From the Guidelines
The workup for scalp itching should begin with a thorough history and physical examination to identify potential causes, and treatment should be guided by the most recent and highest quality evidence, which currently supports the use of topical therapies such as calcipotriene foam for mild to moderate scalp psoriasis, as shown in a 2021 study 1. The most common causes of scalp itching include seborrheic dermatitis, psoriasis, contact dermatitis, fungal infections, and head lice.
- For suspected seborrheic dermatitis, recommend anti-dandruff shampoos containing ketoconazole 2%, selenium sulfide 1%, zinc pyrithione 1-2%, or salicylic acid, used 2-3 times weekly for at least 2-4 weeks.
- For psoriasis, consider coal tar shampoos or prescription topical steroids like fluocinonide 0.05% solution, or vitamin D analogs such as calcipotriene foam, which has been shown to be safe and effective for the treatment of mild to moderate scalp psoriasis 1.
- Fungal infections may require antifungal shampoos or oral medications like fluconazole 150mg weekly for 2-4 weeks.
- For head lice, permethrin 1% is typically applied to the scalp for 10 minutes then rinsed out, with a second application 7-10 days later, as recommended by the American Academy of Pediatrics 1. If these initial treatments fail, consider skin scrapings for microscopic examination, fungal cultures, or a scalp biopsy. Patients should avoid potential irritants like harsh hair products and excessive heat styling. Persistent or severe cases warrant referral to a dermatologist, especially if accompanied by hair loss, spreading lesions, or systemic symptoms. It is essential to note that the treatment of scalp itching should prioritize the patient's quality of life, as shown in a 2011 study where a patient's quality of life was significantly improved with the use of acitretin for palmar and plantar psoriasis 1.
From the FDA Drug Label
Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. The workup for scalp itching is not directly addressed in the provided drug label. Key points to consider in the workup for scalp itching include:
- Considering scabies as a potential cause, especially in infants and geriatric patients
- Looking for infestations in areas such as the hairline, neck, temple, and forehead However, the FDA drug label does not provide a comprehensive workup for scalp itching. 2
From the Research
Workup for Scalp Itching
The workup for scalp itching typically involves a combination of medical history, physical examination, and diagnostic tests to determine the underlying cause of the itching.
- Medical History: A thorough medical history is taken to identify any underlying medical conditions, such as psoriasis, eczema, or seborrheic dermatitis, that may be contributing to the scalp itching 3.
- Physical Examination: A physical examination of the scalp is performed to look for signs of inflammation, redness, or flaking, which can indicate conditions such as dandruff or seborrheic dermatitis 4, 5.
- Diagnostic Tests: Diagnostic tests, such as a scalp biopsy or fungal culture, may be ordered to rule out underlying conditions such as fungal infections or autoimmune disorders 6, 7.
Common Causes of Scalp Itching
Some common causes of scalp itching include:
- Dandruff: a chronic scalp condition characterized by scaling and itching 4, 5.
- Seborrheic dermatitis: a condition that causes inflammation and flaking of the scalp 6, 3.
- Psoriasis: an autoimmune condition that can cause scalp itching and flaking 3.
- Eczema: a condition that can cause scalp itching and inflammation 3.
Treatment Options
Treatment options for scalp itching depend on the underlying cause and may include:
- Medicated Shampoos: Shampoos containing ingredients such as zinc pyrithione, ketoconazole, or climbazole can help to reduce scalp itching and flaking 4, 5, 6, 7.
- Topical Corticosteroids: Creams or ointments containing corticosteroids can help to reduce inflammation and itching 3.
- Antifungal Medications: Medications such as terbinafine or ciclopirox can help to treat fungal infections that may be contributing to scalp itching 3.