Itchy Dry Flaky Scalp?

A presention of scalp seborrheic dermatitis

Dandruff on a woman's shoulder
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An itchy, dry, flaky scalp is a common complaint, often leading to frustration, and trial of many different topical preparations and shampoos.

Most commonly, the cause for the itchy, dry, flaky scalp is a condition called seborrheic dermatitis. It is sometimes also referred to as seborrheic eczema or in babies cradle cap. There is a wide degree of variation in severity – some people only have very mild flaking of the scalp (more commonly referred to as “dandruff”) with mild itching while others have thick, greasy scales encasing the hair with severe itch.

What is seborrheic dermatitis?

Seborrheic dermatitis is an inflammatory condition. Inflammation in the skin is caused by the presence of certain cells which then leads to rashes such as seborrheic dermatitis. Often, this inflammation is marked by accompanying redness. Some of this inflammation can make the scalp feel itchy as well.  Seborrheic dermatitis itself is not a life-threatening condition in general, although, in rare cases, it can be widespread and affect the majority of the skin surface, leading to complications found in erythroderma.  These cases are rare and more common in certain populations such as those infected with the human immunodeficiency virus.

What causes seborrheic dermatitis?

While the exact cause is not known, involvement of the Malessezia yeast has been implicated based on observation that treatment with an anti-yeast agent such as ketoconazole may improve the condition.

We do know that inflammation is present in this condition and some people postulate that the inflammation is in reaction to the yeast.

How does seborrheic dermatitis present?

There is a whole range of presentations of seborrheic dermatitis. Here, we discuss involvement of the scalp. However, this rash can actually affect many other areas, especially those high in sebaceous glands.

Other commonly affected areas include over the eyebrows, the area between the eyebrows, and the area around the sides of the nose. The chest and groin can also be affected.

Seborrheic dermatitis is often accompanied by scaling of the scalp skin. At its mildest, very small thin flakes may be present. When more severe, the flakes can be thicker, and often yellowish or greasy as well. When silvery scales are present, there may be overlap with psoriasis, a condition sometimes referred to as sebopsoriasis.

Seborrheic dermatitis may or may not be itchy. If itch is present, it may vary in its intensity. For some people with seborrheic dermatitis, the itch may be most bothersome at nighttime. Some people report scratching during the night.

How can seborrheic dermatitis be treated?

People with seborrheic dermatitis often opt for treatment for cosmetic or symptomatic reasons. Treatment is often topical and may consist of over the counter or prescription lotions, solutions or shampoos. Over the counter anti-dandruff shampoo such as those containing selenium, salicylic acid, tar, zinc or ketoconazole may be helpful.

Stronger ketoconazole preparations as well as topical steroid lotions or solutions are available by prescription. Your healthcare provider can tell you how to use these prescription medications.

How do you get prescription medications for seborrheic dermatitis?

In many cases, your primary care provider can provide these medications. In more severe or stubborn cases, you may want to see a dermatologist.

What is the prognosis for seborrheic dermatitis?

Seborrheic dermatitis is often considered a chronic condition where it is not cured, but rather, is controlled through the above treatments if desired. The condition may get better and worse on its own at different times as well.

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