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What is the cause for excessive itching on the scalp?

Answered by: Dr. Rishi Parashar
Consultant Dermatologist,
Sir Ganga Ram Hospital,
New Delhi

Q. I have an infection on my head since last 5 years and the area itches. Because of the itching, I keep removing the skin and the underlying skin after getting dry looks like rubber. I am taking constant treatment but with no improvement.

A.  I would like to see your condition ideally before commenting but I suspect the following in your case in order given below:
  • Eczema and seborrhoeic dermatitis
  • Scalp psoriasis
  • Head lice (very doubtful in your case)
  • Scalp dysaesthesia (very doubtful)
1. Although there are several broad categories of eczema, they all result in the skin becoming dry, inflamed, sore and itchy and they all have a constellation of symptoms in common. These include red spots, rough scaling, dryness, soreness, blisters which burst and weep (sometimes), constant irritation and itching. 2. Characteristically, scalp psoriasis often appears to extend just beyond the scalp margin, leaving an inflamed, scaly border extending about 1cm from the hairline. On the scalp, thickened, scaly patches are interspersed with areas of normal skin. In addition, the scalp may be itchy and feel tight or sore. 3. The main features of lice infestations are severe itching and scratching followed by secondary infection. In some cases the resulting clinical picture can be difficult to differentiate from crusted eczema on the scalp. The presence of nits would confirm the diagnosis of head lice infestation. 4. Scalp dysaesthesia, in which patients describe burning, stinging or itching sensations, which are often triggered or exacerbated by physical or psychological stress. Treatment varies according to the diagnosis but you could try the following:
  • Using medicated shampoos containing zinc pyrithione, selenium sulphide or an antiseptic.
  • If the scalp is very scaly then a shampoo containing coal tar or salicylic acid may help to remove it.
  • Application of steroid lotions or tar lotions
  • Taking anti-histamine tablets (to alleviate itching)

A.  I would like to see your condition ideally before commenting but I suspect the following in your case in order given below:
  • Eczema and seborrhoeic dermatitis
  • Scalp psoriasis
  • Head lice (very doubtful in your case)
  • Scalp dysaesthesia (very doubtful)
1. Although there are several broad categories of eczema, they all result in the skin becoming dry, inflamed, sore and itchy and they all have a constellation of symptoms in common. These include red spots, rough scaling, dryness, soreness, blisters which burst and weep (sometimes), constant irritation and itching. 2. Characteristically, scalp psoriasis often appears to extend just beyond the scalp margin, leaving an inflamed, scaly border extending about 1cm from the hairline. On the scalp, thickened, scaly patches are interspersed with areas of normal skin. In addition, the scalp may be itchy and feel tight or sore. 3. The main features of lice infestations are severe itching and scratching followed by secondary infection. In some cases the resulting clinical picture can be difficult to differentiate from crusted eczema on the scalp. The presence of nits would confirm the diagnosis of head lice infestation. 4. Scalp dysaesthesia, in which patients describe burning, stinging or itching sensations, which are often triggered or exacerbated by physical or psychological stress. Treatment varies according to the diagnosis but you could try the following:
  • Using medicated shampoos containing zinc pyrithione, selenium sulphide or an antiseptic.
  • If the scalp is very scaly then a shampoo containing coal tar or salicylic acid may help to remove it.
  • Application of steroid lotions or tar lotions
  • Taking anti-histamine tablets (to alleviate itching)

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