Scalp flakes in your hair may simply be dandruff, but they could also be due to other scalp conditions like psoriasis, seborrheic dermatitis, contact dermatitis, atopic dermatitis, and ringworm.
Some of these conditions can be managed with over-the-counter treatments, while others may require a prescription. Treating the underlying cause of the scalp flakes can also reduce the risk of complications.
Below, you’ll find a list of 9 different scalp conditions or causes that could lead to flakes in your hair, along with treatment options to help get rid of them.
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1. Dandruff
Dandruff is a common scalp condition that leads to itching and large flakes in the hair. These flakes consist of layers of dead skin cells and are usually white or yellow.
Cause
The exact cause of dandruff is not clear. However, factors such as Malassezia (a yeast that naturally resides on our skin), excessive oiliness, and skin barrier dysfunction are thought to play a role. These factors contribute to the overproduction of skin cells, which results in dandruff flakes.
Dandruff is not contagious and is not a hygiene issue.
Treatment
Dandruff can be treated with over-the-counter available anti-dandruff shampoos. Look for ingredients like zinc pyrithione, ketoconazole, sulfur, selenium sulfide, coal tar, and salicylic acid.
These ingredients may either reduce the excess presence of Malassezia or help remove the buildup of dead skin cells, improving the flaking in the hair.
Regular shampooing is recommended to prevent the buildup of oils and dead skin cells. If over-the-counter shampoos are ineffective, your doctor may prescribe a prescription-strength ketoconazole shampoo (2%) or other medications.
Note: A common belief is that “dandruff combing,” which involves using a fine comb to remove dandruff, can effectively treat the condition. While this method may temporarily remove the flakes from your hair, it doesn’t address the underlying cause, leading to the return of dandruff flakes.
2. Dry scalp
Very often, flakes in your hair could be the result of a dry scalp. The symptoms typically include small, white flakes and an itchy scalp.
Unlike dandruff or other conditions, the flakes from a dry scalp are usually smaller and not greasy.
Cause
Factors like cold weather, low humidity, excessive use of hot water, and harsh hair care products could be responsible for a dry scalp.
Treatment
To improve a dry scalp, consider using hydrating shampoo and conditioner. Limiting exposure to hot water and cold, dry air can also help alleviate symptoms.
3. Seborrheic dermatitis
Red patches covered with yellow, greasy scalp flakes may indicate seborrheic dermatitis. This inflammatory skin condition tends to be chronic in adults. In small babies, it is known as cradle cap, which is self-limiting and usually resolves by 6-12 months of age.
Compared to dandruff, the flakes from seborrheic dermatitis are more yellowish and have an oily or waxy appearance. The condition is also associated with inflammation and redness.
In people with darker skin tones, seborrheic dermatitis may lead to either dark or hypopigmented patches (white spots) on the scalp.
Besides the scalp, seborrheic dermatitis can also affect other parts of the body, such as the face, ears, or chest.
Cause
Like dandruff, the exact cause of seborrheic dermatitis is not clear. It’s thought to be associated with an excess of Malassezia (a fungus that’s part of the normal flora of our skin), excessive oiliness, skin barrier defects, some neurological disorders, and certain medications.
Treatment
Over-the-counter anti-dandruff shampoos containing antifungals like ketoconazole, zinc pyrithione, and selenium sulfide, as well as keratolytics like coal tar and salicylic acid, can be effective in managing seborrheic dermatitis.
For more severe cases, your doctor may recommend prescription topical antifungals, steroids, or oral medications.
Seborrheic dermatitis cannot be cured, but there are many treatment options to help manage symptoms and reduce flare-ups.
4. Psoriasis
Scalp psoriasis is another inflammatory skin disorder that can result in a flaking scalp and visible flakes in your hair.
There are various types of psoriasis, with plaque psoriasis being the most common. It can cause bumps and plaques covered with silvery-white scales.
The color of these patches may vary from red in lighter skin tones to reddish-brown, purple, gray, or whitish in darker skin tones.
While the scalp is one of the most commonly affected areas, psoriasis can also extend to the neck, the skin behind the ears, elbows, knees, and trunk. Itching is commonly associated with this condition.
Cause
The exact cause of psoriasis is not completely understood but it is generally linked to genetics, the immune system, and environmental factors. Triggers like stress or skin injuries can lead to an outbreak.
Treatment
Over-the-counter shampoos and topicals containing coal tar or salicylic acid can offer some relief.
Depending on the severity of the disease, your doctor may recommend topical steroids, immunosuppressants, or vitamin D or A derivatives. Phototherapy is another treatment option.
5. Ringworm of the scalp (Tinea capitis)
Tinea capitis, also known as ringworm of the scalp, is a contagious fungal infection that affects both the scalp and the hair shaft. While it is more commonly seen in children, it can occur in individuals of all ages. The infection can weaken the hair shaft, leading to hair breakage.
The condition can be divided into two types:
- The non-inflammatory type, which presents with scaly or flaky spots on the scalp, gray patches, or patches with black dots.
- The inflammatory type, which can lead to painful, pus-filled sores or bumps on the scalp (known as kerion), yellow crusting, and areas of hair loss.
Cause
Ringworm is caused by a group of fungi called dermatophytes. Transmission can occur through direct contact with lesions on someone else, infected animals, contaminated surfaces, or soil.
Treatment
Ringworm of the scalp can’t be cured with over-the-counter topicals. Prescription oral antifungal medications, such as griseofulvin or terbinafine, are generally required and are typically administered for 4-12 weeks.
Additionally, your doctor may recommend the use of anti-dandruff shampoo to prevent the spread of the fungus.
6. Contact dermatitis
Contact dermatitis is a skin rash that can develop if the scalp comes in contact with an irritant or allergen. This may happen due to certain hair care products or other factors such as metal clips.
Symptoms may include redness, itchiness, and a flaking scalp. In most instances, the patient’s history that it started after using a specific hair care product can help identify the cause. If needed, your doctor may recommend patch testing to identify the cause.
Treatment
The best approach is to identify and remove the offending product or environmental factor.
Topical steroids or oral antihistamines may be recommended for mild cases. More severe cases may require oral steroids.
7. Atopic dermatitis
Atopic dermatitis is one of the most common types of eczema and can affect the scalp. It is characterized by red, inflamed skin, and can also produce flakes and intense itching.
Cause
The exact cause is unclear. However, factors like genetics, skin barrier dysfunction, environmental triggers, and an altered skin microbiome may play a role.
People with atopic dermatitis often have a family history of the condition or other allergic conditions like asthma or hay fever.
Treatment
Topical steroids are usually the first line of treatment. In some cases, antihistamines may be prescribed to control itching. Moisturizing shampoos and conditioners can also help manage symptoms.
Additionally, avoiding the use of very hot water and taking shorter baths can help alleviate symptoms.
8. Head lice
While head lice are not a common cause of flaking, they can create an itchy scalp that leads to scratching, subsequently causing scalp flakiness.
Additionally, lice nits attach to the hair shaft and often appear as white specks or spots, which are sometimes mistaken for flakes in the hair.
Transmission
Head lice cannot fly but are transmitted through direct head-to-head contact. They can also be contracted via objects that have come into contact with an infested person’s head, such as caps or brushes.
Head lice are particularly common among children. According to the American Academy of Dermatology Association, 6-12 million children, aged 3 to 12, are affected each year in the U.S.
Treatment
Over-the-counter treatments with ingredients like permethrin are available to treat head lice. A fine-toothed comb is also effective for lice removal.
If over-the-counter options prove ineffective, your doctor may prescribe treatments such as:
- Benzyl alcohol lotion
- Malathion lotion
- Spinosad suspension
- Oral ivermectin pills
To prevent further infestation, follow these additional steps:
- Wash all clothes and bedding in soap and hot water, and dry them in a hot dryer.
- For items that can’t be washed, seal them in a plastic bag for at least two weeks.
- Soak combs and brushes in hot soapy water for at least 10 minutes.
9. Gel flakes or buildup of hair products
If you’re dealing with scalp flakes, another reason may be the accumulation of hair care products like shampoo, conditioner, or styling products such as hair spray, gel, and mousse.
Over time, these can build up on the scalp and interfere with the natural shedding of skin cells, leading to flaking.
Treatment
Frequent hair washing may help prevent the buildup of products. Using a clarifying shampoo once a week can also remove buildup and restore your scalp’s natural balance. Clarifying shampoos generally have stronger cleansing actions compared to everyday shampoos.
Shampoos containing exfoliating agents like salicylic acid can further reduce scalp buildup. Additionally, cutting back on the use of hair products that contribute to flaking may be beneficial.
When to see a doctor
For many people, over-the-counter shampoos or treatments can manage scalp flakes effectively. However, it’s important to consult a doctor if:
- Scalp flaking persists or gets worse despite treatment.
- There’s intense itching, redness, or inflammation that disrupts daily life or sleep.
- Signs of infection, such as yellow or green discharge, swelling, or unpleasant odor, are present.
- Hair loss occurs along with scalp flaking.
- Flakiness extends beyond the scalp, such as to the face, neck, or other body parts.
Key points
Scalp flakes in the hair can occur for a variety of reasons, including but not limited to dandruff, seborrheic dermatitis, psoriasis, ringworm, and contact dermatitis, as well as dry scalp. Identifying the underlying cause is essential for effective treatment.
If symptoms persist despite using over-the-counter treatments, it is best to consult a doctor for a proper diagnosis and treatment plan.
References
- Head lice. CDC.
- Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015 Dec;3(2):10.13188/2373-1044.1000019. doi: 10.13188/2373-1044.1000019. Epub 2015 Dec 15. PMID: 27148560; PMCID: PMC4852869.
Disclaimer: This article is for information purposes only and does not replace medical advice.