Scalp Symptom Triage Checklist for Itch, Flakes, Shedding, and Sores

How do I triage dandruff, itch, shedding, and sores at home safely?

Disclaimer: This content is for educational purposes only and is not medical advice. If you have severe symptoms, signs of infection, or concerns about your health, seek care from a qualified clinician.

Start here: what are you feeling right now?

Subject–Verb–Object lead: You identify the dominant symptom, then move through a short decision tree.
Pick the one you notice first:

• Itch or flaking that looks like dandruff.

• Burning, stinging, or sensitivity after hair products.

• Round bald patches without obvious irritation.

• Diffuse shedding that shows up in the brush, shower, or pillow.

• Painful bumps, yellow crusts, or pus.

• Scaling with broken hairs in a child.

• White specks that cling to hairs and keep coming back.

Each path below explains likely causes, what you can safely try now, and when to book dermatology.

What is dandruff vs seborrheic dermatitis, and what helps tonight?

Definition in plain English: Dandruff and seborrheic dermatitis are related conditions where yeast on the scalp and your skin’s oil interact to cause flaking and itch. Antifungal shampoos help manage it. Ketoconazole or selenium sulfide shampoos reduce flakes and itch in clinical trials.¹ ²

Do this first:

1. Wash the scalp, not just the hair. Massage an antifungal shampoo into the scalp for 3 to 5 minutes, then rinse. Examples include ketoconazole 1 to 2 percent or selenium sulfide 1 percent.¹ ²

2. Rotate actives if needed. If you plateau, alternate antifungal with salicylic acid or pyrithione zinc shampoos.²

3. Soothe between washes. Use fragrance free, lightweight conditioner on mid lengths and ends, not the scalp. If you prefer a fragrance free routine, reach for The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner.

4. Use short bursts of anti inflammatory care. If redness or scaling remains, a short course of a low to mid potency topical steroid solution or foam may be prescribed by a clinician, often used in limited intervals.³

Call the doctor if: scale spreads beyond the scalp, you notice thick yellow crusts, or over the counter care fails after 4 weeks.² ³

Could this be contact dermatitis from hair products?

Definition: Contact dermatitis is an itchy, sometimes burning rash triggered when the skin’s immune system reacts to an ingredient. Fragrance mixes are common culprits. Patch test studies show fragrance allergy in 5 to 11 percent of tested patients, while population estimates range from 0.7 to 2.6 percent.⁴

Clues you can see:

• Itch or burning after dye, dry shampoo, styling sprays, or a new conditioner.

• Rash at the hairline, ears, or neck where product runs.

Do this now:

• Strip back to essentials. Use a simple, fragrance free wash and conditioner for 2 to 4 weeks. Choose The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner for a streamlined trial.

• Avoid leave ins while testing.

• Document exposures. Save photos, list exact products and dates.

When to escalate: Persistent rash needs a dermatology visit and possible patch testing to specific fragrance mixes and preservatives.⁴

Do round, smooth patches of hair loss point to alopecia areata?

Definition: Alopecia areata is an autoimmune condition where the immune system targets hair follicles, causing sudden round or oval bald patches without scaling or redness.⁵

Clues you can see:

• Smooth bare patches.

• Possible nail pitting.⁵

Do this now:

• Do not scrub or pick. Gentle cleansing with a mild shampoo is fine.

• Seek evaluation. Early treatment by a dermatologist improves control. Options include topical, intralesional, or systemic therapies tailored to severity.⁵

Urgency: Book a nonurgent but prompt dermatology appointment. Photos with dates help track regrowth.

Is this telogen effluvium, the temporary shedding after a stressor?

Definition: Telogen effluvium is diffuse shedding that begins about 2 to 3 months after a trigger such as illness, high fever, childbirth, surgery, iron deficiency, crash dieting, or major stress. In most cases it resolves within 6 months.⁶

Clues you can see:

• More hair in the drain or brush.

• A positive tug test with several hairs releasing painlessly.

• A clear trigger 2 to 3 months earlier.⁶

Do this now:

• Reassure yourself. Most cases settle as the body rebalances.⁶

• Support the scalp. Wash regularly with a gentle, fragrance free shampoo such as The Better Scalp Company Sensitive Scalp Shampoo.

• Check basics. Ask your clinician about ferritin, thyroid, vitamin D, and recent medications.

• Be patient with timing. Shedding often improves by 3 to 6 months, with visible regrowth following.⁶

Call the doctor if: shedding lasts longer than 6 months, you see widening parts with miniaturized hairs, or you develop patchy loss.⁶

Are thick scales with red plaques actually scalp psoriasis?

Definition: Psoriasis is an immune mediated disease that speeds skin turnover, producing thick, silvery scale on red plaques. On the scalp it can extend beyond the hairline and feel tight or sore.

Evidence based basics: Topical corticosteroids are recommended for many forms of psoriasis and can be used for extended periods under physician supervision. Vitamin D analogs and other steroid sparing agents often help maintain control.³

Do this now:

• Loosen scale gently. Soak with warm water and apply a keratolytic scalp oil or solution before washing.

• Use prescribed topicals correctly. Apply as directed to plaques, not the whole scalp.

• Keep a calm routine. Gentle, fragrance free cleansing helps the barrier, for example The Better Scalp Company Sensitive Scalp Shampoo.

Call the doctor if: plaques cover large areas, pain interrupts sleep, or you need prescription guidance.³

Could my child’s scaly scalp with broken hairs be ringworm?

Definition: Tinea capitis is a contagious fungal infection of the scalp. Unlike body ringworm, scalp infection needs oral antifungal medication. Creams and powders are not effective for the scalp.⁸

Clues you can see:

• Patchy scale with broken hairs that look like black dots.

• Tender lymph nodes in the neck.

• Sometimes a boggy, pus filled swelling called a kerion.

Do this now:

• See a clinician for diagnosis and a prescription. First line therapy is an oral antifungal for 1 to 3 months, often terbinafine or griseofulvin depending on organism and age.⁸

• Do not share combs, hats, or pillows.

• Clean high touch items and consider screening siblings.

Why speed matters: Untreated kerion can scar. Early treatment prevents spread at home and school.⁸

Are those white specks lice or just dry scalp?

Definition: Head lice are tiny insects that live on hair and feed on blood from the scalp. Nits are eggs stuck to hair shafts. After successful treatment, dead nits can remain attached even when live lice are gone.⁷

Clues you can see:

• Itch at the nape and behind ears.

• Nits within 6 millimeters of the scalp.

• Live crawling lice on careful inspection.

Do this now:

• Confirm before treating. Examine in bright light and use a fine tooth comb.

• Treat and repeat as directed. Over the counter or prescription options are available. Some clinicians may use oral ivermectin in select cases, but it is not FDA approved for head lice and has age and pregnancy restrictions.⁷

• Check close contacts every 2 to 3 days and treat anyone with live lice or close nits.⁷

• De stress the laundry. Routine cleaning of bedding and brushes is enough.

Call the doctor if: you still find live lice after correctly timed treatments, or you are treating infants, pregnant people, or those with allergies to pediculicide ingredients.⁷

What are infection warning signs that should never wait?

Red flags that need urgent care:

• Fever, expanding redness, worsening pain, or pus draining from the scalp.

• Rapidly spreading swelling or tenderness of the skin. These can signal bacterial skin infection that needs medical assessment.⁹

How do I run a 7 day gentle reset for sensitive scalps?

Goal: Reduce irritants, support the barrier, and observe patterns.

Daily for one week:

1. Cleanse the scalp every 1 to 3 days with a gentle, fragrance free option such as The Better Scalp Company Sensitive Scalp Shampoo. Massage the scalp, then rinse thoroughly.

2. Condition the lengths with The Better Scalp Company Sensitive Scalp Conditioner. Keep conditioner off the scalp if greasy or very flaky.

3. Skip leave ins and sprays. Reintroduce one product at a time after the week and watch for itch or burn within 24 to 48 hours.

4. Air dry or use low heat. Avoid tight styles and heavy dry shampoos.

5. Log your symptoms. Note itch, scale, bumps, and shedding with quick photos.

If symptoms improve, keep the routine and introduce actives slowly. If symptoms persist or return the same day as a certain product, suspect contact dermatitis and discuss patch testing.⁴

What should I bring to a dermatology appointment?

• A symptom timeline with the first day you noticed the problem.

• All products you used in the last month or clear photos of labels.

• Medication and supplement list.

• Recent health changes like illness, childbirth, surgery, major stressors, or diet changes.

• Photos showing progression, especially for shedding or patches.

How do I apply medicated shampoos the right way?

• Wet the scalp fully.

• Use enough product to cover the scalp.

• Contact time matters. Leave on 3 to 5 minutes unless the label says otherwise.¹ ²

• Rinse thoroughly.

• Frequency. For dandruff or seborrheic dermatitis, use antifungal shampoos 2 to 3 times weekly, then taper to maintain control.²

When should I choose fragrance free hair care even if I love scents?

Choose fragrance free if you have chronic itch, burning after products, facial or neck rash, or a history of eczema or fragrance allergy. Population studies and patch test data confirm that fragrance is a common contact allergen.⁴ Your calmer routine can still feel luxurious. The Better Scalp Company Sensitive Scalp Shampoo and Sensitive Scalp Conditioner are easy first steps.

Quick comparison: at home care vs when to see a dermatologist

Try at home now

• Dandruff with mild itch. Antifungal shampoo and gentle routine.¹ ²

• Temporary shedding after an obvious trigger. Reassurance and basic labs with your primary care clinician.⁶

• Suspected fragrance irritation. Fragrance free reset and product diary.⁴

• Lice with live bugs confirmed. Pediculicide per instructions and check close contacts.⁷

Book dermatology

• Round, smooth bald patches or nail pitting.⁵

• Scalp psoriasis needing prescription topicals or advanced care.³

• Scaly patches with broken hairs in a child, suspected ringworm.⁸

• Any red flag for infection or treatment failures.⁹

Encouragement to close

You are not alone, and most scalp problems respond well to a clear plan. Use the checklist to narrow the cause, start safe home care, and partner with a dermatologist early for targeted treatment. Your scalp can heal, and your routine can be simple, soothing, and effective.

Glossary

• Seborrheic dermatitis: Inflammatory scalp condition related to yeast and oil that causes flaking and itch.

• Contact dermatitis: Immune reaction to an ingredient that causes rash, burning, or itch where products touch the skin.

• Alopecia areata: Autoimmune hair loss that creates round, smooth bald patches.

• Telogen effluvium: Temporary shedding that starts about 2 to 3 months after a trigger.

• Psoriasis: Immune mediated disease that creates thick, scaly plaques on red skin.

• Tinea capitis: Fungal infection of the scalp that requires oral antifungal medication.

• Nits: Eggs of head lice that stick to hair shafts.

• Keratolytic: Ingredient that helps loosen and lift scale from the skin surface.

• Patch testing: Diagnostic method that applies small amounts of allergens to the skin to identify triggers.

• Steroid sparing agent: Nonsteroid medication used to maintain control and reduce steroid use.

Claims Registry

Citation #	Claim(s) supported	Source title + authors + year + venue	Accessed date (America/New_York)	Anchor extract	Notes
1	Ketoconazole and selenium sulfide shampoos are effective for dandruff and benefit from several minutes of contact	A randomized, double blind, placebo controlled trial of ketoconazole 2% and selenium sulfide 2.5% shampoos for dandruff. Danby FW et al., 1993, J Am Acad Dermatol	2025-11-19	“Both ketoconazole 2% shampoo and selenium sulfide 2.5% shampoo are effective in the treatment of moderate to severe dandruff.”	Peer reviewed RCT on common antifungal shampoos
2	Over the counter antifungal shampoos are first line for scalp seborrheic dermatitis and rotation is reasonable	Diagnosis and Treatment of Seborrheic Dermatitis. Clark GW, Pope SM, Jaboori KA, 2015, American Family Physician	2025-11-19	“Several over the counter shampoos are available for treatment of seborrheic dermatitis of the scalp… patients should be directed to initiate therapy with one of these agents.”	Clinical review used in primary care and dermatology
3	Topical corticosteroids are recommended for psoriasis and can be used longer under supervision. Steroid sparing agents assist	Psoriasis clinical guideline. American Academy of Dermatology, Guideline page	2025-11-19	“Topical corticosteroids are recommended… The use… for more than 12 weeks can be considered under careful supervision.”	Authoritative specialty guideline
4	Fragrance is a common contact allergen with prevalence 0.7 to 2.6 percent in population and 5 to 11 percent in patch test cohorts	Allergic Contact Dermatitis to Fragrances. Reeder MJ et al., 2020, Dermatitis	2025-11-19	“The prevalence… in the general population is between 0.7% and 2.6%. In patch test populations… 5% to 11%.”	Contemporary peer reviewed review
5	Round or oval smooth bald patches and possible nail pitting are typical first signs of alopecia areata	Hair loss types. Alopecia areata signs and symptoms. American Academy of Dermatology	2025-11-19	“Round or oval, smooth bald patch on the scalp… first sign of alopecia areata.”	Trusted patient facing specialty resource
6	Telogen effluvium begins 2 to 3 months after a trigger and usually resolves within 6 months with shedding improving by 3 to 6 months	Telogen Effluvium. Symptoms, Causes, Treatment. Cleveland Clinic	2025-11-19	“Hair loss tends to happen two to three months after a stressor… Acute telogen effluvium goes away… most people see regrowth in a few months.”	Reputable academic medical center
7	After successful lice treatment, nits may remain. Examine household and treat close contacts. Oral ivermectin is not FDA approved for head lice	About Head Lice and Treatment guidance. CDC	2025-11-19	“Nits may stay in hair after treatment… Examine all household members… Oral ivermectin is not FDA approved for treatment of head lice.”	U.S. public health authority
8	Tinea capitis requires oral antifungal therapy for 1 to 3 months. Topical creams are ineffective for scalp	Treatment of Ringworm. CDC	2025-11-19	“Ringworm on the scalp usually needs antifungal medication taken by mouth for 1 to 3 months. Creams do not work for ringworm on the scalp.”	Clear, current guidance for families and clinicians
9	Worsening pain, redness, swelling, or pus are infection warning signs needing medical assessment	Cellulitis. Symptoms, Causes, Treatment and Recovery. Cleveland Clinic	2025-11-19	“Call your healthcare provider if there is an increase in swelling, discoloration or pain or if you see pus.”	Practical infection red flag guidance
10	Correct medicated shampoo technique includes adequate contact time before rinsing	Diagnosis and Treatment of Seborrheic Dermatitis. Clark GW et al., 2015, American Family Physician	2025-11-19	“Shampoos should be left on the scalp for several minutes before rinsing.”	Reinforces application technique from clinical review