Scalp Conditions
Your scalp hosts a complex ecosystem of skin, follicles, sebaceous glands, and microorganisms — and when that balance is disrupted, a range of conditions can emerge. Here are the 10 most common scalp conditions, what causes them, how to recognise them, and what actually works to treat them.
💡 Important: Many scalp conditions share overlapping symptoms — flaking, redness, and itching are common to nearly all of them. Accurate diagnosis matters. If your condition is persistent, severe, or spreading, always consult a dermatologist rather than self-treating.
The 10 Conditions
01
❄️
Dandruff (Pityriasis Capitis)
Affects up to 50% of adults worldwide — the most common scalp condition
Dandruff is characterised by white or grey flakes of shed skin on the scalp and hair. It is driven primarily by an overgrowth of Malassezia yeast, which breaks down scalp oils into irritating fatty acids. Despite its prevalence, dandruff is widely misunderstood — it is not caused by poor hygiene, dry skin, or infrequent washing.
Signs
- White/grey flakes on hair and shoulders
- Mild scalp itch
- No significant redness or inflammation
- Worsens with stress or seasonal changes
Causes
- Malassezia yeast overgrowth
- Excess sebum production
- Stress and hormonal changes
- Cold, dry weather
Treatment
- Zinc pyrithione shampoo (1st line)
- Ketoconazole 2% for persistent cases
- Selenium sulphide shampoo
- Rotate actives every 3–6 months
02
🔴
Seborrheic Dermatitis
Affects 5% of the global population — the more severe end of the dandruff spectrum
Seborrheic dermatitis is the inflammatory upgrade of dandruff — same
Malassezia driver, but with a more pronounced immune reaction. It produces greasy, yellowish scales and visible redness, and can extend beyond the scalp to the face, eyebrows, ears, and chest. It is a chronic, relapsing condition with no permanent cure — the goal is long-term remission maintenance. Read our
full seborrheic dermatitis guide.
Signs
- Greasy, yellowish scales
- Visible redness and inflammation
- Affects scalp, face, ears, chest
- Chronic flares and remissions
Causes
- Malassezia + sebum + immune reactivity
- Stress is the most common trigger
- Hormonal changes
- Cold weather, harsh products
Treatment
- Ketoconazole 2% shampoo (gold standard)
- Zinc pyrithione for maintenance
- Short-term topical corticosteroids
- Stress management is essential
03
🔷
Scalp Psoriasis
Affects 2–3% of the population — often mistaken for severe dandruff
Scalp psoriasis is an autoimmune condition in which the immune system mistakenly accelerates skin cell production, causing thick, silvery-white plaques to build up on the scalp surface. Unlike dandruff or seborrheic dermatitis, psoriasis produces distinctly thicker, more adherent scales that may extend beyond the hairline onto the forehead or neck. It cannot be treated with antifungal shampoos — it requires immunomodulatory treatment.
Signs
- Thick, silvery-white plaques
- Redness extending beyond hairline
- Scales are dry, not greasy
- Temporary hair loss in affected areas
Causes
- Autoimmune T-cell dysregulation
- Genetic predisposition
- Stress is a major flare trigger
- Infections, certain medications
Treatment
- Coal tar or salicylic acid shampoos
- Topical corticosteroids (dermatologist)
- Vitamin D analogues (calcipotriol)
- Biologics for severe cases
04
⭕
Alopecia Areata
Affects 2% of people at some point in life — sudden patchy hair loss
Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, causing sudden, well-defined patches of hair loss. Unlike androgenetic alopecia (pattern baldness), the follicles are not destroyed — they become dormant. This means full regrowth is possible, though the condition is unpredictable and can progress to total scalp hair loss (alopecia totalis) or full body hair loss (alopecia universalis) in severe cases.
Signs
- Round or oval smooth bald patches
- Sudden onset — often overnight
- Exclamation mark hairs at patch edges
- No scarring, skin looks normal
Causes
- Autoimmune attack on follicles
- Genetic predisposition
- Stress as a common trigger
- Associated with thyroid disorders
Treatment
- Intralesional corticosteroid injections
- Topical minoxidil (supports regrowth)
- JAK inhibitors (baricitinib — newer)
- Dermatologist referral essential
05
🔴
Scalp Folliculitis
Bacterial or fungal infection of the hair follicles — common and often recurring
Folliculitis is an infection of hair follicles, most commonly caused by Staphylococcus aureus bacteria. On the scalp, it appears as clusters of small, red, sometimes pustular bumps around hair follicle openings. It can be triggered by oily scalp conditions, tight hairstyles, sweat, or post-transplant healing. Mild cases often resolve with improved hygiene; severe or recurring folliculitis requires antibiotic or antifungal treatment.
Signs
- Small red bumps or pustules on scalp
- Tenderness or pain around follicles
- Clusters at hairline or crown
- Mild to significant itching
Causes
- Staphylococcus aureus (most common)
- Fungal infection (Pityrosporum)
- Excessive sweating or oil buildup
- Tight hairstyles or helmet wear
Treatment
- Antibacterial shampoo (benzoyl peroxide)
- Topical antibiotics (clindamycin)
- Antifungal shampoo for fungal type
- Oral antibiotics for severe cases
06
🍄
Tinea Capitis (Ringworm)
Fungal infection — most common in children, but adults can be affected
Tinea capitis is a fungal infection of the scalp caused by dermatophyte fungi (most commonly Trichophyton and Microsporum species). Despite its name, ringworm has nothing to do with worms — the ring-shaped patches are caused by expanding fungal colonies. It is highly contagious and spreads through direct contact or shared objects like combs and hats. Critically, it cannot be treated with topical antifungals alone — it requires oral antifungal medication.
Signs
- Ring-shaped scaly patches
- Brittle hair that breaks at scalp level
- Black dot appearance (broken stubs)
- Possible lymph node swelling
Causes
- Trichophyton or Microsporum fungi
- Direct contact with infected person
- Shared combs, hats, or pillows
- Contact with infected animals
Treatment
- Oral griseofulvin or terbinafine (essential)
- Topical antifungals alone are insufficient
- Selenium sulphide shampoo (adjunct)
- Treat close contacts and household
07
🌡️
Scalp Eczema (Atopic Dermatitis)
Chronic inflammatory skin condition — often part of the atopic triad with asthma and hay fever
Scalp eczema is part of atopic dermatitis — a chronic inflammatory skin condition caused by a defective skin barrier and overactive immune response. The scalp becomes intensely itchy, red, and scaly. Unlike seborrheic dermatitis (which has a fungal driver), scalp eczema is immune-mediated and often associated with food or environmental allergies. Scratching creates a damaging itch-scratch cycle that worsens the barrier and prolongs flares.
Signs
- Intense, persistent itching
- Red, inflamed, dry patches
- Fine white/grey scales (dry, not greasy)
- Worsens with heat, sweat, stress
Causes
- Filaggrin gene mutation (barrier defect)
- Allergic triggers (dust, pollen, foods)
- Stress and immune dysregulation
- Harsh shampoos or hot water
Treatment
- Fragrance-free, sulfate-free shampoos
- Topical corticosteroids for flares
- Calcineurin inhibitors (tacrolimus)
- Dupilumab for severe atopic cases
08
📉
Androgenetic Alopecia (Pattern Hair Loss)
Affects 50% of men by 50 and up to 40% of women — most common hair loss condition
Androgenetic alopecia (AGA) is the progressive miniaturisation of hair follicles driven by dihydrotestosterone (DHT). In men, it follows the Norwood pattern — hairline recession and crown thinning. In women, it typically presents as diffuse thinning over the crown (Ludwig pattern) while the frontal hairline is preserved. AGA is a scalp condition because the perifollicular inflammation that accompanies DHT sensitivity actively damages the scalp microenvironment over time. Read our guide on
preventing early thinning in men.
Signs
- Gradual hairline recession (men)
- Diffuse crown thinning (women)
- Miniaturised, finer hair shafts
- Family history of hair loss
Causes
- DHT binding to follicle receptors
- Genetic androgen receptor sensitivity
- Perifollicular inflammation
- Age-related collagen decline
Treatment
- Finasteride (men — most effective)
- Minoxidil topical or oral
- Ketoconazole shampoo (adjunct)
- Hair transplant for advanced cases
10
⚠️
Scarring Alopecia (Cicatricial Alopecia)
Rare but serious — permanent destruction of hair follicles requires urgent treatment
Scarring alopecia is a group of rare disorders in which inflammation permanently destroys hair follicles, replacing them with fibrotic scar tissue. Unlike non-scarring conditions, hair loss in scarring alopecia is irreversible — which makes early diagnosis and treatment critical. Common types include lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and discoid lupus erythematosus (DLE). Any rapidly spreading or symptom-free patchy hair loss should be evaluated urgently by a dermatologist or trichologist.
Signs
- Smooth, shiny scalp in affected areas
- No follicle openings visible
- May be painless or burn/itch
- Rapidly spreading in active disease
Causes
- Autoimmune attack on follicle stem cells
- Lichen planopilaris (most common)
- Discoid lupus erythematosus
- Folliculitis decalvans (bacterial)
Treatment
- Urgent dermatologist referral essential
- Hydroxychloroquine for LPP/DLE
- Topical or intralesional steroids
- No treatment can reverse existing scars
At a Glance
| Condition |
Key Feature |
Reversible? |
First Step |
| Dandruff | White flakes, mild itch, no redness | Yes | Zinc pyrithione shampoo |
| Seborrheic Dermatitis | Greasy yellow scales, redness | Managed (not cured) | Ketoconazole shampoo |
| Scalp Psoriasis | Thick silvery plaques | Managed | Dermatologist |
| Alopecia Areata | Round bald patches, smooth scalp | Often yes | Dermatologist |
| Folliculitis | Red pustules around follicles | Yes | Antibacterial shampoo |
| Tinea Capitis | Ring-shaped patches, broken hairs | Yes | Oral antifungal (essential) |
| Scalp Eczema | Intense itch, dry red patches | Managed | Fragrance-free products |
| Androgenetic Alopecia | Gradual miniaturisation | Slowed, not reversed | Minoxidil + finasteride |
| Contact Dermatitis | Reaction after product exposure | Yes (if trigger removed) | Remove trigger, patch test |
| Scarring Alopecia | Smooth shiny scalp, no follicle openings | No (permanent) | Urgent dermatologist |
⚠️ When to See a Dermatologist Urgently: If you notice rapidly spreading hair loss, smooth scalp with no follicle openings, pustules that don’t resolve, significant scalp pain, or swollen lymph nodes near the scalp — seek professional evaluation promptly. Early treatment prevents permanent damage in several of these conditions.
The Bottom Line
Most scalp conditions are manageable — but they require accurate identification. Treating seborrheic dermatitis with a psoriasis protocol, or attempting to manage tinea capitis with topical antifungals, will not work. When in doubt, diagnose first.
- Dandruff and seborrheic dermatitis are the most common — both driven by Malassezia
- Psoriasis, eczema, and alopecia areata are immune-mediated — require different treatment
- Tinea capitis always requires oral antifungals — topical treatment alone is not sufficient
- Androgenetic alopecia is best treated early — follicle miniaturisation is progressive
- Scarring alopecia is irreversible — early dermatologist referral is essential
- Contact dermatitis resolves when the trigger is removed — patch testing identifies it