A long-standing itchy scalp for many years is often linked to conditions like chronic dandruff (seborrheic dermatitis), fungal overgrowth, dry, sensitive scalp, psoriasis, or even irritation from hair oils, shampoos, or styling products, and when it does not improve with ketoconazole shampoo, it usually means the trigger is still active, or the condition needs a different approach. Continuous itching can also keep the scalp inflamed, making the problem persist in a cycle. A simple routine often helps more than switching products frequently, such as using a mild medicated shampoo regularly, washing the scalp properly without leaving residue, and avoiding keeping oil on the scalp for too long. Some cases may need short-term medicated scalp lotions or different antifungal or anti-inflammatory treatments depending on the exact cause. Scratching should be avoided as it worsens irritation and can lead to hair weakening over time. Stress, sweat buildup, and harsh hair products can also make symptoms worse. Since this has been present for many years, it is important to get a dermatologist evaluation to confirm the exact diagnosis and adjust treatment properly so long-term relief can be achieved.