Why do I have an itchy, flaky scalp?
An itchy, flaky scalp is very common, and the usual causes are dandruff (also called seborrhoeic dermatitis), a dry scalp, or a reaction to a hair product. Less often it is a skin condition such as psoriasis or eczema, or an infection. A trichologist can help you look at your hair care and your scalp and work out what is likely going on, and a good one will tell you if a GP or pharmacist is the better first stop.
Common reasons for an itchy, flaky scalp
- Dandruff. The most common cause. The scalp can be a little oily and red, with white or yellowish flakes that may also show on your shoulders. It is not caused by poor hygiene, and it often comes and goes.
- A dry scalp. Smaller, drier flakes, often worse in cold weather or with very hot showers, and the skin on the rest of you may feel dry too.
- Product reactions. Shampoo, conditioner, styling products or hair dye can irritate the skin or cause an allergic reaction, sometimes after years of using the same thing.
- Washing too little or too much. Leaving product and oil to build up can bring flakes, and harsh, frequent washing can dry the scalp out.
- Skin conditions. Psoriasis tends to cause thicker, silvery, well-marked patches, and eczema can cause red, itchy, sore skin.
- Infections. Head lice cause itching, and a fungal infection (ringworm) can cause scaly patches and sometimes hair loss.
What a trichologist looks at
A trichologist focuses on hair and scalp health. At a first visit they usually ask about your hair care routine, products, diet, stress, health and medicines, and when the itching started. They look closely at your scalp and hair, sometimes with a magnifying camera. You will then usually get advice on gentle washing, suitable products and habits to change, and a suggested plan. Trichologists are not doctors and a dermatologist is a doctor, so a good trichologist will say plainly if they think you need medical advice first.
Try something tonight
Want something to try tonight? A simple scalp care guide can show you gentle washing habits and what to look for on a shampoo label.
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What tends to help
For ordinary dandruff, the NHS suggests using an anti-dandruff shampoo regularly, which you can buy at a pharmacy or supermarket, and leaving it on the scalp for a few minutes as the label says. Many people find it helps to rotate shampoos, keep a gentle washing routine, and avoid scratching, which can make the scalp sore. For a dry scalp, milder shampoos and cooler water can help. If you suspect a product, try stopping it for a while and see whether things settle. Your pharmacist can advise on what to try.
How many visits will I need?
It varies. Many people have a first consultation and one or two follow-ups a few weeks apart, so you can see how your scalp responds to a change in routine. Scalps change slowly, so it is sensible to give a new routine several weeks before judging it. It is fair to ask at the start how many visits your trichologist would expect.
Roughly what does it cost?
A trichology consultation in the UK commonly costs from £60, and often more in big cities. Some clinics charge a little less for follow-up visits. Check what the first appointment includes, how long it lasts, and the cancellation terms before you book.
When to see your GP first
Please see your GP or pharmacist first if the scalp is very sore, red, weeping or crusted, if you have thick patches that look like psoriasis, if you notice hair loss or bald patches, or if the itching is severe or keeps you awake. The same goes for signs of infection such as pus or swelling, or if over-the-counter shampoos have made no difference after a few weeks. Tell your GP if you have other skin problems. Please don't stop or change any treatment you have been given on the strength of a trichology visit. A good trichologist will tell you if another route is better first, and many work alongside NHS care.
This page is general information, not medical advice. If you have symptoms that haven't been checked, or you are under medical care, please talk to your GP as well.
More questions
Is dandruff caused by poor hygiene?
No. Dandruff is not a sign of being unclean. It is thought to be linked to a normal yeast on the skin and how your scalp reacts to it, and it can flare up with stress, cold weather or tiredness.
Is dandruff contagious?
No. You cannot catch dandruff from someone else, or pass it on. Head lice and ringworm are different, and those can spread.
How can I tell dandruff from a dry scalp?
Dandruff flakes tend to be larger and may look oily or yellowish, while dry scalp flakes are smaller and drier. It can be hard to tell by eye, and a pharmacist or trichologist can help you work out which fits.
Can stress make my scalp itchy?
Many people notice their scalp is worse when they are stressed or run down. Looking after sleep and finding ways to unwind can help you feel better in yourself, though it is not a replacement for scalp care.
Should I wash my hair less if it is flaky?
Not necessarily. With dandruff, regular washing with a suitable shampoo usually helps, while with a dry scalp gentler, less frequent washing may suit you better. A pharmacist or trichologist can help you find the balance.