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It’s never a good sign when white flakes appear on your shirt and, um, it’s not snowing outside. But dandruff is just one of many common scalp conditions that can mess with your daily routine. Thankfully, modern medicine has the answer to keep your scalp looking and feeling good. Learn more about what’s potentially causing the rashes, pimples, scabs or bumps on your head by reading up on the seven common conditions below. Then, check with a board-certified dermatologist to learn more about what’s really going on and properly treat it. “Your scalp is a body part that you can’t thoroughly inspect yourself,” says Onyeka Obioha, M.D., board-certified dermatologist at Cedars Sinai in Los Angeles. “Proper evaluation and treatment can help avoid unwanted complications.”
Psoriasis
What it looks like: pink plaques with a silvery scale
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The cause: Not to be confused with cirrhosis (liver damage), this condition affects about 1 to 2% of the general population and anyone can get it, at any age. It’s thought to be an autoimmune condition in which the cells in the top layer of skin are in overdrive, manifesting as a pink rash with a characteristic silvery scale.
Psoriasis can affect any part of the body from head to toe (including your nails), but the scalp kind is one of the most difficult types to treat, according to Seemal Desai, M.D., F.A.A.D., clinical assistant professor in the Department of Dermatology at the University of Texas Southwestern Medical Center. Why? The buildup of skin cells creates scaly, patches that can itch, hurt, crust up and bleed. Even more terrible: Trauma to the scalp — including blow-drying and covering grays — can make the situation worse.
The treatment: It’s really about relieving symptoms, says Dr. Desai. Most doctors start with steroids, while tougher situations may require injections called biologics that help to suppress what’s causing the flare ups. Your derm may also suggest trying an excimer laser, which can work on individual spots that are not responding to other therapies.
But you should also take in account your hair care routine, points out Desai. Not shampooing your hair every day may lessen the amount of skin rashes, or a therapeutic oil cream can also do wonders.
Folliculitis
What it looks like: scattered pus bumps
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The cause: This is basically inflammation of the hair follicle caused either by a bacteria (most commonly a staph infection) or irritation from shaving, heavy conditioners, potent hair dyes and excessive sweating. It will mostly likely appear as little pus bumps scattered throughout the scalp that look similar to acne. The bumps can sometimes feel sore.
The treatment: A doctor suspecting folliculitis may perform a culture to check for bacteria. If a microbe is causing your scalp woes, a topical or oral antibiotic will be the best treatment option. “If there isn’t an infectious agent present, then anti-inflammatory medications — such as topical steroid formulations — can be effective,” says Christine Ko, M.D., professor of Dermatology and Pathology at Yale School of Medicine and author of the forthcoming book .
Seborrheic Dermatitis
What it looks like: greasy scale and dandruff flakes
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The cause: Seb derm, as most derms call it, is one of the most common scalp conditions. Cradle cap in babies parlays into red, itchy patches with greasy scale or dandruff in an adult. It isn’t contagious, but it can be embarrassing. Unfortunately, seb derm often comes and goes with triggers such as stress and seasonal changes — it’s usually worse in winter and early spring. It can also affect the face, ears and chest.
Although no definitive cause has been identified, a yeast (fungus) called malassezia that is in the oil secretion on the skin seems to be the most likely culprit. Some factors, such as Parkinson’s, depression, diabetes, a weakened immune system or obesity, may make a person more likely to have seb derm.
The treatment: Dr. Desai recommends treating seborrheic dermatitis early and aggressively to avoid complications such as hair loss. Often a prescription strength anti-yeast shampoo called ketoconazole will do the trick. If flakes are still falling, a topical steroid may be in order.
Just keep in mind that prescription anti-yeast shampoos can be very drying to your hair. To counteract this and improve the effectiveness of the shampoo, Yolanda Lenzy, M.D., board-certified dermatologist and author of Getting to the Root: A Dermatologist’s Guide to Understanding Hair, recommends applying the shampoo directly to your scalp 5 to 10 minutes before wetting the hair and then lathering only the scalp area before you rinse it off. “Follow with a moisturizing shampoo and conditioner on the hair shaft to prevent the dryness that Rx shampoos can often cause, especially in more coily hair types,” advises Dr. Lenzy.
Alopecia
What it looks like: hair loss
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The cause: “Hair loss can be due to a number of different factors, including genetics, medications, inflammation, hormonal abnormalities and hair fragility,” says Dr. Ko. Regardless of the cause, it can be super distressing. If you notice hair breaking/shedding or bald spots on your scalp, it can help to get evaluated by a health care provider immediately. They may run blood work to evaluate for anemia, vitamin deficiency, thyroid abnormalities, irregular hormone levels and autoimmune markers.
Additionally, sources of stress such as the death of a loved one, major weight loss (sometimes related to a high-protein diet), surgery, a car accident, major infection and illness can cause a massive shedding months after the incident — a condition called telogen effluvium. For instance, a survey conducted by Survivor Corps found that nearly 68% of 1,700 COVID-19 survivors that were interviewed reported experiencing hair loss in the wake of their coronavirus infection. “Actress Alyssa Milano even recently took to Twitter to describe her experienced with COVID-19-related hair loss,” notes Dr. Lenzy.
Age can also play a role: As estrogen levels decrease between childbearing age and menopause, so often does our hair. Years of bleaching, dyeing, straightening, perming and rocking tight, slicked-back hairstyles can also catch up to us. The issue of hair loss is obviously complex and takes proper medical attention to figure out.
The treatment: Your doctor is going to want a thorough physical done so that any medical problems that are detected can be treated. Underlying scalp conditions such as seborrheic dermatitis or psoriasis should be addressed. In the case of hormonal thinning, there are treatments such as Rogaine, a solution that thickens existing hair, and spironolactone, a pill that helps block hormones called androgens.
Eating a well-balanced diet filled with vitamins such as B12 and folate is also useful when experiencing hair health woes. On top of that, taking a break from over-processing your hair and rocking more natural styles is definitely encouraged. “Platelet-rich plasma (PRP) is an effective option for androgenetic alopecia (also called male and female pattern hair loss) and the residual thinning after telogen effluvium,” says Dr. Lenzy. “During PRP, a patient’s blood is drawn and the plasma, which is rich in various growth factors effective for stimulating hair regrowth, is isolated and injected or applied to the scalp with microneedling.” In extreme cases, hair transplant is an effective option.
Cysts
What it looks like: skin-colored or pink-red smooth bumps
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The cause: Cysts can occur on the skin, just like they can show up on other organs. The good news: Scalp cysts are common and easy to identify. They are usually marble- or grape-sized bumps that you can feel when your comb or brush runs over them. If you’re unsure about a bump or you can’t get a good look of your scalp, that’s a good time to consult a derm. For the most part, scalp cysts are mostly genetic, benign and no cause for concern. That being said, in some cases they can get infected or irritated, causing pain and drainage.
The treatment: Leave them alone, or turn to a medical professional to have them surgically removed. You see, cysts contain a fluid-filled sac. “Unless the sac is removed, the cyst can recur, thus surgery is the only effective option to completely remove a cyst and ensure it does not recur,” says Dr. Obioha. “If the cyst is inflamed or infected, incision and drainage and/or antibiotics can be helpful to calm down symptoms, but these interventions don’t remove the cyst in its entirety.” Fortunately, the surgical removal is very simple and done with a local anesthetic. While it does leave a scar, Dr. Obioha says it’s often not noticeable.
Ringworm
What it looks like: scaly rash and bald spots
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The cause: Also called tinea capitis, ringworm is a fungal infection that usually happens in little kids, but occasionally adults get it too. According to the Mayo Clinic, there a few ways of contracting the fungus directly: human to human, animal to human (cats are a common source) and object to human (like clothing, towels, bedding, combs and brushes). However, “ringworm can also be transferred by indirect contact through a swimming pool or hot tub,” says Dr. Obioha. The resulting rash is usually painful and scaly, sometimes even causing enlarged lymph nodes. It also can lead to bald spots, broken hairs and black dots.
The treatment: Taking a daily antifungal medication for 4 to 6 weeks usually does the job. “Ringworm is no longer contagious 48 hours after starting treatment,” says Dr. Obioha. Until then, “you want to avoid contact with others as tinea capitis can spread through contact with other areas of the body and other people,” she adds. Treating or discarding infected sources can help to prevent re-infection.
Allergic Contact Dermatitis
What it looks like: itchy redness
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The cause: Paraphenylenediamine (PPD) is a chemical that is widely used as a permanent hair dye and guess what? It can wreak havoc on the skin. It’s also one of the most common causes of scalp allergic contact dermatitis (ACD), with the chemicals/fragrances included in shampoos and conditioners coming in right behind as a close second. “Other relevant possible allergens include propylene glycol, Cocamidopropyl betaine, methylisothiazolinone (MI) or a combined formulation of methylchloroisothiazolinone and MI,” says Dr. Obioha. “ACD can be painful, itchy and even oozing in some cases. The symptoms of a severe case can often be mistaken for infection.” Fortunately, it’s usually easy to figure out the cause because of the timing between chemical contact and rash.
The treatment: Identifying the trigger and eliminating it are the most important steps in treating ACD. Your dermatologist can also recommend a topical steroid gel, foam, cream or ointment. Two to three weeks of treatment should help decrease inflammation and clear up your skin. “Systemic steroids may be prescribed in severe cases,” adds Dr. Obioha.
With additional reporting by Kaitlyn Preiere
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