Itching: It’s an evolutionary function for protection, but when it doesn’t cease, it becomes torturous. Scalp itching, in particular, is a special slice of hell. Not to be confused with dandruff (though dandruff may well be one of its main root causes), scalp itch is typically caused by a number of chronic skin conditions. The good news? A variety of over-the-counter medications can help provide relief.
Below, two board-certified dermatologists — Kunal Malik of Spring Street Dermatology and Barry Goldman of Goldman Dermatology, both in NYC — weigh in on scalp itch, its key causes, and the best remedies for treating it.
The Best Shampoos for an Itchy Scalp: At a Glance
Harry’s Shampoo-Conditioner with Pyrithione Zinc
Selsun Blue Moisturizing Anti-dandruff Shampoo with Aloe, 11 fl. oz., Selenium Sulfide 1%
Tea Tree by Paul Mitchell Tea Tree Shampoo for Oily Scalps
What Causes Scalp Itch?
Most itchy scalps are caused by some sort of dermal inflammatory condition like seborrheic or contact dermatitis (dandruff), folliculitis, or a chronic skin condition like eczema or psoriasis. Allergic reactions to ingredients in certain shampoos or conditioners can cause itchiness, too, as well as unwelcome guests like scabies and head lice. “Many of my patients over-exfoliate the scalp by using multiple products such as shampoos, hair masks, scrubs, hair dyes, and more,” Malik says. “Sometimes hair growth products such as topical minoxidil can cause irritation, too.”
Scalp Itch Remedies
Over-the-Counter Remedies for Scalp Itch
The first step to treating scalp itch is identifying its cause — whether it’s a fungus, bacteria, or inflammatory agent — and finding the right active ingredient to neutralize it. They won’t all work the same way, though, so it’ll likely take some trial and error. Consult with a professional to find the right one.
Ketoconazole
What It Is: Ketoconazole is an antifungal medication used in many prescription and OTC shampoos to control yeast and fungal proliferation and treat flaking, burning, scaling, and itching.
What It Targets: While primarily used to treat seborrheic dermatitis (namely dandruff), ketoconazole is a common defense against scalp ringworm (tinea capitis), as well as other bodily fungal problems such as jock itch, ringworm, and athlete’s foot.
Nizoral 1% Ketoconazole Shampoo
Both doctors listed Nizoral as a gold-standard shampoo for scalp itch. “Nizoral shampoo has been the most effective [anti-itch shampoo] in my experience,” says Goldman “There is a 1 percent OTC version and a 2 percent prescription version.”
Pyrithione Zinc
What It Is: This zinc complex can prevent the proliferation of bacteria and fungus, though it doesn’t always destroy them outright.
What It Targets: Use pyrithione zinc to treat seborrheic dermatitis (namely dandruff), or in smaller concentrations as a routine preventative measure.
Harry’s Shampoo-Conditioner with Pyrithione Zinc
This is just one of two scalp-soothing shampoos from Harry’s, the other of which doubles the dosage of pyrithione zinc for more severe cases. This one is formulated to be used at the first sign of itching or flaking for an easy fix, or once every week or two as a preventative measure.
Salicylic Acid
What It Is: Salicylic acid is an oil-soluble ingredient often derived from willow bark extract. It is also known as a beta-hydroxy acid or BHA, and it can seep into the pores to temper oil levels and clear out dead skin cells.
What It Targets: When used to target scalps, salicylic acid is a terrific quick-fix and short term solution, says Goldman. It can help free up any flakes and dry skin from the scalp while reducing the oil buildup that abets dandruff.
Neutrogena T/Sal Salicylic Acid Shampoo
Kunal cites Neutrogena’s salicylic acid shampoo as a go-to for excessively oily scalps, which inherently become prone to itching and flaking. It has a higher concentration of salicylic acid than most facial products (3 percent compared to the usual 2 percent), so it works especially well at removing dead skin cells and balancing oil levels.
Piroctone Olamine
What It Is: Often positioned as a gentler alternative for pyrithione zinc and ketoconazole, piroctone olamine is an antifungal chemical compound that can also temper oil levels.
What It Targets: Seborrheic dermatitis (dandruff) and other fungal concerns, specifically for people with sensitive skin.
Sebamed Piroctone Olamine Shampoo
This shampoo is optimal for anyone with a sensitive or easily-irritated scalp. It uses piroctone olamine for gentle, routine defense against fungal outbreaks, and keeps the scalp’s pH levels balanced so that it never leaves skin dry or irritated. It is also formulated in Germany, which means it passes the EU’s stricter standards for skin-safe formulations.
Selenium Sulfide
What It Is: An antifungal chemical compound (of selenium and sulfur) with exfoliating and oil-tempering abilities. It draws many comparisons to salicylic acid in that both target acne, oil, and dandruff. Sulfur does tend to be more drying to the skin, though, so those with dry or sensitive skin should consult with a professional before trying it.
What It Targets: Seborrheic dermatitis/dandruff, as well as scalp ringworm (tinea capitis).
Selsun Blue Moisturizing Anti-dandruff Shampoo with Aloe, 11 fl. oz., Selenium Sulfide 1%
Of the many shampoos on scalp-savior Selsun Blue’s roster, this one pairs the maximum-strength OTC concentration of 1 percent selenium sulfide with the cooling and anti-inflammatory powers of aloe vera to keep the scalp cleansed, balanced, and nourished.
Coal Tar
What It Is: Yes, it’s a byproduct of coal gas production, but it’s also been deemed an effective treatment for psoriasis by the American Academy of Dermatology.
What It Targets: In shampoos, coal tar is optimal for countering seborrheic dermatitis and psoriasis.
True+Real Coal Tar Shampoo (Pack of 2)
Most coal tar shampoos don’t go above 0.5-percent grades, but this one offers a 1-percent concentration to give people with psoriasis, and those with persistent itching and dandruff, a big leg up.
Tea Tree Oil
What It Is: An essential oil with antimicrobial and anti-inflammatory properties.
What It Targets: Tea tree oil can help temper oil production while also neutralizing bacteria and fungus that often lead to dandruff. It can also calm itching and inflammation on contact, but should only be used in carefully formulated products, since standalone tea tree oil can be irritating to the skin.
Tea Tree by Paul Mitchell Tea Tree Shampoo for Oily Scalps
Goldman calls out this shampoo for its oil-balancing prowess. While it may not pack the same punch as an anti-dandruff remedy compared to the more active ingredients above, it’s exceptional as an anti-itch solution and for preventing oil buildup in the first place (which in turn stifles things like itching and flaking).
Prescriptions Remedies for Scalp Itch
A board-certified dermatologist should examine any persistent or extremely intolerable itching. If OTC remedies aren’t working — Goldman suggests drawing the line at a month — and then getting in to see the doctor. Anything with scabbing, constant peeling, or pain should be treated immediately.
There’s a good chance the doctor will prescribe something with a higher concentration of the above ingredients. “For example, prescription Nizoral shampoo contains 2 percent ketoconazole, while over-the-counter contains 1 percent,” he explains.
Goldman adds that prescription steroid solutions are another common remedy. Don’t be fooled by the percentage attached to each, though, since the prescriptions usually use more potent molecules in their formulas. “Instead of over-the-counter hydrocortisone 1 percent drops for scalp irritation, a prescription solution of 0.01% fluocinolone is still a more effective steroid despite a lower concentration.”
Frequently Asked Questions About Itchy Scalps
Is it scalp itch or is it dandruff?
It’s a rectangle-square conundrum. Dandruff can be a root cause of scalp itch, but that doesn’t mean one’s scalp itch is necessarily dandruff.
“Large white flakes, especially when brushing the hair, is a telltale sign of dandruff,” explains Malik. “Meanwhile, characteristics that differentiate other scalp itch conditions from run-of-the-mill dandruff include bleeding, oozing, intense itching or burning, as well as discrete spots that are non-healing.”
Goldman adds that any unusual elevation or thickness of the skin is an indication that dandruff is not to blame. Similarly, any bumps that come and go could be folliculitis.
When is it important to visit a dermatologist for scalp itch?
Seek out a board-certified dermatologist for any pain, scabbing, and constant flaking, says Goldman. “And upgrade to a prescription-strength option if, after a month, any over-the-counter products are not working well enough.” It could be that the persistent underlying condition requires attention from a board-certified dermatologist at this point, and clinical treatment shouldn’t be delayed for too long waiting for an over-the-counter solution to take effect.
How can scalp itch be prevented?
Preventing scalp itch involves, first and foremost, taking stock of one’s everyday behaviors and patterns and trying to eliminate primary contributors. Malik suggests taking short, lukewarm (not boiling hot) showers and shampooing every other day with shampoo formulas containing some of the itch-targeting ingredients mentioned above. (Excessive use can often cause dryness, however, so it can help to introduce a non-active shampoo for most washes, and to cycle in an anti-itch or anti-dandruff shampoo once every week or so.) Always follow each shampoo with a nourishing conditioner, and be sure to let it sit on the skin and hair for a couple minutes before rinsing it away.
All of that said, Goldman suggests more frequent shampooing in some cases: “Some conditions like seborrheic dermatitis do better with more frequent washing,” he explains.