Dry Scalp Treatments and Medications

There they are again. White flakes decorating your hair and shoulders. Time to reach for the anti-dandruff shampoo, right? Well, maybe not. If the problem is just dry skin on your head—dry scalp—anti-dandruff shampoo might make it worse. Read on to learn more about dry scalp treatments.

What is dry scalp?

Dry scalp is dry, itchy, and flaky skin on the scalp. The outer skin sheds easily, leaving small, white flakes in the hair. The condition is temporary and usually resolves in a few days with minor changes in hygiene and lifestyle. In rare cases, dry scalp can be chronic and require medical treatment.

Like dry skin elsewhere on the body, dry scalp is the result of too little oil on the skin. Oil glands nestled in the hair follicles secrete sebum, a waxy oil that lubricates hairs and protects the skin from drying out. When this oil is stripped from the skin surface, the skin dries out.

The causes of dry scalp include

• Cold weather

• Dry weather

• Washing the hair too frequently

• Washing the scalp and hair with shampoos containing harsh products or other ingredients

Dry scalp is often confused with other skin and scalp conditions that cause dry, itchy, and scaly skin: eczema, dandruff (seborrheic dermatitis), and psoriasis. All have similar symptoms—dry, itchy skin, and an excess of dead skin—appearing in the hair as flakes. However, these conditions have different causes and require different treatments.

Knowing the difference between simple dry scalp and other scalp conditions is vital to fixing the problem.

Dandruff (seborrheic dermatitis)

It doesn’t help that skin flakes in the hair are popularly called dandruff. However, medical professionals consider dandruff to be a specific medical condition on the same spectrum as seborrheic dermatitis. Unlike dry scalp, dandruff and seborrheic dermatitis are caused by excess oil on the skin due to overactive glands, poor hygiene, or a yeast infection (malassezia) of the hair follicles. The excess oil causes skin cells to grow rapidly. The outer skin flakes off more abundantly than usual, producing dandruff flakes. Treatments for dandruff (such as medicated shampoos) do not help dry scalp, and treatments for dry scalp (such as moisturizers) do not improve dandruff or seborrheic dermatitis.

Contact dermatitis

Contact dermatitis, a type of eczema, is an allergic reaction to an allergen such as soap, shampoo, medication, or some other irritant. The skin reddens, swells, itches, and can grow dry. Contact dermatitis is primarily treated by avoiding the irritant, but over-the-counter or prescription topical steroids can be used to dial back the reaction. Steroids do not help treat dry scalp; in fact, steroids dry out the skin even more.

Atopic dermatitis

Also a form of eczema, atopic dermatitis occurs when the immune system acts up for no reason. The symptoms exactly mirror contact dermatitis, but there is no irritant causing the problem. Atopic dermatitis can affect the scalp, but it will affect other areas on the skin, as well. Atopic dermatitis is also treated with topical steroids.

Psoriasis

Psoriasis, too, causes dry, scaly, and itchy patches, but they tend to occur in patches rather than the entire scalp. Psoriasis is an autoimmune disorder that causes skin cells to grow too fast, producing an abundance of shed skin. Dandruff or dry scalp treatments will have no effect on psoriasis. Instead, psoriasis is treated with prescription medications such as steroids, vitamin A, and anti-inflammatory drugs.

Neurodermatitis

Neurodermatitis is a severe form of eczema commonly mistaken for dry scalp or dandruff when it occurs on the scalp. It, too, causes dry skin, itchiness, and flakes. Neurodermatitis, however, often causes severe itchiness and discomfort. It will probably also occur on other parts of the body. Neurodermatitis is treated with prescription steroids, antihistamines, and, sometimes, antibiotics if an area becomes infected.

Dry scalp, then, can be a symptom of any of these conditions. Or it can be just dry skin. If moisturizing shampoos and lifestyle changes do not resolve the problem, a visit to a healthcare provider can help diagnose the problem.

How is dry scalp diagnosed?

Dry scalp does not usually require a diagnosis. Instead, it is usually self-diagnosed from the symptoms. Dry scalp symptoms include:

• Dry skin on the scalp

• Itchy scalp

• Small, white flakes in the hair

The conditions that cause dry scalp, such as cold or dry weather, can also cause dry skin on other parts of the body.

If lifestyle changes or moisturizers do not resolve the condition, a healthcare professional will help rule out other conditions. A primary physician or dermatologist will make a differential diagnosis based primarily on a medical history and physical examination of the scalp. A biopsy of the skin tissue may be required if the doctor suspects that infection, psoriasis, or an immune reaction is to blame.

Dry scalp treatment options

Dry scalp is effectively treated with lifestyle changes or moisturizers.

Lifestyle changes

Dry scalp treatment should start with lifestyle changes. Reducing the frequency of shampooing, switching to gentler or natural shampoos, covering the head in cold or dry weather, and using humidifiers indoors often resolve the condition naturally. Moisturizers or scalp moisturizing shampoos may help speed the process and relieve symptoms.

Moisturizers

Moisturizers, skin moisturizing shampoos or conditioners, rinses, scalp lotions, scalp scrubs, and scalp masks all contain ingredients that can rehydrate dry skin on the head. Choose products that are specifically indicated as scalp moisturizers rather than hair moisturizing or rehydrating products.

Dry scalp medications

Like dry skin, dry scalp is treated with moisturizers. However, choosing the right product is confusing. Many over-the-counter products help treat other conditions, such as dandruff, and may not help dry scalp. Shampoos, conditioners, and moisturizers often have a long list of puzzling ingredients. A single product might have ingredients that help moisturize dry scalp as well as ingredients that dry out the scalp. Some hair products feature gentle and natural ingredients, such as aloe vera, but are packed with harsh, synthetic detergents and preservatives in the ingredients list that can cause dry scalp or eczema.

It helps to know what to look for. Moisturizing shampoos will have one or more types of moisturizing ingredients:

• Humectants—substances that attract and hold moisture in the skin

• Occlusives—substances that prevent the evaporation of moisture from skin tissues

• Exfoliants—substances that strip away dead skin and oils from the skin’s surface

• Astringents—substances that smooth the skin by reducing the moisture content in the skin tissues

• Counter-irritants and demulcents—substances that provide temporary relief from itching and discomfort

• Medications—substances that treat an underlying condition, such as a fungal infection or inflammation

The most effective shampoos for dry scalp will be rich in humectants and occlusives, use only mild exfoliants, have no astringents, and be free of medications. Substances that soothe itching are optional.

Humectants

Humectants are absorbed into the upper layers of the skin (the stratum corneum) and attract and hold on to water molecules. Humectants are the only moisturizing ingredient that increases the water content in skin tissues, so humectant shampoos or conditioners should be the first choice in treating dry scalp. In the ingredients list, look for hyaluronic acid, hyaluronate, glycosaminoglycans, urea, glycerin, sorbitol, sodium lactate, honey, sugarcane, aloe vera, agave, flaxseed, glycols, or algae extract.

Occlusives

Occlusives create a barrier over the skin that prevents the skin from losing moisture through evaporation. These include petrolatum, dimethicone, lanolin, candelilla, tea tree oil, coconut oil, almond oil, avocado oil, and beeswax, many of which are featured ingredients in moisturizers or shampoos.

Exfoliants

Exfoliants strip away dead skin cells and reduce flakiness. However, exfoliants do cause the skin to dry out. They strip away oils and dead skin that protect the upper skin layers from evaporation. Look for products with mild exfoliants such as willow bark, papain (papaya enzyme), bromelain (pineapple enzyme), allantoin, or citric acid. Avoid harsher exfoliants such as salicylic acid, lactic acid, or glycolic acid unless recommended by your doctor.

Astringents

Astringents such as salt, witch hazel, apple cider vinegar, or alcohol, tighten and tone the skin by pulling water out of the upper layers of the skin. Astringents dry out the skin and should be avoided when treating dry skin or scalp.

Counter-irritants

Counter-irritants temporarily calm itchiness by overwhelming the skin’s nerves with other sensations, such as heat or cold. For itch relief, look for products with menthol, camphor, eucalyptus, spearmint oil, or peppermint oil.

Demulcents

Demulcents, such as honey, mallow, glycerin, and Icelandic moss, form a barrier over dry skin to prevent irritation, so they help relieve the itching and discomfort of dry skin. They are usually identified as “soothing agents” in a product’s packaging or marketing.

Medicated shampoos

Some shampoos and medications that treat “itchy” or dry scalp are often formulated for eczema, seborrheic dermatitis, or psoriasis, not dry scalp. Antifungal medications, commonly found in anti-dandruff shampoo, have no effect on dry scalp, neither good nor bad. They may, however, cause a skin reaction, which will add more itchiness and discomfort to a dry scalp condition. Other medicated shampoos commonly contain variations of hydrocortisone, a steroid that will not relieve dry scalp itching or dryness. Hydrocortisone does, however, dry out the skin, so it could worsen dry scalp. These medicated shampoos are appropriate only for the conditions specified in the instructions and packaging.

What is the best medication for dry scalp?

There is no “best” medication for dry scalp, only shampoos, conditioners, or other products rich in moisturizers. Finding the right moisturizer or shampoo for dry scalp may take some trial and error before lighting on the formula that works for your condition.

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What is the best medication for dry scalp?