Finding a strange patch on your child’s scalp can be stressful, especially when you can’t see a doctor right away. If you notice a red, scaly, or crusty area, there are a few common causes to consider. While “only a healthcare professional can provide a diagnosis,” knowing the possibilities can help you take safe steps in the meantime.

One frequent cause is tinea capitis, also known as scalp ringworm. Despite the name, “it’s not caused by worms—it’s a fungal infection.” Signs include round or irregular scaly patches, redness, broken hairs, small bald spots, and mild itching. It spreads through shared hats, combs, pillows, or close contact. This condition usually requires prescription antifungal medication.

Another possibility is seborrheic dermatitis. It often appears as greasy, flaky scales with mild redness and is “usually not very itchy.” In babies it’s called cradle cap, but older children can develop it too. Medicated shampoos may help manage symptoms.

Psoriasis can also affect the scalp, causing thick, silvery scales and well-defined red patches, sometimes with itching. It is a chronic condition that may need medicated treatment. Eczema (atopic dermatitis) is another cause, especially if your child already has sensitive skin or eczema elsewhere.

While waiting for a doctor, keep the area clean with a mild shampoo and avoid harsh scrubbing. Do not share combs, brushes, hats, pillows, or towels. If you suspect a fungal infection, you may try an over-the-counter antifungal shampoo containing ketoconazole or selenium sulfide 2–3 times per week. This may reduce spread but often won’t fully cure it without oral medication.

Seek urgent care if you notice rapid spreading, severe swelling, pus, fever, or painful swollen lymph nodes. Even if symptoms improve, scalp infections in children often require prescription treatment.