Why You May Have a Scab on Your Scalp

Most scabs on the scalp aren’t cause for concern. They may be caused by exposure to an irritant or a mild skin condition, and either heal on their own or with over-the-counter (OTC) treatments.

However, scabs can also be due to a condition that can only be cleared up with medical attention. Some are chronic, meaning they can cause a recurring scab on the scalp in the same spot—sometimes even with treatment.

And, of course, any scab can stick around if scratched and picked at.

This article looks at common causes of scalp scabs, how they’re treated, and when you should see a healthcare provider.

Contact Dermatitis

Contact dermatitis is an itchy, red rash caused by direct contact with irritants or allergens.

The rash can be anywhere on your body, including the scalp. The rash itself doesn’t involve scabs, but scratching can lead to them, as well as open sores.

Many products contain fragrances and other ingredients that can cause contact dermatitis. Those used on the scalp include:

• Soaps
• Shampoos
• Hairstyling products
• Hair dyes

Without making sure your skin is no longer in contact with whatever the offending substance is, the rash can persist or, if resolved, come back.

Treatment

Home remedies may relieve a contact dermatitis rash. Common ones are:

• Cool compresses: Temporarily relieve the itch, sting, and burn. Place a cold, damp cloth over the rash for 10 to 15 minutes, several times a day.
• Moisturizer: Acts as a barrier for dry, cracked skin and soothes discomfort. Choose fragrance-free, hypoallergenic products.
• Oatmeal baths: Can relieve itching and discomfort. OTC colloidal oatmeal bath additives are available.  

If home remedies don’t help, your doctor may prescribe:

• Antihistamines (allergy pills): Help reduce inflammation and swelling
• Corticosteroids: Topical forms (applied to the skin) soothe a rash; severe cases may require oral (taken by mouth) or injected forms
• Antibiotics: Needed if scratching breaks the skin and leads to a bacterial infection

Psoriasis

Psoriasis is a chronic inflammatory skin condition in which an immune system attack causes skin cells to reproduce too quickly. Then they “pile up” and form thick, crusty patches (plaques) of gray or silver scabs on the skin.

Psoriasis plaques are most often on the elbows, knees, trunk, and scalp. Flare-ups tend to be in the same or similar spots.

Scalp psoriasis may also look like dandruff.

Treatment

Psoriasis treatment depends on the severity. For mild cases, a medicated shampoo can ease itching and reduce skin overgrowth.

OTC medicated shampoos with salicylic acid help remove excess skin. Those containing coal tar can relieve inflammation and slow skin-cell growth.

For more severe cases, or if OTC treatments don’t work, your healthcare provider may prescribe psoriasis creams, medications, or other treatments.

Other ways to treat scalp psoriasis include:

• Light therapy: First-line treatment for moderate to severe scalp psoriasis. It slows growth by exposing the skin to controlled amounts of UVB light.
• Excimer laser treatment: This therapy uses a focused beam of UVB light to target areas of the body that are often difficult to treat. Although effective, it does require traveling to the dermatologist’s office two to three times a week for treatments, for several weeks.
• Oral or injected medications: Corticosteroids, methotrexate, and biologics can help slow skin-cell growth, reduce inflammation, or suppress an overactive immune system. 
• Topical solutions: Medicated shampoos (containing clobetasol propionate or ketoconazole), topical steroids, and tars may be used to treat scalp psoriasis. You can also look into psoriasis soaps.

Head Lice

Head lice are wingless insects that live on your scalp. They feed on blood.

You may feel them moving around on your scalp. Their bites can itch.

Scratching can cause wounds and scabs on your scalp. Head lice don’t carry disease, but scabs can get infected.

Treatment

Head lice are highly contagious. Prompt treatment is important to keep them from spreading.

Treatments for lice include:

• OTC products: Shampoos containing pyrethrin or permethrin. If they don’t work, your healthcare provider may prescribe shampoos with different ingredients.
• Oral prescription medication: Medications like oral ivermectin are prescribed for lice infestations that don’t respond to OTC treatments. 
• Topical prescription medications: Malathion and other topical drugs are rubbed into the scalp. 

Also, it’s important to:

• Wash all bedding, clothing, and furniture with hot water and dry it on high heat.
• Soak all hairbrushes and combs in hot water (130 degrees F).

That should kill the lice and their eggs.

Dermatitis Herpetiformis

Dermatitis herpetiformis is a chronic skin condition. It occurs in people with gluten sensitivity or celiac disease.

Intensely itchy clusters of blisters and red bumps appear on the skin and along the hairline. The first symptom may be a burning sensation.

Then it scabs over and tends to heal within a week or two. Scratching it can also cause scalp scabs. 

The bumps will likely occur on the same areas during every outbreak, so it’s possible that scabs may reoccur in the same spots.

Treatment

Dermatitis herpetiformis is treated with a prescription antibiotic called dapsone. The drug provides almost immediate relief. However, it doesn’t cure it—it only relieves symptoms.

Following a strictly gluten-free diet is the best approach. Even so, you may need to keep taking medication for a while to clear your skin completely. 

Seborrheic Dermatitis

Seborrheic dermatitis is a common and chronic skin condition with symptoms that come and go. It affects the sebaceous (oily) regions of the scalp.

It causes patches of greasy skin covered with itchy, crusty, powdery flakes. The flakes may be white or yellow. Scratching these spots can lead to scabs. 

The condition may be caused by an overgrowth of Malassezia yeast. High amounts of Malassezia are often found on the skin of people with seborrheic dermatitis.

Treatment

Home remedies may help control and eliminate seborrheic dermatitis. They include OTC dandruff shampoos such as:

• Head & Shoulders
• Selsun Blue
• T/Gel

You can also use mineral oil or olive oil on your scalp. Let it sit for one hour, then brush out your hair. That may help with dry, crusty patches.

If none of that works, your healthcare provider may prescribe medicated shampoos or ointments that reduce scalp inflammation.

If topical treatments don’t work, you may need an oral antifungal medication.

Eczema

Eczema usually appears on visible areas of skin. But sometimes it strikes less easy-to-see places like the top of your head.

Scalp eczema causes itchy, dry, red, and inflamed skin. You may also feel a burning sensation.

Scalp eczema itself doesn’t cause scabs. But scratching it can. Because eczema flares tend to happen in the same place, you may continue to have scabs in the same spots over and over.

Treatment

There’s no cure for scalp eczema. But treatments can help reduce symptoms. OTC shampoos may reduce itchiness and get rid of flaky, scaly skin.

Look for shampoos, ointments, creams, and sprays containing:

• Salicylic acid
• Coal tar
• Zinc

Apply to itchy and irritated spots on your scalp.

If your eczema is severe and OTC products don't help, your provider may prescribe something stronger. Other options are:

• Corticosteroids
• Ciclopirox
• Sodium sulfacetamide
• Other drugs that suppress the immune system

Sunlight or light therapy (phototherapy) may help, too.

Shingles

Shingles is a painful skin rash caused by the varicella-zoster virus. That’s the virus that causes chickenpox.

It causes a painful rash with blisters that open and scab over. Shingles may also cause:

• Headaches
• Fever
• Chills
• Upset stomach

The shingles rash is most often on the face and body, but blisters can also form on the scalp. That can make it painful to brush your hair.

In rare instances, you can have more than one shingles infection, but it likely won’t come back in the same spot.

Treatment

Medication can reduce symptoms and make the outbreak shorter.

Drugs prescribed for shingles include:

• Antiviral medications, such as Valtrex (valacyclovir) and Zovirax (acyclovir)
• Pain medication
• Topical treatments  

Eosinophilic Folliculitis

Eosinophilic folliculitis is a skin and scalp disorder. It causes recurring itchy, red, or skin-colored bumps and pustules (bumps containing pus). They eventually scab over.

The scalp scabs can spread. The condition isn’t contagious. It’s mostly found in people with late-stage HIV/AIDS.

Scratching the bumps can lead to scabbing and infection.

Treatment

The treatment for eosinophilic folliculitis varies depending on the severity. Your prior responses to medications may be considered, as well.

Possible treatments include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Dapsone 
• Topical and oral steroids 
• Light therapy

Neuropathic Itching

Some people experience nerve-related itching on the scalp (neuropathic itch). There is no rash, just itchiness. Scratching leads to scabs.

The cause of neuropathic itching is unclear. It’s thought to be related to nerves in the skin. It can also be associated with conditions that are:

• Metabolic
• Orthopedic
• Neurological
• Infectious
• Autoimmune

Treatment

Neuropathic itching is often treated with systemic medications like Neurontin (gabapentin).

Impetigo

Impetigo is a skin infection caused by the bacteria group A Streptococcus or Staphylococcus aureus. It’s most common in kids, but adults can get it too.

The infection is characterized by blisters that appear on the mouth and nose, but they can also develop on the scalp, legs, and arms. In most cases, the blisters are itchy. A yellowish crust will eventually form over them.

Impetigo is incredibly contagious and can spread if someone touches the sore or comes in contact with its fluid.

Most people won’t have a second bout of impetigo, so the scabs are unlikely to reoccur. It’s important to contact a healthcare provider if you suspect you have the condition again.

Treatment

Antibiotics can cure impetigo. Your healthcare provider may recommend a topical cream if there are few sores in one area.

If there are many in one area or they’ve developed on multiple body parts, oral antibiotics will likely be prescribed.

Scalp Ringworm

A fungal infection, scalp ringworm may start off as small bumps on the scalp that itch. Scratching them can cause a scab.

Gradually, the bump expands to form a large circle with a normal-looking inside surrounded by a red border. The hair inside the ring may become brittle and break off easily, leaving a bald patch.

It’s rare for adults to get scalp ringworm, but it happens.

Treatment

This condition can only be successfully treated with antibiotics, which should be taken orally for one to three months.

The infection can come back if it isn’t fully cleared with medication.

Lichen Planus

Lichen planus is a disease that causes bumps on the skin that are often shiny, firm, and purple. They often appear on the wrist, lower back, or ankles, but can develop anywhere—including the scalp. They might be painful and itchy, which can lead to scabs.

The skin disorder is most common in middle-aged adults, and it’s unclear what causes it. Researchers suspect that it may be an autoimmune disease, that it may be linked to hepatitis C, and that genes may play a role in who develops it.

Symptoms can come and go, which means that you may continue to have scabs on your scalp or other places.

Treatment

Lichen planus often goes away on its own within two years, and there’s no cure. However, treatment can reduce symptoms and speed up healing. Some treatment options include:

• Oral antihistamines
• Corticosteroid creams or pills
• PUVA therapy, a type of light treatment
• Oral or topical retinoic acid

Cyst

A bump on your scalp may be a pilar cyst, a relatively common type of cyst that grows out of hair follicles and can also develop on your legs, arms, neck, and face. Most of these smooth bumps are painless and benign. However, if they become infected, they may bleed and scab.

Scientists don’t know for sure why some people get pilar cysts while others don’t, but they believe that genes play a role.

Treatment

If the cyst is infected, a healthcare provider may recommend antibiotics followed by surgical removal. These cysts sometimes grow back (possibly creating a new scab in the same place), so the cyst may have to be removed again.

Injury

Head injuries such as falls or accidents can cause cuts on the scalp that may scab over. If the cut is taking a long time to heal or keeps opening up and scabbing over, it may be or become infected and should be examined by a healthcare provider.

Complications

Scabs form on the skin and scalp as part of a healing process. They protect new skin as it grows in over damaged areas.

It’s important to leave scabs alone. When you pick at them, you can expose the delicate skin underneath to infection. It can also cause scarring or cause the area to bleed again, prompting another scab to form.

Depending on their size and cause, scabs usually fall off within a few days to two weeks if allowed to heal. Depending on the cause, some may return.

Home Remedies for Scalp Scabs

Home remedies aren’t a substitution for treatments that your healthcare provider recommends. But in addition to those treatments, they may help reduce symptoms.

Some popular self-treatment products are:

• Aloe vera: You can cut a leaf of an aloe vera plant to extract the gel or buy an OTC product. Apply it directly to the affected areas. Studies suggest it might be effective for mild to moderate psoriasis.
• Tea tree oil: This essential oil is widely available. It’s also an ingredient in some shampoos. Studies suggest it speeds up wound healing. It might help with seborrheic dermatitis and psoriasis.
• Omega-3 supplements: These supplements are available OTC as capsules or liquid. They might help reduce inflammation from eczema and psoriasis. More research is needed to say for sure whether they’re effective.

Summary

Any rash or sores on your scalp may scab over. They may become infected, too. That’s especially likely if you give in to the urge to scratch.

If you’re unsure what’s causing sores or scabs on your scalp, see a healthcare provider. Many OTC products may help. But it’s important to know what you’re treating first.

If OTC treatments don’t help, you may be able to get prescription topicals or oral medications that clear up the problem. Home remedies may help with symptoms.