20 reasons for your itchy scalp (besides head lice)

If your itchy scalp is accompanied by what looks like red pimples – with a hair in the centre of each one – you may be looking at a case of folliculitis, according to Dr Khatri. The pimples may have pus in them, and they may itch or burn. When the pimples break open, they may drain pus, blood, or both.

Most of the time, the symptoms disappear on their own within a week to 10 days. Topically, you can use an antibacterial cleanser, Dr Kronberg suggests, but if it doesn’t seem to be clearing on its own, you may need a course of oral antibiotics.

A fungal infection (not the same one that causes dandruff) can cause an itchy scalp as well, says Dr Haley, although this is more common in children. It’s also called ringworm, or tinea capitis. A fungal infection can be caused by moisture remaining on the scalp for extended periods, says Dr Kronberg. If you have one, you’ll know soon enough because it won’t respond to anything except oral antifungals, which only your doctor can prescribe.

If you have prolonged redness and scaling, especially if accompanied by pus, see your doctor.

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Like ringworm, wearing a ponytail can cause both hair loss and scalp itching. “Wearing your hair up all day, or in overly tight or heavy hairstyles such as braids, buns, extensions and weaves, can tug on the hair follicles, causing stress and scarring over time, leading to hair thinning and hair loss,” Dr Shainhouse says. “However, this styling also pulls the hairs and surrounding nerves and muscles in an unnatural direction, leaving your scalp sore and sometimes itchy when you let your hair down.” Dr Shainhouse’s simple solution? Stick to looser styles, keep hair in tighter styles only for short periods, and vary your hairstyles throughout the week.

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Another cause of both scalp-itch and hair loss is alopecia areata. Dr Zeichner explains alopecia areata as a condition where your immune system “gets angry at your hair, producing cells that attack it.” Patients may develop small bald spots, or in severe cases, experience complete hair loss. One of the earliest signs of alopecia areata is itching of the scalp. So, Dr Zeichner suggests that if your scalp itching is accompanied by hair loss that can’t be explained by ringworm or an up-do (aka traction alopecia), make sure to visit a dermatologist for evaluation.

A far more rare cause of itching plus hair loss is Lichen planopilaris, according to Dr Haley. Lichen planopilaris is a rare inflammatory condition that results in patchy progressive permanent hair loss mainly on the scalp. The aim of treatment is to slow the progression of the inflammatory process, which includes slowing the loss of hair.

Another unusual reason for scalp itchiness is sarcoidosis, according to Dr Klein. Sarcoidosis is the growth of tiny collections of inflammatory cells (granulomas) in different parts of your body. Doctors believe sarcoidosis results from the body’s immune system responding to an unknown substance, most likely something inhaled from the air. Someone with an itchy scalp should not assume they have sarcoidosis, however, unless other symptoms are present, including:

Fatigue

Fever

Swollen lymph nodes

Weight loss

Persistent dry cough

Shortness of breath

Wheezing

Chest pain

A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch

Disfiguring sores (lesions) on the nose, cheeks, and ears

Areas of skin that are darker or lighter in colour

Blurred vision

Sensitivity to light

In rare cases, an itchy scalp has no organic cause at all, which is to say, it is accompanied by no other objective medical findings, Dr Klein explains. This is known as scalp dysesthesia. It is often triggered or exacerbated by a psychologic or physical stressor and may be a manifestation of an underlying psychiatric issue or chronic pain syndrome. It is usually seen in elderly patients, and the key treatment is low-dose antidepressants, which Dr Klein says can be life-changing for patients.

Oddly enough, an itchy scalp that has no other cause could be a sign of cervical spine disease, which may be visible by imaging, says Dr Klein. The mechanism here is thought to be related to chronic tension and nerve impingement. Treatment may include gabapentin (a drug used for nerve pain that also may be helpful in treating menopause-related symptoms), Botox injection and epidural injections.

Lupus is a serious autoimmune disease that can present with itching as well as dry scalp, says Dr Haley, but it also involves many other symptoms, which may include arthritis, photosensitivity, oral and cutaneous ulcers, and joint pains. A skin biopsy can be helpful in ruling out Lupus.

In very rare cases, an itchy scalp can be a sign of lymphoma, Dr Haley says, specifically, a form called “Cutaneous T-Cell Lymphoma.” The itching with this form of lymphoma tends to be severe and is usually accompanied by a rash and enlarged lymph nodes. It affects more men than women and tends to appear after the age of 50. A skin biopsy will be helpful in diagnosis, as well as blood testing.