“I have dry patches on my scalp that flake when I scratch. What could be the cause?” is a question asked on many skin care forums. Sometimes when combing through your hair with the fingers, you feel or see some small dry patches on the scalp that could be red. The skin could also be shedding white flakes or dandruff. This can indicate various scalp problems.
Dry skin patches on the head can be due to different medical issues. They can sometimes be painful, embarrassing and uncomfortable.
The patches can be few and scattered on the scalp or cover the entire scalp. Discovering what causes them and how to treat them can help control the problem. Some of the causes include:
Ringworm and dry scalp patch
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This is also referred to as Tinea capitis. According to the Mayo Clinic, it’s a fungal infection of the hair shafts and scalp. The fungi that cause it to attack the skins outer layer and hair shaft. Symptoms include itchy, scaly and bald patches on the head. It mostly affects school going kids and toddlers.
It’s not caused by a worm, but the disorders name refers to the circular appearance caused by the infection. The infection is contagious and spreads from human to human, from objects that an infected person touches or from animals that have ringworms, including puppies and kittens.
To prevent ringworms, shampoo the scalp regularly, avoid animals that are infected, keep the hair clean, avoid sharing personal items and be educated on its causes and risks.
Treatment options
The doctor can prescribe antifungal medications to be taken orally. They include terbinafine and Griseofulvin. A medicated shampoo can also be used to clean the hair. This helps avoid spreading the infection and removes fungus spores.
Dry skin
Dry skin on the scalp can be caused by cold or dry air, old age or contact dermatitis (when the skin reacts to products you use on it including hair gel, shampoo or spray). When you have a dry scalp, the skin gets irritated and will flake off. Note that dry scalp is different from dandruff. Dandruff is caused by excessive oil in the skin cells that build up and sheds off.
Treatment options for dry scalp
Use a gentle shampoo to wash the hair and then moisturize with conditioner. You can also get a scalp treatment from your hair stylist to help moisturize the scalp.
Scalp eczema
Eczema appears as red dry itchy patches and can also be referred to as seborrheic dermatitis. With eczema, there is the formation of flaky skin accompanied by rashes and excessive dandruff. The itchiness, if scratched, causes the formation of blisters that break open the rashes and ooze fluids. Eczema of the scalp is attributed to fungal infections.
These patches appear in areas with heavy sebum production. Those affected by the condition get an abundant growth of normal skin yeast in areas affected.
Treatment options
Seek medical attention from a doctor immediately you see any of the symptoms. Over the counter shampoos can be used, especially if they contain ingredients like tar, salicylic acid, selenium sulfide, Ketoconazole or Zinc pyridine. Other topical steroid lotions with a weak potency can be used.
If the area is bald or has no hair, apply topical steroids or antifungal creams. Ointments like Elidel and Protonic can be used although they are quite expensive. Creams that contain ketoconazole can also be used.
Seborrheic dermatitis is incurable and recurrence should be expected. The treatment, according to Medicine Net, should be used frequently so as to control the symptoms.
Home remedies can include the use of moisturizing lotion to keep the area moisturized like Cetaphil. The doctor may prescribe 1% Hydrocortisone cream.
Use of substances that contain apple cider vinegar, coconut oil, biotin or tea tree oil can be taken either orally or applied. They help in controlling the symptoms.
Actinic keratosis
It appears as red scaly patches on the scalp and is caused by overexposure to the sun. The scalp gets damaged if exposed to too much sun. Over the years the scalp will form scaly areas which can later turn to lesions that look like warts. The ultraviolet light over a long period of time damages skin cells leading to actinic keratosis lesions. This can also become malignant.
Treatment options
Actinic keratosis can disappear on its own after some months but will reappear if one keeps exposing the scalp to too much sunlight.
The American Academy of Dermatologists suggests the following treatments:
- Prescription medicine including diclofenac sodium gel, ingenol mebutate cream and imiquimod cream
- Cryotherapy: this is where the lesions get frozen. The treated area of the skin will be blistered and peel for a few weeks but the skin will finally heal. This form of treatment is most common for actinic keratosis.
- Curettage: this is where the dermatologist will use a curette to remove the lesions. Electrosurgery can then be used to remove damaged tissue by burning skin. New skin will then appear at the arear.
- Chemical peel: visit a doctor for this kind of procedure. The peel destroys the damaged top skin layer. After skin goes through the healing process, healthy new skin is restored.
- Photodynamic therapy: here, the dermatologist will apply some solution that makes the skin sensitive to light a bit more. The treated skin is later, after a few hours, exposed to visible laser or blue light. The solution gets activated by the light and destroys the actinic keratosis. The skin then heals and produces healthier new skin.
- Laser resurfacing: a laser is used to remove the top skin surface layer. The lesions are destroyed and the area heals after 1 or two weeks to reveal healthy skin.
If on checkup the lesions are found to be cancerous, then a biopsy can be done.
Scalp psoriasis
This appears as a single or several reddish, scaly patches that can also affect the entire scalp. This can then spread to the back of neck, behind or inside the ear or on the forehead if not treated. There is no known cause although genetics is one of the suspected causes, according to Medicine Net.
Treatment options
Some home remedies include washing the scalp twice a day with shampoos that contain salicylic acid, selenium or tar. Use the fingertips to rub off the patches. Do not use the nails.
One can also use mineral oil to cover the scalp overnight. Cover the head with a shower cap on application to avoid messing the beddings. If the condition is severe, add a topical steroid with the amount added dependent on how severe the condition is.
Other medications can be used including topical calcipotriene in either lotion or foam form.Oral drugs that can treat psoriasis include cyclosporine, methotrexate, apremilast, acitretin and infliximab.
The doctor, and this is in rare situations, can also inject the patches with triamcinolone. This is however very painful, and the results lasts for only six weeks utmost. Psoriasis can also be treated using ultraviolet light for people with bald scalps or sparse hair.
Conclusion
- The myths about dry scalp patches being caused by poor hygiene are not true.
- When cleaning the scalp, do not use harsh soaps or hot water. This can aggravate the skin and worsen the situation.
References
- https://www.medicinenet.com/seborrheic_dermatitis/article.htm
- https://www.aad.org/public/diseases/scaly-skin/actinic-keratosis#treatment
- https://www.mayoclinic.org/diseases-conditions/ringworm-scalp/diagnosis-treatment/drc-20354924
- https://www.healthline.com/health/skin-disorders/dandruff-vs-dry-scalp#treatment
- https://www.medicinenet.com/scalp_psoriasis/article.htm#are_there_support_groups_for_individuals_with_psoriasis