What should you know about an itchy cyst on the scalp?

A pilar or other skin cyst can form around a hair follicle and may feel smooth, firm, or rounded beneath the scalp. Itching can also come from irritation over the lump, scratching, or inflammation. The itch itself does not identify the cause. Flaking or widespread itch may fit dandruff, seborrheic dermatitis, scalp psoriasis, or head lice, while small tender bumps around hairs may fit folliculitis.

A clinician can inspect the surface and feel the lump to distinguish a cyst from a swollen follicle or another skin lump. Avoid trying to diagnose it from its appearance alone.

Keep the area clean with a gentle shampoo, avoid picking or squeezing it, and keep fingernails short so scratching causes less damage. Do not pierce the lump or apply strong household products. Note whether it is growing, draining, crusting, or appearing alongside other itchy areas. If flaking is widespread, a clinician may discuss a suitable medicated shampoo; suspected head lice needs a different treatment plan.

Arrange prompt medical care if the scalp becomes increasingly red, hot, swollen, or painful, or if pus, spreading drainage, fever, or swollen neck glands develops. Seek urgent help for rapidly worsening swelling, severe pain, or feeling very unwell. Even without these signs, book a dermatology assessment when the lump remains, repeatedly returns, bleeds, or changes in colour or shape.

Ask whether the lump looks like a pilar cyst, whether the itching is coming from the lump or surrounding scalp, and whether examination is enough. You can also ask whether a medicated shampoo is appropriate, what changes should trigger review, and whether removal is needed if it keeps returning.