What should you know about severe dandruff and itchy scalp?

Dandruff commonly presents with scalp flaking and itch. Seborrheic dermatitis may add greasy scale and redness. Other conditions that can present with an itchy, flaky scalp include scalp psoriasis, folliculitis, head lice, and irritation from hair products. The appearance of the scale, the presence of spots or plaques, and whether anyone else at home is itchy can help a clinician narrow the cause.

Use a medicated shampoo as directed, working it into the scalp rather than only the hair. Leave it in for the stated contact time, rinse well, and avoid scratching because broken skin can become sore or infected. Pause new fragranced products if symptoms began after a change in hair care. If itching persists or the scalp is inflamed, a clinician may recommend a different shampoo or treatment aimed at the cause. Head lice need specific head-lice treatment, not ordinary dandruff care.

Arrange an assessment for thick plaques, painful bumps, crusting, pus, bleeding, patchy hair loss, or a rash extending to the face or ears. Seek prompt help for fever, rapidly spreading redness, severe tenderness, or swelling. If household contacts are itchy or you see attached nits, mention this because head lice require a different approach. Review is also useful when correctly used medicated shampoo does not settle the symptoms.

Ask whether the pattern fits dandruff, seborrheic dermatitis, psoriasis, folliculitis, or lice; which product is suitable; and how to protect the scalp while irritated skin recovers.