Dry or Flaky Scalp: Causes and Treatment

Dry scalp vs dandruff

If you are unsure, try a medicated dandruff shampoo for 2 to 4 weeks. If flaking improves, it was dandruff. If the scalp gets drier and tighter, it is more likely dry skin. For more on flakes, see dandruff.

Causes of a dry or flaky scalp

Dry skin

The scalp loses moisture in cold, dry air, with hot showers, frequent washing with strong shampoos and with age. People with dry skin elsewhere often notice it on the scalp too.

Dandruff and seborrheic dermatitis

Seborrheic dermatitis is an inflammatory reaction to a yeast that lives normally on oily skin. Mild cases are called dandruff. More severe cases cause red, greasy, itchy patches on the scalp, eyebrows, sides of the nose, behind the ears and on the chest. It tends to come and go and flares with stress, illness and winter. It is more common and severe in people with Parkinson's disease or HIV. In babies it appears as cradle cap.

Scalp psoriasis

Psoriasis on the scalp causes thick, well-defined, silvery-white scaly plaques that may extend past the hairline onto the forehead, neck or behind the ears. It can be very itchy and may bleed when scratched. Look for psoriasis on elbows, knees or nails.

Contact dermatitis

A reaction to hair dye (especially paraphenylenediamine, PPD), shampoo fragrances, preservatives or styling products causes itching, redness and flaking, sometimes with swelling of the scalp edges, ears and eyelids. See contact dermatitis.

Scalp ringworm (tinea capitis)

A fungal infection that is most common in children. It causes scaly, itchy patches with hair loss or broken hairs ("black dots"), and sometimes swollen glands in the neck. It is contagious and needs antifungal tablets, as shampoo alone will not cure it. See tinea capitis.

Other causes

• Eczema (atopic dermatitis): dry, itchy, scaly patches in people with eczema elsewhere.
• Product build-up: dry shampoo, gels and hairsprays can mimic flakes.
• Sunburn: peeling on a thinning scalp.
• Head lice: cause itching; the eggs (nits) are glued to hairs rather than loose flakes.

How a flaky scalp is diagnosed

Most causes are diagnosed by looking at the scalp, hair and other skin areas. A doctor may scrape scales or pluck hairs to test for fungus if ringworm is possible. Patch testing identifies contact allergies to hair dye or product ingredients. A biopsy is rarely needed.

Treatment for dry or flaky scalp

For dry scalp

• Wash with lukewarm, not hot, water.
• Use a mild, fragrance-free shampoo and conditioner.
• Shampoo less often if your hair allows, for example every 2 to 3 days.
• Massage a little plain oil (such as coconut or jojoba oil) or a scalp moisturizer into the scalp before washing.
• Use a humidifier in winter.

For dandruff and seborrheic dermatitis

Medicated shampoos work by reducing yeast, slowing skin turnover or loosening scale. Use the shampoo 2 to 3 times a week, leave it on for 5 minutes before rinsing, and continue once or twice a week after flakes clear to prevent return.

If one ingredient stops working, alternate with another. Doctors may prescribe a stronger antifungal shampoo, or a short course of a steroid lotion or foam for red, inflamed patches.

For scalp psoriasis

Coal tar or salicylic acid shampoos, plus prescription steroid or vitamin D-based scalp lotions. Severe or widespread psoriasis may need light therapy or systemic medicines.

For contact dermatitis

Stop the suspected product. A steroid scalp lotion calms the reaction. People allergic to PPD often need to avoid permanent dark hair dyes.

Frequently asked questions

How do I know if I have dry scalp or dandruff?

Dry scalp gives small, white, powdery flakes with a tight feeling, often with dry skin elsewhere. Dandruff gives larger, oily, yellowish flakes, sometimes with redness, and may affect eyebrows and the sides of the nose. Dandruff improves with medicated shampoo, while dry scalp improves with gentler care.

What is the best shampoo for a flaky scalp?

For dandruff, shampoos with ketoconazole, zinc pyrithione or selenium sulfide work best, used 2 to 3 times a week and left on for 5 minutes. For thick scale or psoriasis, salicylic acid or coal tar help. For dry scalp, a mild fragrance-free shampoo is best.

Can a dry or flaky scalp cause hair loss?

Dandruff and dry scalp do not directly cause hair loss, though heavy scratching can break hairs. Hair loss with scaling, especially patchy loss in a child, suggests scalp ringworm, which needs antifungal tablets. Severe psoriasis or seborrheic dermatitis can cause temporary shedding.

Is a flaky scalp contagious?

Dry scalp, dandruff, seborrheic dermatitis and psoriasis are not contagious. Scalp ringworm (tinea capitis) and head lice are contagious and spread through close contact and shared combs, hats or pillows.

How long does it take to get rid of a flaky scalp?

With the right treatment, most dandruff and dry scalp improve within 2 to 4 weeks. Seborrheic dermatitis often returns, so ongoing use of a medicated shampoo once or twice a week helps keep it under control. See a doctor if there is no improvement after 4 weeks.