What should you know about a very itchy scalp at night?

Itch can feel stronger at night when there are fewer distractions, the room is warm, or sweat and dry air irritate the scalp. Dandruff and seborrheic dermatitis may bring flakes or greasy scale. Psoriasis can cause thicker plaques, while lice can cause persistent itch with nits attached near the roots. Folliculitis tends to produce tender bumps or pustules. A new pillow product, hair treatment, or shampoo can also cause contact irritation.

Keep the room cool, use a clean pillowcase, and avoid applying fragranced oils or sprays before bed. Wash gently and follow the directions for any suitable medicated shampoo rather than leaving products on longer than advised. Check behind the ears and at the nape for nits if lice are possible, and do not share combs or bedding. Trim nails to reduce skin damage from unconscious scratching.

Book an examination when night-time itch repeatedly disrupts sleep, the scalp is sore, or you see thick scale, bleeding, crusts, pustules, or hair loss. Seek prompt care for fever, rapidly spreading redness, facial swelling, breathing difficulty, or severe pain. A dermatologist can distinguish lice from inflammatory scalp disease and match the treatment to the finding.

Ask whether the scalp needs checking for nits, plaques, dermatitis, or folliculitis; which shampoo is appropriate; whether household contacts need review; and how to stop night-time scratching from damaging the skin.