How can I manage a painless scalp bump with dry skin?

Question

Hello doctor,

I have a skin-colored bump on my scalp, about the size of a penny, covered with dry skin. It is not painful, and I have no associated symptoms. My boyfriend mentioned that the bump has been present for a while, and I only noticed it recently while tying my hair.

I have no prior history of this specific issue, but there is a family history of psoriasis and eczema. I am currently using Nexplanon.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Based on the appearance of the lesion and your history, this is most consistent with seborrheic dermatitis, which is a common, non-contagious scalp condition. It occurs due to skin sensitivity combined with overgrowth of a normal scalp yeast, leading to dry, flaky skin, mild redness, and sometimes slightly raised patches. It can remain present for a long time, may come and go, and often does not cause pain.

Even though you have a positive family history of psoriasis (a chronic autoimmune condition) and eczema (a non-contagious skin condition), this lesion does not appear to be psoriasis. Seborrheic dermatitis is considered a form of eczema, but it is very manageable, and there is no need to worry.

Seborrheic dermatitis is a common but harmless skin condition that mainly affects areas rich in oil glands, such as the scalp, eyebrows, sides of the nose, and behind the ears. It develops due to a combination of skin sensitivity and overgrowth of a normal yeast called Malassezia that lives on the skin. This leads to flaking, mild redness, and greasy or dry scales. It is not contagious, not related to poor hygiene, and can fluctuate over time. Flares are often triggered by stress, weather changes, or fatigue, and with proper treatment, they are usually easy to control.

For treatment, apply Betamethasone lotion (Betnovate) once daily at bedtime to the affected area on the scalp. Use a thin layer only and gently massage it in. This helps reduce inflammation and scaling. Continue for seven to 10 days only.

If you experience itching, you may take Cetirizine 10 mg once at bedtime. This can help relieve itching and also support better sleep.

In addition, use Ketoconazole shampoo. Use it twice weekly for three weeks. Leave the shampoo on the scalp for three to five minutes before rinsing, so it works effectively. Since Ketoconazole can sometimes dry the hair and scalp, you may use a conditioner afterward, focusing on the hair lengths rather than the scalp.

Avoid scratching or picking at the flakes, as this can irritate the skin and worsen scaling. Use lukewarm water instead of hot water when washing your hair, as hot water can further dry the scalp.

Overall, seborrheic dermatitis is a benign and very manageable condition, and you should notice significant improvement with this routine. If the patch spreads, becomes painful, or does not improve after a few weeks, a follow-up review would be helpful. Otherwise, this is not something to worry about and should settle well with consistent care.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.