Scalp itch can come from flakes (dandruff) or inflamed hair follicles (folliculitis). Knowing the difference guides treatment.
Dandruff (Seborrheic Dermatitis)
- What it looks like: White/yellow flakes with mild redness; greasy scale on scalp, eyebrows, sides of nose, ears.
- Feel: Itchy but usually not painful; no tender pus bumps.
- Triggers: Oily scalp, stress, cold/dry weather.
- Treatment:
- Anti-dandruff shampoos 2–3× weekly: ketoconazole 1–2%, selenium sulfide, zinc pyrithione, coal tar, or salicylic acid. Leave on 3–5 minutes before rinsing.
- For stubborn redness/itch, clinician may add short courses of prescription anti-inflammatory solutions/foams.
Scalp Folliculitis
- What it looks like: Small red pimples or pus bumps centered on hair follicles; can crust. Often at the back of scalp, hairline, or under hats/helmets.
- Feel: Tender or sore bumps; may burn/itch. Can flare after sweating or shaving very close.
- Triggers: Friction (helmets, tight hats), sweat, occlusive hair products, close shaving, bacteria (Staph), yeast (Malassezia), or mites (Demodex) in some.
- Home care (mild cases):
- Wash after sweating; use a benzoyl peroxide 3–5% wash on scalp 3–4× weekly (rinse well; use white towels/sheets to avoid bleaching).
- Rotate with an antifungal shampoo (ketoconazole) 2–3× weekly if bumps recur.
- Avoid heavy oils and pomades on the scalp; choose non-comedogenic products.
- Minimize friction: loosen hat bands, clean helmet liners regularly.
- When to see a clinician:
- If painful, spreading, recurrent, or scarring areas develop.
- May need topical antibiotics (clindamycin), oral antibiotics (e.g., doxycycline), anti-yeast treatments, or short courses of anti-inflammatories depending on cause.
Quick tip
- Flakes without tender bumps = dandruff. Tender/pus bumps at hair follicles = folliculitis. They can coexist; treat the dominant issue first.