Pharmaceutical and Natural Remedies For Flakey Scalps
Sometimes scalp itch goes beyond typical dandruff. There may be burning and severe flaking that is not relieved by over-the-counter (OTC) medicated shampoos. If you have gone through bottles of Head & Shoulders, T-Gel, Selsun Blue, Denorex or Nizoral and still can’t find relief beyond a day or two, contact your dermatologist. Some powerful remedies lurk behind a doctor’s prescription pad.
Historically, cortisone has been the remedy for inflammation. Adverse affects associated with topical corticosteroids (i.e. liver damage) have shifted focus to:
- Anti-fungal remedies: zinc pyrithione, selenium sulfide, propylene glycol, lithium succinate
- Hydroxypyridones: ciclopirox
- Azoles: bifonazole, fluconazole, itraconazole, ketoconazole*, miconazole, metronidazole
- Allylamines: terbinafine
Many of these are active ingredients in the over-the-counter shampoos. For stubborn cases of scalp psoriasis, your doctor may prescribe oral medications, such as methotrexate (Trexall®) or cyclosporine, or combine stronger medications with medicated creams and ointments.  Ciclopriox (Loprox®) is currently available only with a prescription. Severe cases of scalp psoriasis may also be treated with phototherapy using the Excimer Laser or a UV light.
Why Does My Scalp Itch So Much?
Psoriasis, clinically called atopic or seborrheic dermatitis, is a lifelong dermatology condition that causes thick, red patches of skin and silvery-white scales affecting approximately 2.2 percent of the population. Rapid skin cell proliferation forms patches on top of one another—forcing prematurely discarded skin cells to the surface. These psoriatic patches can be itchy, sore, and even burn. The condition can be either mild, moderate or severe. Though it can’t be cured, it can be controlled.
Symptoms and appearance may resemble eczema and are therefore treated similarly. For distinction, eczema has been called by some dermatologists the itch that becomes a rash; skin manifestations are usually secondary to scratching. Whereas psoriasis is a manifested skin condition that also itches.
Closeup flakey scalp
A dietary deficiency in essential fatty acids (EFAs) like omega-3 and omega-6 is common among psoriasis patients and vegetarians or vegans. Psoriasis, seborrheic dermatitis, and eczema have been linked to allergies, stress, and genetics.
A study of 319,000 13-14 year olds from 107 centers in 51 countries and more than 181,000 six to seven year olds from 64 centers in 31 countries links fast-food consumption to eczema and asthma. The authors suggest plausible explanations for the findings: fast food contains high levels of saturated and trans fatty acids, which are known to affect immunity, while fruit is rich in antioxidants and other beneficial compounds. 
What is The Cure for Scalp Psoriasis?
Ciclopriox clinical study: If OTC shampoos cannot keep flaking under control for more than three or four days, ciclopirox offers some promising results. One hundred and two patients were randomly selected to apply either ciclopirox olamine 1% shampoo or the vehicle shampoo to the scalp for 5 minutes, twice per week for 4 weeks.
By the end of the study, erythema (reddening), scaling, and pruritus (itching) had significantly improved or cleared in 93% of the ciclopirox shampoo-treated patients compared to 41% in the placebo group (P<0.00001).  According to GoodRx, Ciclopirox prescription prices range from $20–75.
What if you already have—or could purchase for under $20—a non-prescription remedy in your kitchen cabinet? Perhaps you prefer natural approaches or are awaiting a prescription refill in the mail. Do you require something more than a watered down shampoo when your prescription is running low? There are some options that may temporarily decrease scalp psoriasis flareups.
Natural Remedies for Itchy Scalp
Flaxseed oil: Rich in omega-3 essential fatty acids, flaxseed oil, applied topically, soothes dry skin and may provide the EFAs necessary to inhibit the compounds in the body that cause inflammation. [4,5] Flaxseed oil (an acquired taste) taken orally and topically may reduce the symptoms or eczema and psoriasis for some people.
You can drink flaxseed oil from a tablespoon, in capsules in juice or in protein shakes. The oil doesn’t retain its properties more than about six months even when refrigerated. This might make it difficult to consume a large bottle before it goes bad.
Apple Cider Vinegar: There is no clinical support for the efficacy of vinegar in treating psoriasis. Anecdotal reports suggests apple cider vinegar provides symptom relief for many chronic sufferers. Apart from the elements that are good for detoxification and cleansing, there are others that fight against bacteria that cause skin ailments. 
Some people have had success drinking the vinegar to attack psoriasis from within. You may consume a tablespoon of apple cider vinegar diluted with water 3:1 to reduce acidity twice a day. [7,8] Twenty minutes afterwards, drink a full glass of water and one hour later, as with all citrus juices, it is advisable to brush teeth to minimize tooth enamel erosion. (Brushing immediately after drinking citric acid has reverse effect.)
Depending upon the severity of your condition, you might apply the diluted vinegar topically. Use once or twice per week until the condition is under control (or until your prescription arrives). Soak a cotton ball or cotton swab with vinegar and blot it on the affected areas. Or soak a compress in a mixture of vinegar and water and apply it directly to the skin. Leave it in for about 30 minutes before exfoliating with a fingernail brush, soft-bristle toothbrush (no longer used orally), silicone skin brush, or facecloth. Rinse with cool water.
If the residual vinegar smell is too strong, use a mild shampoo like Johnson’s No More Tears or Neutrogena Anti-Residue shampoo. Washed skin requires moisturization to halt inflammation.
You can try using a tea tree oil conditioner to nourish hair and scalp but rinse throughly with cool water to prevent irritation. In place of a conditioner, you might pat dry and massage a teaspoon of flaxseed oil or aloe vera into the scalp. Some with eczema on other parts of their body, add flaxseed oil to bathwater.
Hello, I am 20 years old and have been suffering from severe Atopic dermatitis since I was an infant.  I’ve tried everything from steroid treatments to antibiotics and have had no semi-permanent relief from traditional medicine. I have recently been seeing a homeopathic doctor and have started to see great results.
The key to treating eczema is to treat the person as a whole by building up the immune system instead of suppressing it. I have had a recurring problem with eczema on my scalp and have found amazing relief in flaxseed oil. Flaxseed oil can be applied directly to the scalp and taken orally. When applied to the scalp, it provides immediate relief. I am eager to educate other eczema sufferers on the great benefits of this wonderful oil. Please post this letter for others to view. Thank you, Mallory.
Ease into topical use by treating a small non-facial area first—perhaps an inconspicuous spot behind an ear or on a temple. If there are no flare ups, you may decide to treat your a larger area of your face or scalp. The positive aspect of using a single-ingredient remedy is that you learn fairly quickly if it doesn’t agree with you.
Psoriasis is a complex disorder with hereditary, dietary, emotional, and dermatological triggers. Consider any suggestions offered as an adjunct to professional care. Consult your primary doctor or dermatologist if your condition worsens or you do not see improvement within two weeks.  Looking to join an online support group? Visit patientslikeme.com.
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* Oral prescriptions of Ketoconazole for skin infections should be discontinued. Ketoconazole tablets (Nizoral, Janssen Pharmaceuticals) have been prescribed to treat skin and nail fungal infections. The FDA now warns that serious liver damage and death outweigh benefits. The warning does not affect topical solutions and shampoos.
- Difference between scalp psoriasis and seborrheic dermatitis. mayoclinic.com msn.com/health/scalp-psoriasis/AN01177 Retrieved 22 Jan 2018
- Fast Food Diet Linked to Asthma and Eczema Severity in Kids. sciencedaily.com/releases/2013/01/130116085352.htm Retrieved 22 Jan 2018
- Ciclopirox Shampoo for Treating Seborrheic Dermatitis. medscape.com/viewarticle/482650_2 Retrieved 22 Jan 2018
- The Benefits of Topically Applying Flaxseed Oil to Skin. livestrong.com/article/180899-the-benefits-of-topically-applying-flaxseed-oil-to-skin/ Retrieved 22 Jan 2018
- How Vinegar Helps Dry Itchy Skin. ehow.com Retrieved 22 Jan 2018
- Health Benefits of Apple Cider Vinegar (ACV). eatingbirdfood.com/2012/02/health-benefits-of-apple-cider-vinegar-acv/ Retrieved 22 Jan 2018
- Psoriasis Treatment Using Vinegar. ehow.com/way_5463386_psoriasis-treatment-using-vinegar.html Retrieved 22 Jan 2018
- Eczema cure - Apple cider vinegar. steadyhealth.com/eczema_cure_apple_cider_vinegar.html Retrieved 22 Jan 2018
- Flaxseed oil for scalp eczema - Mallory, Asheville, USA. talkeczema.com/talkeczema/stories/category.php?c=27 Retrieved 22 Jan 2018
- Let doctors know if you’re using alternative medicine. kevinmd.com/blog/2013/02/doctors-alternative-medicine.html Retrieved 22 Jan 2018
- Image by Fotografie NRW licensed from iStock Photo.