Dr Kara Johns
Creator and Director of SBK
hello@sbk.store
We’ve talked about itchy scalps. We’ve talked about flaky scalps. This one is about the scalp that just hurts!
A burning, stinging, or tender scalp is more common than most people realise — and it’s just as frequently misunderstood. The instinct is usually to change the shampoo. Sometimes that helps. But scalp pain can come from a surprising range of places, and knowing which one you’re dealing with makes all the difference. Let’s go through them.
Category 1: Skin Conditions
These conditions originate in the scalp skin itself — in the barrier, the follicles, the inflammatory response, or the surface microenvironment. The pain, stinging, or soreness is a direct result of what is happening at the skin level.
1. Seborrhoeic Dermatitis
The most common cause of an itchy, flaky, and sometimes painful, scalp. It shows up as greasy, yellowish scale in oil-rich areas — scalp, hairline, eyebrows, sides of the nose. 'Dandruff' is actually the mildest form of this same condition — the uninflamed version, without the redness. 'Cradle cap' is the infant version.
What’s actually happening: The exact cause of seborrhoeic dermatitis is not fully understood, however, it seems to be from a combination of hormonal, nutritional, yeast and neurological factors. It is not about hygiene, and it comes and goes in flares, often worse with stress or in winter.
During a flare, the skin barrier is compromised, and becomes acutely sensitive. Stinging and burning can occur when your scalp is in contract with water, shampoo, styling products (worse if there are known irritants in the products!) or even when brushing your hair or resting your head against a pillow. This hypersensitivity arises because active inflammation lowers the pain threshold of the nerve endings in the affected area.
Managing it: there are 2 main approaches to management - reduce the yeast with ingredients like ketaconazole, and encourage cell shedding with salicylic acid - the process of the outer dead skin cells releasing rather than being sticky.
Avoiding products with known irritants will also help reduce the pain - so look for fragrance free products. Skin barrier-supporting ingredients may also help - think niacinamide, panthenol, green tea extract - as these can help reduce inflammation and strengthen the skin barrier function.
Avoiding products with known irritants will also help reduce the pain - so look for fragrance free products. Skin barrier-supporting ingredients may also help - think niacinamide, panthenol, green tea extract - as these can help reduce inflammation and strengthen the skin barrier function.
2. Irritant Contact Dermatitis and Allergic Contact Dermatitis
Irritant contact dermatitis occurs when a chemical or physical substance directly damages the scalp skin. It is more common in people that are susceptible to atopic dermatitis - eczema, and is one of the most common causes of a stinging, burning scalp that develops after using a new product.
Allergic contact dermatitis is similar to irritant contact dermatitis, except the reaction is more dramatic, with blisters and weeping, and less people experience this. The skin issues may not appear for 1-2 days after contact, and similarly, it is more common in people that are prone to atopic dermatitis - eczema, as they already have an impaired skin barrier.
What’s actually happening: Irritant contact dermatitis: Harsh Surfactants — particularly sodium lauryl sulphate (SLS) — are among the most common culprits. They strip protective lipids from the skin barrier, allowing the irritant (typically types of fragrance in hair products) direct access to the skin cells beneath. If the skin barrier is already weaker (as in allergic contact dermatitis) it doesn’t take much to strip way enough of the skin barrier for irritants to cause issues.
Stinging and burning can begin quickly - sometimes within hours of using a new product. But it can also appear after a build up effect - meaning after repeated exposure, making it tricker to work out the cause.
Allergic contact dermatitis: is a type of hypersensitivity reaction, where the immune system is activated and responds quite enthusiastically! It is rarer than irritant contact dermatitis and the severity often gives it away.
Managing it: Identify and remove the offending product. The scalp usually recovers within days to a week once the irritant/allergen is removed. If the stinging and burning is severe, make sure you see your doctor, as you may need a short course of treatment to support your scalp to heal. Sometimes further testing may be needed if the reaction is suspected to be an allergic one.
Barrier-supportive ingredients may help speed recovery - so look for products that contain soothing and repairing ingredients such as centella asiatica, green tea extract, panthenol and bisabolol.
3. Scalp Psoriasis
Distinguished by thick, well-defined, silvery-white plaques with redness underneath, than extend beyond the hairline.
Pain and tenderness are underappreciated features of scalp psoriasis and arise due to the consequences of the condition, rather than as an initial feature. Thick active plaques can be sore to touch, meaning brushing or combing your hair can be sore. The skin around the edges of a plaque can also crack and bleed, causing pain. These open areas can then also burn and sting when they come in contact of shampoo/products
What’s actually happening: psoriasis is an immune-driven condition where skin cells are produced far faster than normal, so the stratum corneum — the outermost layer of dead skin cells — builds up faster than it can shed. That build-up is the plaque you can see and feel.
Managing it: because it’s fundamentally a build-up problem, keratolytics like salicylic acid are a cornerstone of management — they work by breaking down the excess keratin holding the scale together, helping it lift and clear. This is usually paired with anti-inflammatory treatment from your doctor to address what’s driving the overproduction underneath. Barrier-supportive ingredients may also be helpful if you have cracked areas - look for products that contain soothing and repairing ingredients such as centella asiatica, green tea extract, panthenol and bisabolol. But this is definitely a condition you need to speak with your doctor about!
4. Folliculitis
This is inflammation or infection around individual hair follicles, often showing up as small, tender, sometimes pus-filled bumps. These bumps, known as papule and pustules, are often sore to touch, causing local pain around the bump itself. In severe cases, with many bumps, the pain can be more wide spread over the scalp.
What’s actually happening: hair follicles become blocked or irritated — from built up skin, sweat, heat, tight hairstyles, friction, or product build-up — and this lets bacteria (commonly Staphylococcus) or sometime fungus, take hold and inflame the follicle.
Managing it: depends on the severity. Very mild cases often can clear up on its own by cleaning your hair and avoiding the trigger. But severe cases often need medical care, which means off to see your doctor! Left untreated, it can cause hair loss.
5. Fungal Infections (Tinea Capitis)
A fungal infection, more common in children, that can cause itchy, scaly patches — sometimes with patchy hair loss or broken hairs. Pain and tenderness can occur, particularly in more inflammatory version where a kerion develops. A kerion is an acute, boggy, inflamed area that forms when the immune system mounts an aggressive response to the fungal infection. It is associated with hair loss and bumps (pustules) - which makes is tender to touch.
What’s actually happening: Fungal organisms invade the hair shaft and follicle, triggering both a direct tissue response and an immune-mediated inflammatory reaction. The kerion represents an exaggerated immune response to fungal antigens — and can actually mean that the immune system is effectively fighting the infection!
Managing it: This one requires medical care! This is because the fungus sits inside the hair follicle, so nothing applied to the skin will work. No matter how good a scalp product is, it just won’t work!
6. Sunburn
Sunburn on the scalp is common and frequently underestimated — particularly in people with thinning hair or a visible part line. The scalp receives direct UV exposure and responds to overexposure in exactly the same way as skin anywhere else.
Scalp sunburn causes acute pain, tenderness, redness, and heat — typically developing 2–6 hours after UV exposure and peaking at 12–24 hours. The scalp may feel tight, raw, and acutely sensitive to touch, water, and even air movement. In severe cases, blistering occurs. Peeling follows over subsequent days as the damaged skin sheds.
What’s actually happening: UV radiation causes direct DNA damage to skin cells, triggering an acute inflammatory response. This process sensitises pain receptors in the skin — producing the characteristic tenderness. This is the same mechanism as sunburn anywhere on the body.
Managing it: prevention is the best management! Always wear an appropriate hat when outdoors, to product your scalp from UV radiation. If you scalp does inadvertently get sunburnt, try cooling the scalp with a cold compression and consider a scalp product that contains ingredients that can sooth and hydrate the scalp skin - such as green tea extract, bisbolol, rice extract and pantheon.
7. Skin Cancer on the Scalp
In addition to sunburn, UV exposure on the scalp - particularly in fair-skinned individuals and men with hair loss or thinning - increases your risk of skin cancers. Because the scalp is difficult to self-examine and often covered by hair, lesions here are frequently detected later than those on more visible areas; especially given most early skin cancers are painless. However, some can become tender as they grow, especially if they bleed, crust or ulcerate. Some skin cancers can track along nerves, causing localized pain, tingling and numbness. Any non-healing lesion anywhere on your body needs prompt medical assessment.
What’s actually happening: the cancer cells invade surrounding tissue, including nerve structures. This invasion causes an inflammatory response triggering pain, but the invasion can also happen directly to a nerve.
Managing it: prevention is again the best management! The next best step is to get skin checks, but there is no clear guidance on when to start doing this, or how frequently you should. Speak with you doctor about your individual risk and recommended skin check interval. And remember, any non-healing lesion needs to get checked promptly.
Category 2: Non-Skin Conditions
These conditions originate outside the scalp skin itself — in nerves, blood vessels, or muscles underneath — but produce pain that is felt on or across the scalp surface. The scalp may look completely normal on examination, which can make these causes frustrating to identify without medical assessment.
COMING SOON!
Watch This Space
Scalp care has been on my mind for a while now — for all the reasons above. We will be releasing a scalp product soon, formulated with the same evidence-based, fragrance-free approach behind everything else we make.
If your scalp has been bothering you, you’re not alone — and you don’t need to just live with it. Understanding what’s actually going on is the first step.
This blog will be updated soon!
