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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 as 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, a fungal 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 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.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a scalp problem?
This also includes hair loss.
Yes
Scalp problem
No
Scalp problem
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you have a rash?
Yes
Rash
No
Rash
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have a health problem or take medicine that weakens your immune system?
What weakens the immune system in an adult or older child may be different than in a young child or baby.
Yes
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Do you have a painful rash or painful blisters on your scalp?
Yes
Painful rash or blisters on scalp
No
Painful rash or blisters on scalp
Does your scalp itch; have red, flaky areas; or have crusty, oozing sores?
Yes
Scalp is itchy or flaky or has crusty sores
No
Scalp is itchy or flaky or has crusty sores
Is the itching and flaking severe, moderate, or mild?
Severe means that it is bad enough to interfere with sleep and your normal activities.
Severe
Severe itching or flaking
Moderate
Moderate itching or flaking
Mild
Mild itching or flaking
Have you tried home treatment for more than 2 days?
Yes
Home treatment for more than 2 days
No
Home treatment for more than 2 days
Is it helping?
Yes
Home treatment is helping
No
Home treatment is helping
Has there been a change in a mole or other skin spot?
Yes
Changes in mole or skin spot
No
Changes in mole or skin spot
Do you think that a medicine could be causing hair loss or the scalp problem?
Think about whether the problem started after you began using a new medicine or a higher dose of a medicine.
Yes
Medicine may be causing scalp problem or hair loss
No
Medicine may be causing scalp problem or hair loss
Are you concerned about hair loss or about your hair thinning or breaking?
Yes
Concern about hair loss, thinning, or breakage
No
Concern about hair loss, thinning, or breakage
Rash, Age 11 and Younger
Rash, Age 12 and Older

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Many prescription and nonprescription medicines can cause hair loss or thinning or other scalp problems. A few examples are:

  • Medicines used to treat cancer (chemotherapy).
  • Birth control pills.
  • Seizure medicines.
  • Amphetamines, such as dextroamphetamine (for example, Dexedrine) or methamphetamine.
  • Vitamin A in high doses.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
  • Steroid medicines, which are used to treat a variety of conditions.
  • Medicines taken after organ transplant.
  • Chemotherapy and radiation therapy for cancer.
  • Not having a spleen.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

A change to a mole or other skin spot can mean that the spot has:

  • Gotten bigger.
  • Developed uneven borders.
  • Gotten thicker, raised, or worn down.
  • Changed color.
  • Started to bleed easily.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Home Treatment

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

  • Try home treatment for dandruff, such as using an antidandruff shampoo for dandruff that causes white flakes on your head.
  • 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.

There may be other things you can do at home for other kinds of scalp problems.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

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, flat irons or straighteners, hot rollers, 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 scalp (and the rest of your skin) from the sun.

  • 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:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • Have you had this problem in the past? If so, how was it treated? Did the treatment help?
  • 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, such as using hair dyes?
  • Question for women: Are you using a hormonal birth control method?
  • 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?
  • 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?

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
H. Michael O'Connor, MD - Emergency Medicine
Last Revised December 12, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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