Itchy Scalp

This might appear a mundane symptom to the GP, but it can cause the patient significant distress. It’s usually a welcome presentation, as it’s perceived as a quickie – one of those problems in which a brief examination can be performed at the same time as an equally brief history. This approach generally pays dividends, but the problem can sometimes be more complicated than it might at first appear.

Published: 2nd August 2022 | Updated: 15th August 2022

Differential diagnosis

Common Diagnoses

  • Head Lice
  • Seborrhoeic Eczema
  • Psoriasis
  • Lichen Simplex
  • Impetigo (May be Underlying Head Lice or Eczema)

Occasional Diagnoses

  • Allergic/Contact Eczema
  • Other Fungal Infections

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.
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Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.