Sensitive Scalp Symptoms: Identify Causes and Choose Safe Treatments

Disclaimer: This guide is for educational purposes only and is not medical advice. It does not replace diagnosis or treatment from your clinician.

How do I tell dandruff, psoriasis, allergy, shedding, or infection apart?

Start here: a calm, clinical checklist

Name your top symptom. Describe what you feel or see in simple words: itch, burn, tenderness, flake, scale, redness, bumps, or hair coming out in clumps. Clear language helps you match symptoms to causes and choose the safest next step.

Note when it started and what changed. New products, recent coloring, tight styles, illness, stress, a new medication, or a big life event can all shift the scalp’s balance. Telogen effluvium, the medical term for stress-related shedding, typically begins two to three months after a trigger and settles over three to six months in most cases.⁹

Check the pattern. Is the problem patchy or diffuse. Localized or all over. Front, crown, or back. A pattern often points to a diagnosis, like circular patches of hair loss in alopecia areata, or bitemporal thinning in pattern hair loss.¹⁰

List your products. Write down every formula that touches your scalp, including “unscented” items, which can still contain masking fragrances. Fragrance allergy is not rare in the general population and can be much higher in specialty patch-test clinics.⁶

Know red flags and act. Painful pustules, fever, expanding warm redness, sudden bald patches in a child, or thick crusts with broken hairs need timely medical assessment.

What is “sensitive scalp” really?

Sensitive scalp is not a single disease. It is a cluster of symptoms caused by different conditions that inflame skin or disrupt the hair cycle. The most common culprits include seborrheic dermatitis, scalp psoriasis, contact dermatitis, fungal infections, folliculitis, stress-related shedding, and the two common forms of pattern hair loss. Each has a distinct mechanism, look, and fix.

Is it dandruff or seborrheic dermatitis?

Define it. Seborrheic dermatitis is an inflammatory condition linked to skin yeast, oil, and individual immune response. It causes flakes, itch, and redness on the scalp and other oily sites. In adults, estimates suggest about 1 to 3 percent are affected.²

What you see. Yellowish or white flakes that recur, mild itching, and redness around hair follicles. Face creases and eyebrows may be involved.²

First fixes that help. Use an over-the-counter dandruff shampoo with a proven active such as zinc pyrithione, salicylic acid, selenium sulfide, ketoconazole, sulfur, or coal tar. Lather onto the scalp, not just the hair, and leave on for up to 5 to 10 minutes if the label allows. Rotate actives if one stalls.¹

Sensitive-scalp tip. On non-medicated wash days, use a fragrance-free cleanser to reduce exposure to potential irritants. Choose The Better Scalp Company Sensitive Scalp Shampoo and follow with The Better Scalp Company Sensitive Scalp Conditioner to maintain comfort between medicated washes.

Could it be scalp psoriasis?

Define it. Psoriasis is an immune mediated skin disease that forms thick, dry, raised plaques with silvery scale. On the scalp it can mimic dandruff yet often looks drier and more adherent.³ ⁸

What you see. Reddish patches with silvery white scale. Skin can crack and bleed if very dry.³

First fixes that help. Learn “scale then calm.” Keratolytics like salicylic acid shampoos can soften thick plaques so prescription topicals can penetrate better. Keep fragrance free basics in your routine. Use The Better Scalp Company Sensitive Scalp Shampoo or Conditioner on off days.

When to see a clinician. If plaques are thick, widespread, or painful, you may need prescription care guided by a dermatologist.

Did a product trigger allergic or irritant contact dermatitis?

Define it. Contact dermatitis is inflammation caused by either direct irritation or true allergy to ingredients. Hair dye allergens like paraphenylenediamine, preservatives such as methylisothiazolinone, and fragrances are notable triggers.⁴ ⁵ ⁶

What you see. Burning, stinging, or intense itch, with redness, flaking, or swelling along the hairline, ears, or neck. Timing often tracks a new product, color service, or a scented dry shampoo.⁴

What confirms it. Patch testing places small amounts of common allergens on the skin for several days and reads for delayed reactions. PPD is routinely tested at 1 percent in petrolatum and graded to guide safe dye decisions.⁵ Expanded panels can catch allergens beyond standard trays.⁷

First fixes that help. Stop new or suspect products. Switch to fragrance free basics. Use The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner while your skin quiets. Resume items one at a time after patch testing to avoid guesswork.⁴ ⁵

Is it a scalp fungus like tinea capitis?

Define it. Tinea capitis is a dermatophyte infection of the scalp and hair shaft. It occurs in children more often than adults and can cause scaly patches, broken hairs, or tender, boggy swelling called a kerion. Diagnosis relies on examining hair or scale with potassium hydroxide preparation and culture. Wood’s lamp can help for certain species.⁷

What you see. Round scaly patches with black dot hairs or diffuse scale in kids, sometimes tender nodes or a painful lump. Seek care quickly to protect the follicles.

First fixes that help. This needs oral antifungals. Do not rely on shampoos alone. A clinician should confirm with KOH or culture and select treatment.⁷

Are the bumps actually folliculitis?

Define it. Folliculitis is inflammation or infection within hair follicles. On the scalp, yeast driven Malassezia folliculitis produces monomorphic, itchy, small follicle based papules and pustules. Comedones are absent, which distinguishes it from acne. Wood’s lamp may show yellow green fluorescence.⁸

What you see. Even looking, itchy bumps at follicles on the scalp or hairline. Scratching can spread or worsen it.

First fixes that help. Your clinician may recommend antifungal washes or topicals. Keep basics gentle and fragrance free to minimize added irritation. Use The Better Scalp Company Sensitive Scalp Shampoo during recovery.

Is it shedding or true hair loss?

Define it clearly. Shedding is increased daily fallout from follicles that are still healthy, often due to a stressor. Hair loss means follicles are miniaturizing or inflamed and not replacing hair. A dermatologist can tell the difference with history, exam, and sometimes gentle pull tests.⁹

What you see with telogen effluvium. More hair in the brush or drain several months after illness, childbirth, surgery, crash diet, or major stress. Shedding usually improves over three to six months as the trigger resolves.⁹

First fixes that help. Address the cause, optimize nutrition, reduce tight styles and heat, and keep the scalp calm. Gentle, fragrance free cleansing such as The Better Scalp Company Sensitive Scalp Shampoo supports barrier recovery while you heal.

Does the pattern match androgenetic alopecia?

Define it. Androgenetic alopecia, also called pattern hair loss, gradually miniaturizes hair in predictable patterns: bitemporal recession and vertex thinning in many men and diffuse central thinning with preserved frontal hairline in many women.¹⁰

What you see. Gradual widening of the part in women or a thinning crown in men. Scalp skin usually looks normal.

First fixes that help. Evidence based options include topical minoxidil and, when appropriate, prescription therapies selected by your clinician.¹⁰ Continue gentle, fragrance free scalp care to avoid compounding irritation.

How do I tell alopecia areata from other causes?

Define it. Alopecia areata is an autoimmune attack on hair follicles that creates sharply defined, round or oval bald patches. Nail pitting can occur and may support the diagnosis.

What you see. Smooth, bare patches without scale. You might notice short “exclamation point” hairs at the edges.

First fixes that help. See a clinician for early treatment. Keep daily care soothing and simple while medical treatment gets underway.

A simple decision path you can actually use

Step 1. Identify the main symptom.
Flakes and itch suggest seborrheic dermatitis. Dry, silvery plaques point toward psoriasis. Burning and swelling after a new product signal contact dermatitis. Small uniform itchy bumps often mean folliculitis. Round scaly patches in a child suggest tinea capitis.

Step 2. Map timing to triggers.
Two to three months after a fever or stress points to telogen effluvium. Same day or next day reactions after hair dye suggest contact allergy to PPD.⁵ ⁹

Step 3. Try targeted, gentle care for two to four weeks.
For dandruff or seborrheic dermatitis, rotate proven anti dandruff actives and respect label contact times.¹
On off days use The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner.
For suspected contact dermatitis, stop new products and book patch testing rather than guessing.⁴ ⁵ ⁷

Step 4. Seek help for red flags or no improvement.
See a dermatologist if you have pain, pus, thick plaques, bald patches, shedding beyond six months, or any scalp problem in a child.

Home care that supports medical treatment

Wash with purpose. When using medicated shampoos, apply to the scalp first, massage, and leave in place as directed, often several minutes, before rinsing. This contact time matters.¹

Keep the base routine fragrance free. Fragrance allergy affects a measurable portion of the population and is even more common in patch test clinics, so simplifying exposures helps many sensitive scalps.⁶ Choose The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner as your daily anchors.

Style kindly. Avoid tight ponytails, heavy extensions, or high heat while the scalp is reactive. Lower mechanical stress gives inflamed follicles time to recover.

Patch test new leave ons. Trial a pea sized amount behind the ear for three nights. Stop if you feel sting, burn, or see redness.

What to take to your dermatology visit

Bring a short symptom timeline, photos of flares, and the full list of products with clear photos of ingredient labels. Ask whether you need:

• A KOH exam or culture for suspected fungus.⁷

• Patch testing, including extended panels, for product reactions.⁵ ⁷

• Prescription anti inflammatories for psoriasis, contact dermatitis, or alopecia areata.

• A plan for pattern hair loss or prolonged shedding.¹⁰ ⁹

Gentle myths, kindly corrected

“Unscented means fragrance free.” Unscented products can hide masking fragrances. Choose fragrance free when your scalp is reactive.⁶

“If it burns, it is working.” Stinging is not a sign of progress in sensitive scalps. Stop and reassess if a product hurts.⁴

“No shampoo fixes everything.” Different actives do different jobs. Rotating proven ingredients for dandruff while keeping your base routine fragrance free is often the winning combination.¹

When to worry less

If your shedding started after a clear stressor and is already easing by month three, telogen effluvium is likely to settle with supportive care and time. Most cases improve as the body resets.⁹ Keep routines gentle and consistent while density recovers.

Bottom line

You can identify the cause of most scalp symptoms by pairing what you see with timing and a few simple tests. Treat flaking with targeted actives. Confirm allergies with patch testing rather than guessing. Protect your baseline with fragrance free care like The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner. Ask early for help when patterns or red flags appear. Your scalp can be calm again.

Glossary

• Seborrheic dermatitis: An inflammatory scalp condition with flakes, redness, and itch linked to yeast and oil.²
• Psoriasis: An immune mediated disease causing thick, dry plaques with silvery scale that can involve the scalp.³ ⁸
• Contact dermatitis: Skin inflammation caused by irritation or allergy to ingredients in products, including fragrances and dyes.⁴ ⁵ ⁶
• Paraphenylenediamine (PPD): A common hair dye allergen used in permanent color; routinely patch tested at 1 percent.⁵
• Tinea capitis: A fungal infection of the scalp and hair shaft diagnosed by KOH microscopy and culture.⁷
• Malassezia folliculitis: Yeast driven follicle inflammation causing small, uniform itchy bumps without blackheads.⁸
• Telogen effluvium: Stress related shedding that often starts two to three months after a trigger and improves in three to six months.⁹
• Androgenetic alopecia: Pattern hair loss with predictable thinning patterns in men and women.¹⁰
• Alopecia areata: Autoimmune hair loss causing sharply defined bald patches with possible nail pitting.
• KOH prep: A simple microscope test using potassium hydroxide to look for fungal elements.⁷

Claims Registry

Citation #	Claim(s) supported	Source title + authors + year + venue	Accessed date (America/New_York)	Anchor extract	Notes
1	Use a dandruff shampoo with zinc pyrithione, salicylic acid, selenium sulfide, ketoconazole, sulfur, or coal tar, and leave on as directed	How to treat dandruff. American Academy of Dermatology, 2023. AAD.org	2025-11-20	“Look for a shampoo with zinc pyrithione, salicylic acid, sulfur, selenium sulfide, ketoconazole, and coal tar. Allow 5 to 10 minutes.”	Authoritative patient guidance from AAD
2	Adults are affected by seborrheic dermatitis around 1 to 3 percent	Seborrheic Dermatitis and Dandruff: A Comprehensive Review. Borda LJ, Wikramanayake TC. 2015. Journal of Clinical Investigative Dermatology (PMC)	2025-11-20	“Incidence is 1 to 3 percent of the general adult population.”	Peer reviewed review on epidemiology
3	Scalp psoriasis forms reddish patches with silvery white scale and very dry skin that can crack	Scalp psoriasis: Symptoms. American Academy of Dermatology	2025-11-20	“Dandruff like flaking and silvery white scale. The scalp may be so dry that the skin cracks and bleeds.”	AAD patient material describing hallmark signs
4	Allergic and irritant contact dermatitis from hair products are common culprits of scalp symptoms	Allergic contact dermatitis of the scalp: a review. Hwang JC et al. 2024. Dermatology Reports (PMC)	2025-11-20	“Standardized patch tests cover common scalp allergens such as PPD in hair products.”	Contemporary review focused on scalp ACD
5	PPD is patch tested at 1 percent in petrolatum with graded reactions to guide dye use	Paraphenylenediamine and hair dye contact allergy. DermNet NZ	2025-11-20	“Patch testing using 1 percent PPD in petrolatum. 1 plus to 3 plus indicates allergic contact dermatitis.”	Widely used dermatology reference on PPD
6	Fragrance allergy occurs in the general population and is more frequent in patch test clinics	Fragrances: Contact Allergy and Other Adverse Effects. de Groot AC, 2020. American Contact Dermatitis Society	2025-11-20	“In the general adult population, up to 4.5 percent may be allergic. In consecutive patients, 20 to 25 percent.”	Authoritative review from contact dermatitis experts
7	Diagnosing tinea capitis relies on KOH microscopy, culture, and sometimes Wood’s lamp	Tinea Capitis. Al Aboud AM, 2023. StatPearls (NCBI Bookshelf)	2025-11-20	“A few drops of KOH examined for hyphae and spores. Wood’s light is a modality.”	Clinical reference on evaluation
8	Malassezia folliculitis shows small, uniform itchy follicular papules and pustules with no comedones	Malassezia folliculitis. DermNet NZ	2025-11-20	“Small, uniform, itchy papules and pustules. Comedones are not seen.”	Clinical features summarized by DermNet
9	Telogen effluvium often starts 2 to 3 months after a trigger and settles in 3 to 6 months for most	Telogen Effluvium. Cleveland Clinic, 2022	2025-11-20	“Acute telogen effluvium lasts fewer than six months. Hair will usually grow back in three to six months.”	Patient friendly summary from a major academic center
10	Pattern hair loss shows bitemporal recession and vertex thinning in many men and central thinning in many women; evidence based options include minoxidil	Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Kaiser M et al., 2023. Clinical, Cosmetic and Investigational Dermatology (PMC)	2025-11-20	“Typical pattern is bitemporal recession and vertex thinning. In women, diffuse central thinning.”	Recent review on AGA patterns and therapies