SymptomSkin, hair & nails
Scalp Scaling: Causes and Treatment
Scalp scaling means flakes or crusts of dead skin build up on the scalp. The most common causes are dandruff and seborrheic dermatitis, which produce loose white or greasy yellow flakes, and scalp psoriasis, which forms thick, silvery scale on raised red patches. In children, scaling with patchy hair loss may be scalp ringworm, which needs antifungal tablets. Most scalp scaling improves with the right medicated shampoo used regularly.
Also called: Scaly scalp, scalp scales, flaky scalp, scalp flaking, scaling of the scalp
At a glance
- What it is
- Visible flakes or adherent scale on the scalp, from loose white flakes to thick crusted plaques.
- Common causes
- Dandruff, seborrheic dermatitis, psoriasis, dry scalp, and cradle cap in babies.
- Other causes
- Scalp ringworm, contact dermatitis, eczema, actinic keratosis and, rarely, lupus or lichen planopilaris.
- Diagnosis
- Usually by appearance; scrapings for fungus or a biopsy if unclear.
- Treatment
- Medicated shampoos (ketoconazole, selenium sulfide, zinc pyrithione, coal tar, salicylic acid) and steroid scalp lotions.
When to get help
See a doctor within a day or two
- A swollen, painful, boggy patch with pus and hair loss, especially in a child, or with fever
- Widespread scaling with red skin over most of the body, chills or feeling unwell
Book a routine appointment
- Scaling with patches of hair loss, broken hairs or black dots, especially in a child
- Thick scale that does not improve after 4 to 6 weeks of medicated shampoo
- Scaling with shiny, scarred bald patches
- A rough, scaly spot on a bald or sun-exposed scalp that does not heal, bleeds or grows
Usually safe to manage at home
- Fine white or greasy yellow flakes with mild itch and no hair loss
- Cradle cap in a baby who is otherwise well
What scalp scaling looks like
Scaling happens when skin cells shed faster than normal, or clump together instead of falling away invisibly. The type of scale gives strong clues to the cause.
| Type of scale | Most likely cause |
|---|---|
| Small, loose, white flakes on shoulders; little redness | Dandruff or dry scalp |
| Greasy, yellowish flakes with redness, also on eyebrows and beside the nose | Seborrheic dermatitis |
| Thick, silvery-white scale on well-defined raised red plaques, beyond the hairline | Psoriasis |
| Scale stuck to hair shafts in sleeves (pityriasis amiantacea) | Psoriasis or seborrheic dermatitis |
| Round scaly patches with broken hairs, in a child | Tinea capitis (ringworm) |
| Thick yellow, greasy crusts in a baby | Cradle cap |
| Rough, sandpapery spots on a bald scalp | Actinic keratosis |
Causes of a scaly scalp
Dandruff and seborrheic dermatitis
Dandruff is the mild end of the same spectrum as seborrheic dermatitis. Both are linked to an inflammatory reaction to Malassezia, a yeast that lives on everyone's skin. Flakes are worse in winter, with stress, and when hair is washed less often. Seborrheic dermatitis adds redness and itch, and often affects the eyebrows, sides of the nose, behind the ears and the chest.
Scalp psoriasis
Psoriasis causes thicker, drier, silvery scale on sharply defined red plaques. It often extends beyond the hairline onto the forehead, neck and around the ears. Look for psoriasis on the elbows, knees, lower back and nails (pitting). Scalp psoriasis can itch intensely and occasionally causes temporary hair shedding.
Dry scalp
Dry scalp produces small, dry, white flakes without greasiness or much redness. Cold, dry air, hot water, frequent washing and harsh shampoos contribute. Dry skin elsewhere on the body is common at the same time.
Scalp ringworm
Tinea capitis is a fungal infection mostly seen in children. It causes scaly patches with hair breakage and sometimes swollen glands at the back of the neck. Creams and shampoos alone do not cure it.
Cradle cap
Cradle cap is seborrheic dermatitis in babies, causing thick, yellow, greasy scale. It is harmless and usually clears by 6 to 12 months.
Other causes
- Contact dermatitis from hair dye, shampoos or styling products, with redness and itch.
- Atopic eczema on the scalp.
- Actinic keratosis from sun damage on a thinning or bald scalp.
- Discoid lupus and lichen planopilaris, which scale and can scar.
How the cause is diagnosed
A doctor or dermatologist examines the scalp, hairline, face, ears, nails and the rest of the skin. A dermatoscope helps distinguish psoriasis from seborrheic dermatitis. Scrapings and hair samples are sent for fungal testing if ringworm is possible, and a biopsy is taken if scarring or a skin growth is suspected. For skin changes beyond scaling, see irregular appearing scalp.
Treatment
Medicated shampoos
| Active ingredient | Best for | How it works |
|---|---|---|
| Ketoconazole, ciclopirox | Dandruff, seborrheic dermatitis | Reduces yeast |
| Selenium sulfide, zinc pyrithione | Dandruff, seborrheic dermatitis | Antifungal, slows shedding |
| Coal tar | Psoriasis, seborrheic dermatitis | Slows skin cell growth |
| Salicylic acid | Thick scale, psoriasis | Softens and lifts scale |
Massage into the scalp and leave on for 3 to 5 minutes before rinsing. Use 2 to 3 times a week until controlled, then once a week to keep it away. Rotating two types often works better than one.
For thick or stubborn scale
- Soften scale with a mineral oil, olive oil or salicylic acid product applied for several hours or overnight, then wash and gently comb out.
- Steroid scalp lotions, foams or shampoos for inflamed seborrheic dermatitis or psoriasis, used as prescribed.
- Vitamin D preparations (calcipotriol) for psoriasis.
- Systemic or biologic treatment for severe psoriasis.
Other causes
- Ringworm: antifungal tablets such as griseofulvin or terbinafine for several weeks, plus antifungal shampoo.
- Cradle cap: gently massage with baby oil or emollient, then brush out loose scale with a soft brush and wash with a mild baby shampoo.
- Contact dermatitis: stop the product causing it.
Frequently asked questions
What causes a scaly scalp?
The commonest causes are dandruff, seborrheic dermatitis and scalp psoriasis. Dry scalp, cradle cap in babies, scalp ringworm in children, contact reactions to hair products, and sun damage are other causes. The appearance of the scale usually points to which one.
How can I tell scalp psoriasis from dandruff?
Dandruff gives loose, fine, white or yellowish flakes with little redness. Psoriasis causes thick, silvery scale on raised, sharply defined red patches that often extend beyond the hairline. Psoriasis elsewhere on the body or nail pitting supports psoriasis.
How do I remove thick scales from my scalp?
Soften the scale with oil or a salicylic acid product left on for a few hours or overnight, then wash with a coal tar or medicated shampoo and gently comb out loosened scale. Do not pick or scratch it off, which can cause bleeding and infection.
Is a scaly scalp contagious?
Dandruff, seborrheic dermatitis and psoriasis are not contagious. Scalp ringworm is contagious through shared combs, hats, pillows and close contact, so children with scaly patches and hair loss should be checked and treated.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Dandruff, how to treat
- American Academy of Dermatology: Scalp psoriasis
- National Psoriasis Foundation: Scalp Psoriasis
- MedlinePlus: Seborrheic dermatitis
- NHS: Scalp ringworm