Scalp Problems

Topic Overview

Many people have hair or scalp problems. Hair may thin or fall out, break off, or grow slowly. Dandruff or an itching or peeling scalp may cause embarrassment and discomfort. Hair and scalp problems can be upsetting, but they usually are not caused by serious medical problems.

Hair loss

Hair loss, including thinning and breaking, is the most common scalp problem. Most people lose from 50 to 100 hairs per day.

Hair gradually thins as people age, although not all people are affected to the same degree. Hereditary thinning or balding is the most common cause of thinning hair. You can inherit this from either your mother's or father's side of the family. Women with this trait develop thinning hair, while men may become completely bald. The condition can start in the teens, 20s, or 30s.

Babies often lose their fine baby hair, which is then replaced by mature hair. Because of changes in hormones, women often lose hair for 1 to 6 months after childbirth or after breast-feeding is completed.

Other possible causes for excessive hair loss, thinning, or breakage include:

• Damage to the hair from hair care products, such dyes and permanents, and from hot rollers, curling irons, or hair dryers.
• Hair-pulling or hair-twisting habits. Trichotillomania is a mental health problem in which a person pulls out his or her own hair, usually from the head, eyelashes, and eyebrows.
• Side effects of medicines or medical treatments, such as chemotherapy or radiation therapy.
• Recent surgery, high fever, or emotional stress. You may have a lot of hair loss 4 weeks to 3 months after severe physical or emotional stress. This type of hair loss usually stops within a few months.
• Diseases, such as lupus and hyperthyroidism.
• Heavy metal poisoning, such as thallium or arsenic poisoning.
• Poor nutrition, especially lack of protein or iron in the diet.
• Damage to the hair shafts from burns or other injuries.

Itching, flaking, or crusting of the scalp

Itching, flaking, or crusting of the scalp may be caused by:

• Cradle cap, an oily, yellow crusting on a baby's scalp. It is common in babies and is not caused by an illness. It does not mean that a baby is not being well cared for. See a picture of cradle cap .
• Dandruff, a shedding of the skin on the scalp that leaves white flakes on the head, neck, and shoulders. It may be a form of a skin condition called eczema, which causes increased shedding of normal scalp skin cells. Dandruff can also be caused by a fungal infection. Hormonal or seasonal changes can make dandruff worse.
• Head lice , tiny wingless insects that cause itching and raw patches on the scalp. Head lice are most common in school-age children.
• Ringworm, an infection of the outer layer of the scalp and in the hair. It usually causes a rash made up of circular patches with raised, red edges that resemble worms. The rash spreads from these edges, often leaving the center clear, giving it a ring shape.
• Ongoing (chronic) skin conditions, such as psoriasis, eczema, and seborrhea.
• An uncommon, recurrent skin condition called lichen planus. This condition appears more often during stress, fatigue, or exposure to medicines or chemicals.

Sores, blisters, or bumps on the scalp

Painful sores, blisters, or bumps that develop on the scalp may be caused by:

• Infection of the hair shafts (folliculitis) or the skin (such as impetigo).
• An allergic skin reaction (contact dermatitis).
• Viral infections, such as chickenpox and shingles.
• A skin condition, such as acne.
• A cyst, such as an epidermal or sebaceous cyst, a sac beneath the outer layer of the skin that is filled with a greasy white material. These cysts most often appear on the scalp, ears, face, back, or scrotum and are caused by plugged ducts at the site of a hair shaft. Other problems can develop if the cyst becomes infected.

Skin cancer can occur on the scalp, particularly in areas not well-covered by hair. It can destroy skin cells and tissues and, in some cases, spread (metastasize) to other parts of the body. Skin cancer may appear as a growth or mole, a change in a growth or mole, a sore that does not heal, or irritation of the skin. The three most common types of skin cancer are basal cell skin cancer, squamous cell skin cancer, and melanoma.

Treatment

The treatment for scalp problems depends on what is causing the problem.

Review the Check Your Symptoms section to determine if and when you need to see a doctor.

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

• A cut on your scalp: Go to the topic Cuts.

	Yes	Do you have a painful rash on your scalp? When to See a Doctor See significance of a painful rash on your scalp if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain from a rash or blisters on your scalp? Call your health professional today if you answer "Yes" to the following question. Yes Do you have moderate pain from a rash or blisters on your scalp? Note: Call your doctor as soon as possible. If your symptoms are caused by an infection with the herpes virus, you may be able to take a medicine to limit the pain and rash. Medicines work best if you start taking them within 2 to 3 days of the start of the rash. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild to moderate pain from a rash or blisters for more than 3 to 4 days? Note: Call your doctor as soon as possible. If your symptoms are caused by an infection with the herpes virus, you may be able to take a medicine to limit the pain and rash. Medicines work best if you start taking them within 2 to 3 days of the start of the rash. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have a skin infection? When to See a Doctor See significance of symptoms of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Yes Do you have red streaks extending from an area in your scalp? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth in your scalp? Yes Do you have pus in or around a rash or sore in your scalp? Yes Do you know or think you have a fever? Yes Do you have a crusty, blistered sore that is draining honey-colored fluid? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a sore or broken blister for 24 hours or longer? Yes Have you had swollen lymph nodes in your neck for longer than 24 hours? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Has a mole or other colored (pigmented) skin spot changed? When to See a Doctor See significance of a change in a mole or colored skin spot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Has a mole or colored skin spot gotten larger? Yes Has a mole or colored skin spot developed jagged or scalloped edges (irregular borders)? Yes Has part or all of a mole or colored skin spot turned red, white, blue, black, or a mix of colors? Yes Has part or all of a mole or colored skin spot lost its color? Yes Has color from part or all of a mole or colored skin spot spread into surrounding skin? Yes Has a flat mole or colored skin spot become thicker or raised? Yes Does a mole or colored skin spot look crusty or worn down (eroded)? Yes Does a mole or colored skin spot itch, tingle, burn, or hurt when you touch it? Yes Do you have an open sore in a mole or colored skin spot? Yes Does a mole or colored skin spot bleed easily? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your scalp look flaky or crusty? When to See a Doctor See significance of a crusty scalp if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have red areas on your scalp that are topped with loose, silvery flakes of skin? Yes Do you have blisters or crusty, oozing sores on your scalp? Yes Do you have an itchy scalp with a solid red rash or crusty sores? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your scalp itch? When to See a Doctor See significance of an itchy scalp if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have new patches of itchy, oozing blisters on your scalp? Yes Is severe itching interfering with your usual activities or preventing sleep even after 12 hours of home treatment? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you still have moderate scalp itching after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have recurrent patches of itchy sores or blisters on the scalp? Yes Can you still see head lice or their eggs on your scalp, the nape of your neck, or behind your ears after using a prescription or nonprescription treatment for head lice? Note: Call your doctor today to arrange for your treatment. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that a medicine is causing your hair loss or scalp problem? When to See a Doctor See significance of hair loss or a scalp problem caused by a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think that your hair loss or scalp problem may be caused by a medicine? Note: If your answer is "Yes": Call the doctor who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. If you feel you need to continue taking the medicine, call your doctor. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have flakes of skin on your scalp? When to See a Doctor See significance of flakes of skin from the scalp if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a red, irritated scalp for 2 weeks or longer? Yes Have you had broken scalp hairs for 2 weeks or longer? Yes Have you had patchy hair loss for 2 weeks or longer? Yes Have you had a crusty, flaky scalp with any other symptoms for 2 weeks or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you still have dandruff after 2 weeks of treatment with an antidandruff shampoo? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have hair loss, thinning, or breakage? When to See a Doctor See significance of hair loss, thinning, or breakage if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you been unable to control the urge to pull out your own hair for longer than 2 weeks? Yes Have you had sudden, unexplained hair loss for longer than 2 weeks? Yes Are you concerned about hair loss or thinning? Yes Do you have a new bald spot? Yes Do you have a rash or crusting on your scalp? Yes Do you continue to have new hair breakage even after 2 weeks of home treatment? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• A rash on another area of the body: Go to the topic Rash, Age 11 and Younger or Rash, Age 12 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Try one of the following home treatment measures to resolve a scalp problem.

• Try home treatment for dandruff that causes white flakes on your head, neck, and shoulders.
• Perform a skin self-exam to help identify suspicious scalp growths. Part your hair to look at your scalp. If you have trouble seeing your scalp, ask a friend or family member to check the spot for you.
• If your baby has yellow crusting on his or her scalp, try home treatment for cradle cap.
  • An hour before shampooing, rub your baby's scalp with baby oil, mineral oil, or petroleum jelly to help lift the crusts and loosen scales.
  • When ready to shampoo, first get the scalp wet, then gently scrub the scalp with a soft-bristle brush (a soft toothbrush works well) for a few minutes to remove the scales. You can also try gently removing the scales with a fine-tooth comb.
  • Then wash the scalp with baby shampoo, rinse well, and gently towel dry.
• If your baby has a bald spot at the back or side of the scalp, change your baby's position frequently. Lying in one position may be causing the bald spot.

More suggestions can be found in the Home Treatment section of topics that may be related to scalp problems.

• For treating head lice effectively, see the topic Lice.
• For hair pulling that may be related to stress, see the topic Stress Management.
• For ringworm, see the topic Ringworm of the Scalp or Beard.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Signs of a skin infection develop.
• Symptoms become more severe or frequent or do not go away.

Prevention

To maintain normal hair production, eat 2 to 3 servings of protein a day. Protein is found in meat, chicken, fish, eggs, some cheeses, dried beans, tofu, grains, and nuts. For more information, see the topic Healthy Eating.

Treat your hair gently. If your hair breaks easily:

• Shampoo, comb, and brush your hair less frequently.
• Use a cream rinse or conditioner after shampooing your hair. This will make your hair easier to comb and more manageable.
• Use wide-tooth combs and brushes with smooth tips.
• Avoid rough combing, brushing, or rubbing with a towel when your hair is wet. Wet hair is more fragile and thus more likely to break.
• Avoid hairstyles that pull on your hair, such as ponytails, cornrows, and braids. The constant pulling causes some hair loss, especially along the sides of the scalp. If you do use these hairstyles, avoid tight ponytails and braids. Alternate with looser hairstyles.
• Limit your use of curling irons, hot roller, and hair dryers. If you use these products, use the low heat setting.
• Avoid chemical treatments until hair you have previously treated with chemicals has grown out.

To prevent head lice, do not share hats, combs, or other items. For more information, see the topic Lice.

To prevent skin cancer, protect your skin, including your scalp.

• Limit your exposure to the sun, especially from 10:00 a.m. to 4:00 p.m.
• Wear a wide-brimmed hat.
• Do not use tanning booths or sunlamps.

For more information, see the topics Skin Cancer, Melanoma and Skin Cancer, Nonmelanoma.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• If you are concerned about hair loss or thinning, when did you last have what you consider a normal head of hair?
• Do you have a family history of hair loss?
• What are your hair care habits?
  • How often do you wash your hair?
  • Do you use hot rollers, a hair dryer, or a curling iron?
  • Have you had a recent permanent or used a hair color product?
  • Do you regularly use elastic bands, barrettes, or bobby pins?
• Questions for women:
  • Are you using a hormonal birth control method?
  • When was your last menstrual period?
  • Has your baby stopped breast-feeding within the past 6 months?
• What nonprescription and prescription medicines, including vitamins, have you taken in the last 6 months?
• Have you had any recent illness or surgery?
• Do you have any skin disorders or chronic illnesses?
• Have you had this problem in the past? If so, how was it treated? Did the treatment help?
• Have you recently lost more than 10 lb (4.5 kg)?
• Do you think you may have been exposed to head lice or ringworm?
• Does anyone in your family have similar symptoms?
• Do you have any health risks?

Related Information

• Acne Vulgaris
• Allergic Reaction
• Anxiety
• Atopic Dermatitis
• Folliculitis
• Hair Loss
• Healthy Eating
• Hyperthyroidism
• Hypothyroidism
• Iron Deficiency Anemia
• Lice
• Psoriasis
• Rash, Age 11 and Younger
• Rash, Age 12 and Older
• Ringworm of the Scalp or Beard
• Shingles
• Skin Cancer, Melanoma
• Skin Cancer, Nonmelanoma
• Stress Management

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