Scalp treatment in London

Common scalp conditions

First, which one is it?

Four conditions account for nearly every itchy, flaky or sore scalp we hear about. See which description fits you.

Dandruff and seborrhoeic dermatitis

These are the same thing at different strengths. A yeast that lives on everybody's scalp overreacts to the natural oil there, and the skin responds by flaking and itching. At the mild end that's dandruff - fine white flakes, a bit of an itch.

At the stronger end it's seborrhoeic dermatitis - greasy yellowish scale, red patches, real itching, and often the same thing behind the ears, in the eyebrows, or in the creases beside the nose.

It flares with stress, tiredness, illness and cold weather, which is why a long London winter can make it worse and why it comes and goes. It doesn't cause permanent hair loss. An antifungal shampoo such as ketoconazole 2%, used properly, can control it well, but it comes back when you stop, so think of it as maintenance rather than cure.

Scalp psoriasis

Thick, well-defined patches with silvery-white scale, often creeping past your hairline onto your forehead or the back of your neck, with similar patches on your elbows, knees or changes to your nails. Hair does thin within the plaques, partly from the scale and partly from scratching, and it grows back once the psoriasis is controlled.

Mild scalp psoriasis responds to coal tar or salicylic acid preparation from a pharmacy. Anything beyond mild needs your London GP, because the treatments that work best for psoriasis are prescription-only. If you've noticed new joint pain or stiffness alongside it, mention that to your GP too, as psoriasis can sometimes affect joints.

Folliculitis

Small red or pus-filled spots around individual hairs, tender to touch, sometimes after sweating a lot, wearing a helmet or tight hat, or shaving your head. Mild folliculitis usually settles with an antibacterial or antifungal wash and being left alone, so no picking or squeezing.

If spots spread, are painful, keep coming back, or are leaving bald or shiny patches behind, then speak to a GP quickly. There's a rare scarring form of folliculitis that destroys follicles permanently.

Contact dermatitis

Itching, redness and sometimes tiny blisters that start within a day or two of a new hair dye, product or salon treatment, usually worst at the hairline, around the ears and down the neck. The treatment is stopping whatever caused it and seeking advice from your GP. If it was a dye, do a patch test 48 hours before the next one, every time, even with a product you've used before, because dye allergies can develop suddenly and get worse with each exposure.

Scalp treatment

What actually works on the scalp

How to use a medicated shampoo properly

Put it on your scalp, not your lengths. Massage it in gently, not with your nails! Leave it on for two to five minutes. Rinse. Do that twice a week for about a month. Once things have settled, drop to once a week to keep it away, and use your normal shampoo the rest of the time.

Which type of shampoo for which problem

A pharmacist should be able to confirm what options to consider if you're not sure.

Some people experience scalp and other conditions at the same time - if that sounds like you, read our guide to hair loss treatments in London.

What doesn't help

Scalp scrubs, exfoliating brushes, oils on a dandruff-prone or seborrhoeic scalp, tea tree and apple cider vinegar as a cure, picking and scratching. None of them treat the cause, and most of them irritate the skin you're trying to calm.

What to expect, and when

• Itching and flaking should be noticeably better within two to four weeks of using the right shampoo properly.
• Psoriasis plaques are slower and often need the GP route to settle fully.
• Hair that's thinned from scale or scratching regrows over a few months once the scalp is calm - be patient with it and don't measure it weekly.
• If nothing has changed after a month of doing it right, that's your cue to visit your London GP practice or a trichologist.

Why the supermarket shampoo didn't work

Many people who land on this page have already tried an anti-dandruff shampoo, seen no difference, and quietly decided their problem must be something worse. Usually it isn't. Usually it's the product and the way it was used.

Everyday anti-dandruff shampoos use milder ingredients at lower strength, and they're designed to be used like normal shampoo - lather, rinse, done. Which means they're washed off before they've had time to do much.

A pharmacy-strength antifungal shampoo is a different product, and it's used a different way - massaged into the scalp, left for two to five minutes while you do the rest of your shower, then rinsed, twice a week. It's the same idea, but a completely different result.

And if what you have is psoriasis-type scale rather than dandruff, an anti-dandruff shampoo was never the right tool in the first place. Coal tar, juniper tar or salicylic acid, which soften and lift thick scales, are the ones for that job.

So "nothing works" almost always means "the right thing hasn't been used the right way yet."

Every treatment we've discussed is available from most pharmacies or big supermarkets in London - you don't have to buy from us, we just want you to receive the right advice.

Wash more, not less (if it's dandruff or seborrhoeic dermatitis)

This is the most common mistake we see, and it's the exact opposite of what your instincts tell you.

Faced with a flaky, itchy, sore-looking scalp, most people wash their hair less, to "let it heal" and avoid irritating it, and reach for something soothing, like coconut oil, olive oil, castor oil, a hair mask. It feels like the right thing to do, but for dandruff and seborrhoeic dermatitis it's the wrong move. The yeast behind dandruff and seborrhoeic dermatitis feeds on oil. Washing less leaves more oil on your scalp, adding oil on top feeds it a buffet. Both make the flaking and itching worse, and then people decide the condition is getting more serious.

Instead, do the opposite. Wash more often, not less, with the right shampoo for the problem. Keep oils, masks and leave-in treatments off your scalp. If you like them for your lengths, apply them from the ears down. If your hair is very dry, coily or afro-textured and daily washing isn't realistic, the medicated shampoo still needs to reach your scalp twice a week - just keep the conditioning products off the scalp itself. You can expect a visible difference within two to four weeks.

We know it's easier said than done, but you also need to stop scratching. The itch-scratch cycle breaks hairs at the surface and inflames the skin, so an itchy patch quickly turns into an itchy patch with short, stubby hairs in it, which looks like hair loss even though it may not be. Keep your nails short, and try not to check the spot with your fingers ten times a day. It's the checking that's keeping it angry.

When to see a doctor

When your scalp needs a GP, not a shampoo

Most scalp problems are a pharmacy matter. But some aren't:

• Pain, rather than itch
• Pus-filled spots that are spreading or keep coming back
• Skin that looks scarred, shiny, or smooth where hair follicles used to be
• Hair loss in defined patches, especially with scale or hairs broken off short, which in children and sometimes in adults can be scalp ringworm - this is contagious
• A hairline that's receding while your eyebrows are thinning too
• A scalp that hasn't improved at all after a month of using the right shampoo properly

Patchy loss, a sore or inflamed scalp, or hairline and eyebrow thinning in women should be seen by a GP first. Some of these need a dermatologist and some are time-sensitive, because once a follicle scars, nothing brings the hair back.

If the London Hair Loss Clinic assessment picks up any of them, it won't offer you treatment. It gives you a short, clear list of what to say and ask your GP.

Does an itchy scalp cause hair loss?

An inflamed, itchy scalp can add to your shedding. Scratching breaks hairs and pulls loose ones out early, and inflammation in the skin can nudge some hairs into their resting phase, so they fall a couple of months later. All of that settles once the scalp does, and the hair comes back.

A scalp condition almost never causes the things people are frightened of - the parting that's slowly getting wider, the temples that are creeping back, the crown you can see through under bright lights. That's pattern hair loss.

So if your hair is thinning once your scalp is calm, the scalp wasn't the cause, and it's time to read about female hair loss, male pattern baldness or hair shedding instead, or just take the assessment and let it tell you which.

Scalp treatment FAQs