An itchy, flaky, or painful scalp is more than just a “dandruff problem” for many people. Scalp infections—caused by fungi, bacteria, or viruses—can lead to redness, swelling, pus‑filled bumps, and even patchy hair loss if not treated properly. In humid Indian climates, crowded living conditions, and shared combs or helmets, scalp infections spread easily among children and adults alike.
This guide walks you through the most common scalp infections, how to recognise them, what treatments work best, and when to see a dermatologist or paediatrician.
What Is a Scalp Infection?
A scalp infection occurs when microorganisms grow excessively on the skin of the scalp and around hair follicles, causing inflammation.
Typical features include:
- Itching and irritation.
- Red, scaly, or crusted patches.
- Painful bumps or pustules.
- Sometimes hair breakage or hair loss in the affected area.
Different germs cause different patterns and need specific treatments.
Major Types of Scalp Infections
1) Fungal Infections (Tinea Capitis – Scalp Ringworm)
- Caused by dermatophyte fungi that thrive in warm, moist conditions.
- Typically affects children but can spread to adults.
- Highly contagious: spreads via sharing combs, towels, pillows, caps, or close contact.
Typical signs:
- Round or irregular scaly patches on scalp with broken hairs.
- Itching and mild redness.
- Sometimes black dots where hair has broken at scalp level.
- In severe cases: boggy, tender swelling (kerion) with pus and crusts.
2) Bacterial Infections (Folliculitis, Impetigo)
- Common bacteria include Staphylococcus and Streptococcus species.
- Often occur when small cuts, insect bites, or scratching allow bacteria into hair follicles.
Features:
- Folliculitis
- Red, itchy or tender bumps at hair follicles, sometimes with pus (“scalp acne”).
- Impetigo
- Honey‑coloured crusted sores, often around hairline or behind ears.
- Highly contagious, especially among children.
- Honey‑coloured crusted sores, often around hairline or behind ears.
3) Malassezia‑Related Scalp Conditions (Seborrhoeic Dermatitis)
- Caused by overgrowth of normal scalp yeast (Malassezia) in oily areas.
- Typically presents as:
- Persistent dandruff.
- Red, greasy scales and itching on scalp, eyebrows, and sides of nose.
- Persistent dandruff.
4) Viral Scalp Infections (Herpes Zoster/Shingles, Herpes Simplex)
- Herpes zoster (shingles) can affect the scalp along a nerve path.
- Symptoms include:
- Painful, burning sensation in a strip on one side of the scalp.
- Clusters of fluid‑filled blisters that crust over.
- Temporary hair loss in that band.
- Painful, burning sensation in a strip on one side of the scalp.
Common Symptoms to Watch For
While each infection has specific signs, overlapping symptoms include
Persistent scalp itching or burning.
- Flaky skin or severe dandruff unresponsive to regular shampoo.
- Red, scaly, or moist patches.
- Painful lumps, boils, or blisters with or without pus.
- Foul odour in severe or neglected infections.
- Hair breakage or patchy hair loss where infection is active.
Any combination of these symptoms lasting more than 1–2 weeks or spreading despite basic care needs medical attention.
How Are Scalp Infections Diagnosed?
A dermatologist or trained clinician typically can diagnose by:
- Clinical examination: looking at lesion pattern, distribution, and hair changes.
- Dermoscopy (trichoscopy): magnified view of scalp and hair shafts.
- Scalp scrapings or hair samples: sent for microscopy and fungal culture.
- Swabs: for bacterial culture in pus‑filled lesions.
In complicated or recurrent infections, tests may be done to check for diabetes or immune problems.
Treatment Options: What Really Works
Treatment depends on the cause—self‑treatment with random over‑the‑counter creams can make things worse.
1) Treating Fungal Scalp Infections (Tinea Capitis)
- Oral antifungal medications are usually essential; shampoos alone are not enough for deep infections.
- Common options include specific systemic antifungals prescribed by a doctor.
- Medicated shampoos (with ketoconazole, selenium sulfide, or zinc pyrithione) help reduce surface fungal load and contagiousness.
- Treatment often continues for several weeks even after visible improvement to prevent relapse.
2) Treating Bacterial Scalp Infections
- Topical antibiotics: creams, gels, or ointments used for mild limited infections like simple folliculitis or small impetigo patches.
- Oral antibiotics: needed if there are multiple lesions, spreading infection, fever, or deeper boils.
- Gentle cleansing, avoiding squeezing or popping boils, and improving scalp hygiene are vital.
3) Managing Seborrhoeic Dermatitis (Dandruff‑Related)
- Medicated anti‑dandruff shampoos 2–3 times a week containing:
- Ketoconazole
- Selenium sulfide
- Zinc pyrithione
- Coal tar or salicylic acid in some cases
- Ketoconazole
- In flares, doctors may add mild topical steroid lotions or non‑steroidal anti‑inflammatory creams for itch and redness.
4) Treating Viral Scalp Infections
- Antiviral medications for herpes zoster or simplex shorten course and reduce pain when started early
- Pain control with analgesics and sometimes nerve‑pain medications.
- Maintaining hygiene and avoiding scratching to prevent bacterial super‑infection.
Home Care, Hygiene, and Prevention
Regardless of the infection type, some general rules help:
- Wash hair and scalp regularly with appropriate shampoo (frequency adjusted to hair type and climate).
- Avoid sharing combs, towels, caps, helmets, and pillow covers.
- Disinfect or replace combs and hair accessories after infections.
- Keep scalp dry—dry thoroughly after baths and avoid wearing tight caps on a sweaty scalp for long periods.
- Treat dandruff or minor itching early before scratching and secondary infection start.
- Children in schools and hostels should be encouraged not to share personal hair‑care items.
In recurrent infections, screening and treating close contacts may be necessary.
When to See a Doctor or Dermatologist
Seek medical care if you notice:
- Painful, pus‑filled bumps or boils on the scalp.
- Rapidly spreading red patches or honey‑coloured crusts (impetigo).
- Scaly patches with hair loss areas in children.
- Severe itching with thick scales not helped by anti‑dandruff shampoos.
- Fever, swollen lymph nodes in neck, or general unwell feeling with scalp lesions.
Early diagnosis and specific treatment prevent scarring and permanent hair loss.
FAQs
1) How do I know if my child’s “dandruff” is actually a scalp infection?
Simple dandruff usually causes fine white flakes without much redness, pain, or hair loss. If your child has round or patchy areas of redness, thick scale, broken hairs, pus‑filled spots, or very intense itching, it is more likely a fungal or bacterial infection than just dandruff. In such cases, a paediatrician or dermatologist should examine the scalp.
2) Can scalp infections cause permanent bald patches?
Yes, if deep fungal or bacterial infections are left untreated or if there is a severe inflammatory reaction (such as a kerion in tinea capitis), hair follicles can be destroyed and scarring alopecia (permanent hair loss) may occur. Timely treatment with appropriate antifungal or antibiotic medication usually prevents this outcome and allows normal hair regrowth.
3) Are medicated shampoos enough to cure all scalp infections?
No. While medicated shampoos help with surface yeast overgrowth (like dandruff/seborrhoeic dermatitis) and can reduce contagiousness, deep fungal infections like tinea capitis almost always need oral antifungals, and moderate to severe bacterial infections need antibiotics. Using shampoos alone may temporarily mask symptoms but will not clear deeper infections.