Many people have hair or scalp problems. Hair may thin or fall out, break off, or grow slowly. Dandruff or an itching or peeling scalp may cause embarrassment and discomfort. Hair and scalp problems can be upsetting, but they usually are not caused by serious medical problems.
Hair loss, including thinning and breaking, is the most common scalp problem. Most people lose from 50 to 100 hairs per day.
Hair gradually thins as people age, although not all people are affected to the same degree. Hereditary thinning or balding is the most common cause of thinning hair. You can inherit this from either your mother's or father's side of the family. Women with this trait develop thinning hair, while men may become completely bald. The condition can start in the teens, 20s, or 30s.
Babies often lose their fine baby hair, which is then replaced by mature hair. Because of changes in hormones, women often lose hair for 1 to 6 months after childbirth or after breastfeeding is completed.
Other possible causes for excessive hair loss, thinning, or breakage include:
- Damage to the hair from hair care products, such as dyes and permanents, and from hot rollers, curling irons, or hair dryers.
- Hair-pulling or hair-twisting habits. Trichotillomania is a mental health problem in which a person pulls out his or her own hair, usually from the head, eyelashes, and eyebrows.
- Side effects of medicines or medical treatments, such as chemotherapy or radiation therapy.
- Recent surgery, high fever, or emotional stress. You may have a lot of hair loss 4 weeks to 3 months after severe physical or emotional stress. This type of hair loss usually stops within a few months.
- Diseases, such as lupus and hyperthyroidism.
- Heavy metal poisoning, such as thallium or arsenic poisoning.
- Poor nutrition, especially lack of protein or iron in the diet.
- Damage to the hair shafts from burns or other injuries.
Itching, flaking, or crusting of the scalp
Itching, flaking, or crusting of the scalp may be caused by:
- Cradle cap, an oily, yellow crusting on a baby's scalp. It is common in babies and is not caused by an illness. It does not mean that a baby is not being well cared for. See a picture of cradle cap.
- Dandruff, a shedding of the skin on the scalp that leaves white flakes on the head, neck, and shoulders. It may be a form of a skin condition called eczema, which causes increased shedding of normal scalp skin cells. Dandruff can also be caused by a fungal infection. Hormonal or seasonal changes can make dandruff worse.
- Head lice, tiny wingless insects that cause itching and raw patches on the scalp. Head lice are most common in school-age children.
- Ringworm, a fungal infection of the outer layer of the scalp and in the hair. It usually causes a rash made up of circular patches with raised, red edges that resemble worms. The rash spreads from these edges, often leaving the centre clear, giving it a ring shape.
- Ongoing (chronic) skin conditions, such as psoriasis and seborrhea.
- An uncommon, recurrent skin condition called lichen planus. This condition appears more often during stress, fatigue, or exposure to medicines or chemicals.
Sores, blisters, or bumps on the scalp
Painful sores, blisters, or bumps that develop on the scalp may be caused by:
- Infection of the hair shafts (folliculitis) or the skin (such as impetigo).
- An allergic skin reaction (contact dermatitis).
- Viral infections, such as chickenpox and shingles.
- A skin condition, such as acne.
- A cyst, such as an epidermal cyst.
Skin cancer can occur on the scalp, particularly in areas not well-covered by hair. It can destroy skin cells and tissues and, in some cases, spread (metastasize) to other parts of the body. Skin cancer may appear as a growth or mole, a change in a growth or mole, a sore that does not heal, or irritation of the skin. The three most common types of skin cancer are basal cell skin cancer, squamous cell skin cancer, and melanoma.
The treatment for scalp problems depends on what is causing the problem.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Many prescription and non-prescription medicines can cause hair loss or thinning or other scalp problems. A few examples are:
- Medicines used to treat cancer (chemotherapy).
- Birth control pills.
- Seizure medicines.
- Amphetamines, such as dextroamphetamine (for example, Dexedrine) or methamphetamine.
- Vitamin A in high doses.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
A change to a mole or other skin spot can mean that the spot has:
- Gotten bigger.
- Developed uneven borders.
- Gotten thicker, raised, or worn down.
- Changed colour.
- Started to bleed easily.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Try one of the following home treatment measures to resolve a scalp problem.
- Try home treatment for dandruff, such as using an anti-dandruff shampoo for dandruff that causes white flakes on your head.
- Perform a skin self-examination to help identify suspicious scalp growths. Part your hair to look at your scalp. If you have trouble seeing your scalp, ask a friend or family member to check the spot for you.
- If your baby has yellow crusting on his or her scalp, try home treatment for cradle cap.
- An hour before shampooing, rub your baby's scalp with baby oil, mineral oil, or petroleum jelly to help lift the crusts and loosen scales.
- When ready to shampoo, first get the scalp wet, then gently scrub the scalp with a soft-bristle brush (a soft toothbrush works well) for a few minutes to remove the scales. You can also try gently removing the scales with a fine-tooth comb.
- Then wash the scalp with baby shampoo, rinse well, and gently towel dry.
- If your baby has a bald spot at the back or side of the scalp, change your baby's position frequently. Lying in one position may be causing the bald spot.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Signs of a skin infection develop.
- Symptoms become more severe or frequent or do not go away.
To maintain normal hair production, eat 2 to 3 servings of protein a day. Protein is found in meat, chicken, fish, eggs, some cheeses, dried beans, tofu, grains, and nuts.
Treat your hair gently. If your hair breaks easily:
- Shampoo, comb, and brush your hair less frequently.
- Use a cream rinse or conditioner after shampooing your hair. This will make your hair easier to comb and more manageable.
- Use wide-tooth combs and brushes with smooth tips.
- Avoid rough combing, brushing, or rubbing with a towel when your hair is wet. Wet hair is more fragile and thus more likely to break.
- Avoid hairstyles that pull on your hair, such as ponytails, cornrows, and braids. The constant pulling causes some hair loss, especially along the sides of the scalp. If you do use these hairstyles, avoid tight ponytails and braids. Alternate with looser hairstyles.
- Limit your use of curling irons, flat irons or straighteners, hot rollers, and hair dryers. If you use these products, use the low heat setting.
- Avoid chemical treatments until hair you have previously treated with chemicals has grown out.
To prevent head lice, do not share hats, combs, or other items. For more information, see the topic Head Lice.
To prevent skin cancer, protect your scalp (and the rest of your skin) from the sun.
- Limit your exposure to the sun, especially from 11 a.m. to 3 p.m.
- Wear a wide-brimmed hat.
- Do not use tanning booths or sunlamps.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms?
- How long have you had your symptoms?
- Have you had this problem in the past? If so, how was it treated? Did the treatment help?
- If you are concerned about hair loss or thinning, when did you last have what you consider a normal head of hair?
- Do you have a family history of hair loss?
- What are your hair care habits, such as using hair dyes?
- Question for women: Are you using a hormonal birth control method?
- What non-prescription and prescription medicines, including vitamins, have you taken in the last 6 months?
- Have you had any recent illness or surgery?
- Do you have any skin disorders or chronic illnesses?
- Do you think you may have been exposed to head lice or ringworm?
- Does anyone in your family have similar symptoms?
- Do you have any health risks?
Current as of: February 26, 2020
Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
H. Michael O'Connor MD - Emergency Medicine
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