psoriasis
As an autoimmune condition, scalp psoriasis is not something that you can combat on your own.
Instead, you’ll need the help of a medical professional like a dermatologist.
There are two treatment options prescribed to patients with psoriasis: topical solutions, and systemic or oral medications (9).
The first set of options consists of corticosteroids vitamin D3 analogues. The second consists of acitretin (a synthetic retinoid), methotrexate (an inhibitor of folate biosynthesis), and cyclosporine (a calcineurin inhibitor).
Phototherapy is also a mainstay treatment as vitamin D3 plays a critical role in symptom prevention (10).
3. Tinea Capitis
Tinea capitis, more commonly referred to as ringworm, is a fungal infection that largely affects children and adolescents (11).
What Causes Tinea Capitis?
Tinea capitis is a condition caused by fungal overgrowth on the scalp or body.
This infection affects your scalp and hair shafts and it often results in small patches of itchy, scaly skin.
Tinea Capitis Symptoms
The symptoms vary depending on the severity of the infection, as well as the origin.
Ringworm that is passed from animal to human is often more likely to be inflamed, for example.
The initial symptoms of the condition including itching and a red, scaly patch in the shape of a ring.
You may soon begin to notice hair thinning and hair breakage at the site of infection.
This may soon be accompanied by a large patch of scaling and, if left untreated, it can even spread to different areas of the scalp and body.
Can Tinea Capitis Cause Hair Loss?
Alongside scalp psoriasis, tinea capitis is another condition on our list that itself can trigger hair loss.
The good news is, though, that ringworm can be treated relatively easily. And the hair that was lost during the initial infection can even regrow.
How to Treat Tinea Capitis
As tinea capitis is caused by the presence of a fungus, it must be treated with an antifungal medication, cream, or medicated shampoo.
Antifungal medications can be prescribed by a physician, and they are sometimes the only option for more aggressive infections.
The alternative is an over-the-counter antifungal cream, such as Lamisil.
Your doctor may also prescribe a medicated shampoo. This may be an alternative to a harsh oral drug, or it can be prescribed alongside the medication for particularly stubborn fungi.
To prevent reinfection, it’s important that you wash and disinfect all bedding, towels, hats, and clothing that the infected individual came into contact with. You’ll also want to replace or sterilize combs and brushes.
4. Lichen Planopilaris
Lichen planus is a skin condition that results in scaling of the skin and eventual scarring.
This specific name – lichen planopilaris – is given to the lichen planus condition that affects the scalp (12).
And just like scalp psoriasis, those with lichen planopilaris will experience flares as well as periods of remission.
What Causes Lichen Planopilaris?
The cause of lichen planopilaris, and it’s flares, is unknown. Though the usual culprits – stress, illness, and a poor immune response – are suspected (13).
Lichen Planopilaris Symptoms
The initial symptom experienced by sufferers is an intense itching of the scalp which is often fixated at the vertex and crown (14).
Pain, scalp tenderness, and burning may be soon to follow.
As the condition worsens, you’ll notice areas of redness and scaling around the base of the hairs. This will soon result in permanent hair loss as the follicles are replaced by scarred tissue.
Can Lichen Planopilaris Cause Hair Loss?
Lichen planopilaris, by its very nature, is a condition that results in permanent scarring hair loss.
The hair loss often presents as distinct patches. They will initially be red and scaly but, as the scarred tissue takes over the scalp, it will transition to a shiny, smooth texture.
How to Treat Lichen Planopilaris
Due to the inflammatory nature of the condition, the main treatments during a flare-up are steroid creams and immunosuppressive drugs.
Unfortunately, there is no way to reverse the hair loss that occurred due to the condition.
You can work with a dermatologist to keep your remaining hair, though, and you can also work with an immunologist to find a treatment plan that works most effectively for you.
5. Head Lice
If the term “head lice” gives you flashbacks to grade school “head checks,” you’re not alone.
That’s because this condition affects millions of people, young and old, each year (15).
How Is Head Lice Acquired?
As head lice are bugs, they can easily be passed from one person to another.
They are most often shared among classmates and family members due to close proximity. But it’s possible to get head lice from anywhere.
Head Lice Symptoms
You or your child may first experience an itching sensation that seems to come out of nowhere.
A closer look at the hair and scalp, however, will quickly reveal the issue.
Lice and nits are white and, therefore, quite visible in most hair types.
The lice will often be much closer to the scalp, while the nits are laid on the hair shafts.
Can Head Lice Cause Hair Loss?
If the head lice infestation is left untreated, it can cause excessive itching which may lead to thinning and bald patches.
This is why it’s best to treat the condition quickly.
How to Treat Head Lice
Unlike the other conditions which focus on treating an underlying cause, head lice requires that you remove the parasites from the scalp.
Lice removal can be tedious, but you must remove every last lice and nit to ensure the problem is resolved.
Your best bet is to section the hair and go through each section with a fine-toothed comb. You may also consider over-the-counter products like Rid, though lice are becoming increasingly resistant.
You’ll also need to wash all bedding, clothing, stuffed animals, and furniture the affected individual has come into contact with.
Here’s a good rule of thumb: if it’s fabric, it needs to be washed.
You can also wipe down non-fabric surfaces to ensure there are no lice currently awaiting their next victim.
Is Itchy Scalp a Sign of Pattern Hair Loss?
While you should consider the more common causes of itchy scalp above, there is a real possibility that itchy scalp can be a sign of another problem – pattern hair loss.
Pattern hair loss, also known as Androgenetic Alopecia (AGA), is a genetic condition that causes hairline recession, thinning, and eventual balding (16).
The process involves sensitivity to the androgen hormone DHT, which then triggers miniaturization within the follicle (17). This leads to inflammation which, if left untreated, can cause the problems mentioned above.
There are other symptoms that often appear before the major hair loss starts, though.
These include tightness of the scalp, general irritation, and yes, even itching.
Just because itching is present, however, doesn’t mean that pattern hair loss is the culprit.
You should first consider whether pattern hair loss runs in your family. But you should also consider whether other signs – thinning at the temples, brittle hair, and noticeable shedding – are also present.
Of course, you can always speak with your physician if pattern hair loss is a concern.
An itchy scalp is a common complaint in the hair loss community.
But before you freak out, you should know that there are many possible causes of itching.
While some of these conditions can trigger hair loss, the majority of them will be relatively harmless as long as they’re treated properly.
Of course, if you’re concerned, you should seek out the help of a dermatologist so you can pinpoint the problem and treat it accordingly.
Do you have questions about the information shared above? Leave a comment down below.