Why Do I Have an Itchy, Flaky Scalp?'

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Name: Jan

Question: I've had an itchy, flaky scalp for a while that's been really bad for about three months now. My whole scalp itches and I get loads of dandruff on my clothes and furniture as well as small white scaly looking patches on my scalp which is a bit red. Is this something I should be worried about? How can I stop the itching and get rid of the dandruff flakes?

Answer: Hi Jan, we would to assess your scalp to provide a confirmed diagnosis, however, this sounds likely to be seborrhoeic dermatitis (sebderm).

seborrhoeic dermatitis sebderm itchy flaky scalp
An example of seborrhoeic dermatitis

Sebderm can cause the precise symptoms you describe and is a common scalp conditioncaused by an overgrowth of Malassezia - a type of yeast which lives on our skin - or by our immune system over-reacting to this.

It tends to appear on oilier areas of the skin, commonly including the scalp and areas where there are folds in the skin, such as either side of the nose and/or behind the ears.

Stress, tirednessand cold weather can trigger or exacerbate this condition, so the timing of your current flare up may be due to any of these factors.

Dandruff is actually a type of mild sebderm so, depending on how severe your condition is, you could try a medicated shampoo as your first port of call. Ideally look for a formulation containing a tar ingredient, ketoconazole or salicylic acid.

Try to wash your hair every day but use this cleanser in accordance with the product directions as most good quality medicated treatment shampoos are not suitable for every day use.

If this approach does not work for you, there are other options, including the short-term use of topical steroid solutions, such as corticosteroids, or the anti-fungal, betamethasone. Again, this should be used as instructed by your doctor or dermatologist but is often recommended in severe cases of sebderm for twice daily use, then twice-weekly use to sustain improvements once the condition is better under control.

Your medical professional should oversee this usage of prescription treatments - which can be used in conjunction with medicated shampoo unless you are advised otherwise - as there are a number of potential side effects linked to their long-term or over-use. These can include thinning skin and skin discolouration.

At Belgravia patients who visit us for hair loss treatment but also present with scalp conditions such as seborrhoeic dermatitis are often provided a scalp de-scaling lotion to use at home. This is also available to non-patients and its purchase can be arranged by contacting the centre or visiting one of our Central London hair loss clinics in person.

Whilst clients can have these scalp conditions addressed during clinical therapy sessions, with a bespoke mix of treatments and therapies used for their specific issues, a version of one aspect can also be carried out at home.

Scalp steaming can be beneficial once the scalp descaling solution has been applied. If you do not have a portable home-use hair steamer, a simple alternative is to dampen a small towel and microwave it for a short time until it is as warm as possible, but not hot enough to scald you. After applying the scalp solution you can wrap the towel around your head for 15 minutes to half an hour to maximise the scalp's ability to absorb the treatment. Be sure to wrap a separate towel around your shoulders to catch any moisture.

If you start to notice any issues with hair loss due to the repeated scalp scratching and occasional hair pulling that can affect people with sebderm, a specialist will be happy to assess and diagnose you, then discuss options for treatment, where appropriate.

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