When patients complain of scalp problems I find that there are two major variable factors: the severity of the problem as perceived by us both and the ability I have to diagnose it. Individuals seem remarkably variable in their tolerance of the itching and scaliness of scalps. Some seem greatly distressed by a few microscopic spots, while others apologise for troubling me when their head is a total cosmetic disaster. My heart tends to sink with either end of the spectrum!