Feature Article

Scalp pruritus: easing the itch




An itchy scalp is common in people of all ages. Treatment depends on an accurate diagnosis. Causes range from everyday skin conditions such as seborrhoeic dermatitis, psoriasis and head lice to rare disorders such as dermatitis herpetiformis and trigeminal trophic syndrome.

Key Points

  • Scalp pruritus is a feature of many common dermatological conditions, including seborrhoeic dermatitis, psoriasis, pediculosis capitis, eczema, lichen simplex chronicus and contact dermatitis.
  • Scalp pruritus may also be a prominent feature of rare conditions such as dermatitis herpetiformis, lichen planopilaris and trigeminal trophic syndrome.
  • Pruritus of the scalp can occur without any noticeable skin changes; psychological issues can exacerbate or manifest as scalp pruritus.
  • Scalp pruritus can be a diagnostic and therapeutic challenge; distinguishing features in the patient’s history should be sought and physical examination should include whole-body skin inspection.
  • Sometimes a therapeutic trial is required before the diagnosis is known.
  • A definitive cause for scalp pruritus is not always found; these patients may benefit from symptomatic antipruritic treatments.
  • Referral to a dermatologist is recommended when the diagnosis remains unclear or the disease does not respond to treatment. Early dermatology referral is essential for patients with dermatitis herpetiformis, lichen planopilaris and alopecia.

    Picture credit: © 2018 Audra Geras