A flaky scalp can be embarrassing. Many of us might recall dandruff shampoo commercials where the lead walks away in shame when another character points at the white flakes falling on their shoulders. The pesky skin flakes, combined with other symptoms, could point to more serious conditions such as eczema or psoriasis. A flaky scalp is not an issue of poor hygiene, nor is it contagious, but it is your body’s way of signalling that something is off.
Different Conditions That Cause Flaky Scalp
A flaky scalp could be a sign of several skin conditions. Read on to learn how to differentiate them.
1. Occasional or chronic?
Mild dandruff that may crop up occasionally from time to time usually stems from an especially oily scalp, which causes the skin cells on your scalp to shed skin faster. This results in the formation of dead skin flakes. Shampoos can easily treat dandruff due to this occasional overproduction of sebum.
Dandruff is also considered a mild form of seborrheic dermatitis, which is a type of eczema. Eczema is an over-reaction of your immune system’s response to otherwise normal pathogens on human skin, such as Malassezia (yeast).
A different cause to chronic flaky scalp could be psoriasis. It is also an autoimmune condition, but it is different from eczema. If you have psoriasis, your body renews skin cells too quickly for no apparent reason, making your skin unnaturally thick and leading to flaking.
2. Location and nature of itchy, flaky skin
The main difference between mild dandruff and the other more serious skin conditions is that dandruff is only on your scalp. Seborrheic dermatitis, on the other hand, can be apparent on your scalp, eyelids, eyebrows, face, neck, and other parts of the body. Dandruff can be a nuisance and a source of embarrassment, but it is rarely overly itchy or inflamed.
Severe seborrheic dermatitis can become so red and itchy, you might scratch until your skin is inflamed and even bleeds. Similarly, flaky scalp due to psoriasis can also be accompanied by similar skin plaques forming elsewhere, but the itching can be milder.
Those who suffer from psoriasis may also be in great pain when the abnormally thickened skin breaks and bleeds. The condition can also be accompanied by grooved, cracked nails, and sometimes joint pain. Some doctors may describe psoriasis flakes to be more silvery in colour, although to most of us, it would be quite hard to differentiate with just the naked eye.
3. Does being out in the sun usually make it worse, or better?
If your scalp starts flaking and getting itchy, accompanied with a lot of sweating when you are outdoors with the sun out, it could well be a typical dandruff. This is especially if it happens only occasionally. If you have existing red patches of itchy skin and the redness and inflammation severely flare up when you get hot, you might be among eczema sufferers who are also sensitive to heat. Meanwhile, with psoriasis, the UV rays in sunlight can help slow down the overproduction of new skin layers, and may provide you with relief instead.
Addressing Flaky Scalp with Western and Eastern Medicines
While the occasional dandruff problem can be addressed with over-the-counter shampoos, treatments for eczema and psoriasis require specific medical evaluation, diagnosis, and intervention by a doctor. Some people also find great relief and success by working with a licensed and professional Traditional Chinese Medicine (TCM) practitioner.
Options in Western Medicine for Flaky Scalp Treatment
Western medicine treats these skin conditions using medications which either address pathogens that instigate or make the condition worse, or help reduce the symptoms arising from your own body’s attacking of its own cells. These include dandruff shampoos that contain antifungal or antibacterial agents, or low concentrations of chemicals like salicylic acid. These help shed the dead skin cells and smoothen the outermost surface of the skin.
Moderate to severe eczema or psoriasis may be treated with topical corticosteroids that are anti-inflammatory and suppress the immune response. Severe psoriasis is sometimes treated with systemic drugs that affect your entire body. Symptoms temporarily calm, but side effects include lowered immunity and organ damage.
Flaky Scalp in TCM
According to TCM physician Brandon Yew, TCM views flaky scalp as a symptom of internal imbalances associated with Heat, Wind, Dampness and Blood Deficiency. Specific types of flaky scalp arise due to different patterns of disharmony within the body, namely:
- Flaky scalp with skin redness: caused by Heat toxins
- Flaky scalp with red and itchy rashes: caused by Wind and Heat pathogens
- Flaky and oily scalp: caused by Wind and Dampness pathogens
- Flaky with dry and pale scalp: caused by Wind pathogen and Liver Blood Deficiency
“The above pathologies arise from pressure-cooker work stress, poor work-life balance, unhealthy dietary habits, prolonged and direct exposure to air-conditioner at the head and regular usage of harsh chemical hair products,” Physician Yew shares.
The first order of business is to assess the behaviours or environmental factors that create the “perfect” conditions for these pathologies to form. Avoid the triggers mentioned, but more importantly, those with flaky scalp must try to manage stress, both physically and mentally, get adequate rest, eat healthily and exercise regularly.
Treatment Options for Flaky Scalp
“TCM can help treat flaky scalp through herbal medications, acupuncture, cupping, moxibustion, tuina (Chinese manual therapy), and blood-letting. These are formulated carefully by the TCM physician to address specifically the unique body constitution of every individual patient. Hence, it is best to always consult the TCM physician for proper assessment and treatment,” Physician Yew further elaborates.
You can try TCM supplements that improve health such as essence of chicken with Dang gui (Angelica sinensis, 当归) and He shou wu (tuber fleeceflower, 何首乌). Work with your TCM practitioner who may also consider the following herbal formulas:
- Qiang huo sheng shi tang (羌活胜湿汤): Dispels Wind and Dampness; suitable for flaky and oily scalp
- Si miao yong an tang (四妙勇安汤): Regenerates Liver blood, cools the blood and dissipates clots, neutralises Heat toxins; suitable for flaky scalp with redness
- Xiao feng san (消风散): Dispels Wind and Heat; suitable for flaky scalp with red and itchy rashes
- Dang gui yin zi (当归饮子): Regenerates Liver blood, promotes blood circulation to dispel Wind; suitable for flaky with dry and pale scalp
Massaging certain acupressure points can also provide mild symptomatic relief by directly dispelling Wind, Heat, and Dampness within the scalp, restoring and enhancing localised qi and blood circulation, such as bai hui (DU20, 百会), jiao sun (SJ20, 角孙), and feng chi (GB20, 风池).
For acupoints that restore and enhance blood circulation to the scalp, try nei guan (PC6, 内关) and xue hai (SP10, 血海) to dispel Heat and Dampness, feng shi (GB31, 风市) to dispel Wind, yin ling quan (SP9, 阴陵泉) to dispel Dampness) and tai chong (R3, 太沖) which soothes Liver to dispel Heat and Wind, and regenerates blood to nourish the Liver.
Pay attention to the nature of your flaky scalp. Our bodies are very adept at signalling to us if we need to address imbalances. Utilise both Western and TCM approaches to understand your specific condition on your way to a flake-free and disease-free existence.
- Cleveland Clinic. 2020. Psoriasis. [Accessed 26 April 2022].
- Cleveland Clinic. 2020. Seborrheic Dermatitis. [Accessed 26 April 2022].
- Journal of Clinical and Investigative Dermatology. 2015. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. [Accessed 26 April 2022].
- Dermatology Research and Practice. 2012. A Nonimmunosuppressant Approach on Asia Psoriasis Subjects: 5-Year Followup and 11-Year Data Analysis. [Accessed 26 April 2022].
- Penn Medicine. 2022. Eczema vs. Psoriasis: Similarities, Differences and Treatments. [Accessed 26 April 2022].
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