Itchy Scalp

Differential Diagnosis

Common Diagnoses

Occasional Diagnoses

Rare Diagnoses

  • Stress/Depression
  • Viral Infection (e.g. Chickenpox – a Common Problem but only Rarely Presents with Scalp Itch)

Ready Reckoner

Key distinguishing features of the most common diagnoses

Head LiceSeborrhoeic EczemaPsoriasisLichen SimplexImpetigo
Scaly ScalpNoYesYesPossibleNo
Pustular LesionsPossibleNoNoNoYes
Skin Lesions ElsewhereNoPossiblePossiblePossiblePossible
Visible Egg CasesYesNoNoNoNo
Chronic ProblemNoPossibleYesPossibleNo

Possible Investigations

  • It is highly unlikely that any investigations will be required at all. Confirmation of a fungal infection may be obtained via fluorescence under a Wood’s light or by microscopy and culture of scalp and hair samples.

Top Tips

  • Whatever the actual diagnosis, scratching will perpetuate or complicate the problem and so should be discouraged.
  • Consider examining the skin and nails, as these may provide useful additional clues.
  • The diagnosis in a child is very likely to be head lice; the list of differentials increases the older the patient.

Red Flags

  • Scalp impetigo in a child – particularly if it relapses rapidly – suggests an underlying problem such as head lice or eczema. This needs treating too, or the symptom will persist.
  • In an otherwise puzzling case, consider psychological causes – stress and depression can sometimes present with scalp itching.

Published: 2nd August 2022 Updated: 10th April 2024

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