Feature Article

The itchy scalp

Jonathan Ng, Alvin Chong, Peter Foley
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Many dermatological conditions can cause scalp pruritus of varying degrees, but it can be difficult to make an accurate diagnosis as signs are often nonspecific.

Key Points

  • Scalp pruritus may be a feature of many common dermatological conditions including seborrhoeic dermatitis, psoriasis, pediculosis, eczema and lichen simplex chronicus. In some patients, androgenetic alopecia is associated with itching and irritation of the scalp.
  • Scalp pruritus can also be a prominent feature of contact dermatitis and rare conditions such as dermatitis herpetiformis, lichen planopilaris and trigeminal trophic syndrome.
  • Psychological issues, particularly anxiety, may exacerbate or manifest as scalp pruritus.
  • Identifying distinguishing features in the patient’s history and examination to make an accurate diagnosis is important. Sometimes a therapeutic trial is required before the diagnosis is known.
  • A definitive cause for scalp pruritus may not be found in some cases, but empirical topical treatments may still help to alleviate symptoms.