Scalps can be scaly for a number of reasons: underlying medical conditions like psoriasis, or fungal infections (ringworm or dandruff), irritation from hair products, or scaling from sun damage, actinic keratoses or skin cancers. It can be associated with itch or tenderness and should be addressed. With so many underlying causes of scaling in the scalp, it’s important to see an expert. Let Patricia O’Connor, MD, and the team at Absolute Dermatology and Skin Cancer Center in Glen Allen and Chesterfield, Virginia, take care of your scalp. Book your appointment today by calling the Richmond-area office nearest you, or send us a message to book an appointment on our contact page.
Plaque psoriasis: Just like psoriasis can cause thick, red, and scaling plaques on the knees and elbows, it can affect the scalp. This inflammation and scaling can cause itch and tenderness and extend onto the ears.
Tinea capitis: Commonly called ringworm, tinea capitis is a fungal infection on the scalp common in children. Risk factors are warm and humid climates or frequent contact with pets.
Seborrheic Dermatitis (Dandruff): The most common presentation of dandruff is the sensitivity to yeast. It tends to come and go and requires constant management.
Irritant Contact Dermatitis: We all want our hair to smell nice and don’t want mold growing in our hair care products. Fragrance and preservatives are two of the most common skin irritants and, when in our hair care products, can lead to redness, scaling, and sometimes pustules on the scalp.
Sun damage, Actinic Keratoses, and Skin Cancer: As we age, our natural sun protection (hair) on the scalp becomes thinner, leading to more sun exposure. Sun damage begins as scaling, and eventually, these develop discrete patches that can evolve, if untreated, into frank skin cancers.
While seborrheic dermatitis can cause varying degrees of scaling throughout the scalp, psoriasis tends to have focal patches of thick and inflamed skin, and specific scaling lesions will be seen in skin cancers and their predecessors. With tinea capitis, the lymph nodes at the base of the scalp and in the neck can be inflamed and felt through the skin.
Commonly, a scaling scalp can be diagnosed based on a visual exam alone. However, if an infection is suspected, this can be confirmed with a fungal culture, which is done by swabbing the involved scalp. If there is concern for skin cancer, a procedure called a skin biopsy will be done to remove all or part of the lesion for microscopic evaluation by a dermatopathologist.
The treatment will depend on the diagnosis and can be as simple as working with your provider to find the right prescription topical. Systemic medications can be indicated in certain fungal infections or psoriasis if it involves other body sites. Sun damage and skin cancer on the scalp will be treated more or less aggressively depending on the type. If the scaling is diffuse and consistent with background sun damage and actinic keratoses, they can be treated with light therapy or sometimes topical creams. If it has progressed beyond this stage, Mohs surgery can be done in our office for the most effective treatment with the best cosmetic outcome.
Don't live with a scaling scalp. Make an appointment at Absolute Dermatology & Skin Cancer Center today by calling the nearest office or send us a message to book an appointment on our contact page.
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