Many people suffer from an itchy scalp. The most common reason people have an itchy scalp is because of a condition known as seborrheic dermatitis. Seborrheic dermatitis, also known as seborrhea, usually presents as pink and red scaling patches that often have a greasy texture and are located on the scalp.
It frequently appears elsewhere on the body, especially in areas where there are higher concentrations of oil-producing glands called sebaceous glands. These areas include the scalp and face, especially the eyebrows, beard area, and creases around the sides of the nose and mouth; high numbers of oil glands are also found in the ears, on the chest and back, under the arms, and in the groin. Dandruff is very mild seborrheic dermatitis characterized by fine scaling with little to no redness.
The cause of seborrhea it is unclear, but Malassezia yeasts seem to play a role in its development. These species of yeasts are normally found on the skin and grow best in the oily areas of the skin discussed above. Patients with seborrhea may have normal levels of Malassezia species on their skin, but have an abnormal immune response to these organisms, which leads to the development of an itchy rash. Sebum is the oil produced by the sebaceous glands in the skin and is also thought to be involved in the development of seborrheic dermatitis. Patients with neurologic disorders like Parkinson’s disease and Alzheimer’s disease are more likely to develop seborrhea and have been found to have an excessive accumulation of sebum on their skin.
Treatment of Seborrhea
Treatment of seborrheic dermatitis begins with decreasing the amount of Malassezia species present and removing excess sebum from the skin. Therefore, frequently washing the scalp and affected areas on your body with anti-dandruff shampoos and antifungal shampoos is the first step in treating seborrhea. Anti-dandruff shampoos that contain zinc pyrithione and selenium sulfide (for example, the Head & Shoulders shampoo line) or antifungal agents (like ketoconazole) are the most common cosmetically elegant treatments for an itchy scalp. Tar shampoos, with or without salicylic acid, are also effective, but often have an unacceptable smell. If your infant has an itchy and scaly scalp, then only use a mild baby shampoo and see your doctor. Sometimes the treatments noted above are not enough to control seborrhea, and more aggressive therapy from your doctor is required, including topical steroids, steroid containing shampoos, prescription strength antifungal shampoos, antifungal creams, or anti-inflammatory agents that don’t contain steroids. Your doctor also will rule out other causes of an itchy scalp.
Other common reasons for scalp itching and rash include fungal infection (“ringworm”), psoriasis, allergic reactions, and atopic dermatitis (eczema). Rarely, rashes on your scalp can indicate more serious problems with the immune system and/or diseases like lupus erythematosus, sarcoidosis, lymphoma, and HIV/AIDS. If the itching and scaling on your scalp does not clear with anti-dandruff shampoos, then be sure to see your dermatologist for an accurate diagnosis and prescription strength therapies.
The Center for Integrative Dermatology treats all types of skin problems, including seborrheic dermatitis. If you live locally here in South Jersey, call (856) 782-8688 for an appointment with Dr. Donald Baker.