Scalp Conditions

Why is my scalp so itchy and flaky? (Dandruff, seborrhoeic dermatitis and other scalp conditions)

A persistently itchy, flaky scalp is usually one of three things: ordinary dandruff, seborrhoeic dermatitis, or scalp psoriasis. All three are common, none of them reflects poor hygiene, and all of them are manageable. They look very similar in the bathroom mirror, and they respond to different approaches.

Is this you?

• Flakes on your shoulders, parting or pillow that keep coming back despite regular washing

• Itching that flares in cold weather, with stress, or a few days after wash day

• Greasy, yellowish scale in patches, sometimes also at the eyebrows, the creases of the nose or behind the ears

• Thicker, silvery or ashy plaques with well defined edges, sometimes extending past the hairline

• Soreness, tightness or a burning feeling, with or without visible flakes

• Flakes that cling to the hair shaft rather than falling free

These symptoms overlap heavily across several conditions, and with fungal infection and simple product build up, so flaking alone cannot tell you which one you have.

What is happening and why

Dandruff is mild, widespread flaking. Seborrhoeic dermatitis is a stronger version of the same problem, producing inflamed, often greasy, yellowish scale on the scalp and sometimes the brows and sides of the nose. Scalp psoriasis is a different condition altogether, producing thicker, sharply bordered plaques that may extend beyond the hairline and can appear alongside psoriasis elsewhere on the body.

Presentation also varies with skin tone and hair type. On darker skin, inflammation often appears violet, brown or ashy rather than red, and both conditions can leave lighter or darker patches after they settle. In textured and Afro hair, longer wash intervals, oils and protective styles all change how scale builds and how treatment fits into a real routine. General advice regularly misses this.

Several conditions produce very similar flaking and itch, and telling them apart requires examining the scalp, which is what the assessment is for.

How I assess it

Your appointment begins with your story. I will ask how long this has been going on, what pattern it follows, what flares it, and about your wash routine, products, styling and general health, because scalp conditions rarely exist in isolation from routine.

I then examine your scalp with trichoscopy. Under magnification, the distinctions that are invisible at home become clear: the character and colour of the scale, how it attaches, the state of the skin beneath, whether follicles are inflamed, and whether the condition is starting to affect hair growth, since long standing scalp inflammation can. I assess this across all skin tones and hair textures, including the subtler appearance of inflammation on darker skin. I take clinical photographs to record a baseline, so improvement can be properly compared. Where anything I find needs medical care, I will say so plainly and refer you on.

The assessment identifies which condition you are actually dealing with, so treatment can be matched to it.

Treatment options, and why the right one depends on the cause

Well established approaches. It is well established that medicated shampoos containing antifungal ingredients, available from pharmacies, are the mainstay for dandruff and seborrhoeic dermatitis. Which type, and how it fits a once a week textured hair routine as opposed to daily washing, is worked out at assessment. Psoriasis usually needs a different approach, which I can help manage alongside your GP or a dermatologist.

In clinic scalp treatments. Supportive in clinic treatments, gentle descaling, scalp cleansing and calming therapies, can help settle a flaring scalp and make home treatment work better. They support treatment of the underlying condition rather than replacing it.

Routine adjustments. Wash frequency, product choice, oil use and style tension all influence flare ups, particularly in textured hair. The right adjustments depend on which condition you actually have, and months spent treating dandruff that is actually psoriasis is time and comfort wasted.

See also: traction alopecia and alopecia areata.

When to see your GP

See your GP if the scalp is weeping, crusted or painful, or if psoriasis is affecting your joints, with stiffness or swelling. Where anything I find at assessment needs medical treatment, I will refer you on and coordinate with your GP.

Getting help in Ipswich and Suffolk

I am based in Ipswich and see clients from across Suffolk, including Woodbridge, Felixstowe, Stowmarket and Bury St Edmunds, many of whom have tried half the shampoo aisle without knowing which condition they were treating. Flaking and itch are among the easiest problems to improve once correctly identified, and the way to identify them correctly is to look at the scalp properly. For most scalp concerns, the £65 Scalp Health Check is the right starting point. If the problem is long standing, spreading, or affecting your hair growth, a full consultation gives us the time to look at everything together.