Eczema on the scalp

What Causes Eczema on the Scalp, and How Is It Treated?

Treatments for scalp eczema will vary based on the type you have. If you know what triggers your eczema, you can make certain lifestyle changes to reduce your risk.

But if lifestyle changes and over-the-counter (OTC) medications aren’t enough, see your doctor. Also see your doctor if you’re experiencing severe pain, swelling, or other unusual symptoms.

Lifestyle changes

Work with your doctor to determine what’s triggering your flare-ups. In some cases, you may find it beneficial to keep a notebook where you list when you had a flare-up and what activities or environments you were in that day.

For example, you may want to take note of:

  • what you ate
  • what the weather was like
  • whether you were feeling any stress and what it was about
  • when you last washed or styled your hair
  • what hair products you used

Once you identify your triggers, you can work to avoid them.

Shampoos and other hair products

If your eczema isn’t the result of an avoidable irritant or environmental trigger, dandruff shampoo may be beneficial.

Look for shampoos containing:

  • zinc pyrithione
  • salicylic acid
  • sulfur
  • coal tar
  • selenium sulfide
  • ketoconazole

Try using a dandruff shampoo every other day, and follow the label’s directions. Use regular shampoo on the days you skip the dandruff shampoo.

Keep in mind that coal tar may darken lighter hair colors. Coal tar can also make your scalp more sensitive to the sun, so wear a hat when outside.

Once the eczema has cleared, you may be able to cut back to using the dandruff shampoo just once or twice a week.

Shop for dandruff shampoo.

Medications

Seborrheic and atopic dermatitis can be treated with an OTC or prescription corticosteroid cream or another topical steroid, like:

  • mometasone (Elocon)
  • betamethasone (Bettamousse)
  • fluocinolone acetonide (Synalar)

Try to only use these medications during a flare-up. Extended use may lead to side effects.

If your eczema doesn’t respond to steroid creams, your doctor may recommend topical medications like tacrolimus (Protopic) or pimecrolimus (Elidel). Your doctor may also prescribe an oral antifungal medication, such as fluconazole (Diflucan).

For contact dermatitis, you may want to try an antihistamine if the product you encountered caused an allergic reaction. Treating the skin may require a topical corticosteroid. Your doctor may prescribe an oral steroid, like prednisone (Rayos), if your scalp eczema is severe.

If your eczema has become infected, your doctor will prescribe an antibiotic in topical or oral form.

Eczema on Your Scalp? Here’s How to Ease the Symptoms

B. BOISSONNET / BSIP B. Boissonnet/Getty Images

In addition to your body, hands, and face, eczema can also plague the scalp, usually in a condition known as seborrheic dermatitis. There is some disagreement among experts about whether or not seborrheic dermatitis should be considered a form of chronic eczema or a separate skin condition, although the National Eczema Association considers it to be a type of eczema. (Eczema is a general term that includes a variety of conditions that cause red, inflamed skin.)

“Seborrheic dermatitis is a common form of chronic eczema on the scalp associated with a fungi,” says Gil Yosipovitch, MD, professor of medicine at the University of Miami Miller School of Medicine and author of Living With Itch ($19; amazon.com).

In addition to the scalp, seborrheic dermatitis may also affect parts of the face (such as the nose), the back, ears, or center of the chest. It strikes parts of the body with many oil-producing (sebaceous) glands, leading to symptoms such as redness, flakes, and patches of greasy, swollen-looking skin.

Unlike atopic dermatitis, a chronic form of eczema that is thought to be caused by an abnormal immune reaction, seborrheic dermatitis doesn’t usually cause severe itching. However, you can be diagnosed with both seborrheic dermatitis and atopic dermatitis at the same time.

RELATED: 5 Reasons Why You Have an Itchy Scalp

Experts aren’t sure exactly what causes seborrheic dermatitis. Genetics might make you more susceptible, and hormones, stress, or other triggers may lead to an overactive immune response that causes symptoms like red, painful, flaky skin to appear. A fungus called malassezia also plays a role. (This same fungus has been linked to dandruff, which is considered to be a mild form of scalp seborrheic dermatitis.)

Seborrheic dermatitis can usually be treated with medicated shampoos that contain tar, zinc pyrithione, salicylic acid, selenium sulfide, or ketoconazole. Leave the shampoo on for five or 10 minutes before rinsing it off. At first, you may want to use it several times a week, then use it once a week if symptoms improve.

Ross S. Levy, MD, chief of dermatology at Northern Westchester Hospital Center in Mount Kisco, N.Y. and an associate clinical professor of medicine at Mount Sinai School of Medicine in New York City, tells us you can also have a separate type of eczema without the presence of seborrheic dermatitis. “It can be difficult to differentiate,” he says. This type is contact dermatitis, and is triggered by a reaction to an irritating substance on the scalp (think: hair dyes or scented hair products).

Short-term use of topical corticosteroids made for the scalp may help. “They come in solution form. You can put a drop into your scalp, or more,” says Dr. Levy. “It’s more like a gel, almost like a mousse. Those are good for purely calming down the inflammation.”

But for both contact dermatitis and seborrheic dermatitis, it’s important not to itch your scalp: hair loss can occur with either condition.

“If there’s enough irritation you can get hair loss,” Dr. Levy cautions. “You can scratch and irritate your scalp, enough that can kill off the hair so you can lose hair.”

Eczema (dermatitis): A particular type of inflammatory reaction of the skin in which there is erythema (reddening), edema (swelling), papules (bumps), and crusting of the skin followed, finally, by lichenification (thickening) and scaling of the skin. Eczema characteristically causes itching and burning of the skin.

Atopic eczema, which is also called atopic dermatitis, is a very common skin problem. It may start in infancy, later in childhood, or in adulthood. Once it gets underway, it tends not to go quickly away.

There are numerous types of eczema, including:

  • Atopic dermatitis — a chronic skin disease characterized by itchy, inflamed skin
  • Irritant contact eczema — a localized reaction that includes redness, itching, and burning where the skin has come into contact with an irritant such as an acid, a cleaning agent, or other chemical
  • Allergic contact eczema — a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
  • Seborrheic eczema — a form of skin inflammation of unknown cause that presents as yellowish, oily, scaly areas of skin on the scalp, face, and occasionally other parts of the body
  • Nummular eczema — coin-shaped areas of irritated skin most commonly on the arms, back, buttocks, and lower legs that may be crusted, scaling, and extremely itchy
  • Neurodermatitis — scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched
  • Stasis dermatitis — a skin irritation on the lower legs, generally related to circulatory problems
  • Dyshidrotic eczema — irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.

How Is Eczema Treated?

The goal of treatment for eczema is to relieve and prevent itching, which can lead to infection. Since the disease makes skin dry and itchy, lotions and creams are recommended to keep the skin moist. These products are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching.

Over-the-counter products, such as hydrocortisone 1% cream, or prescription creams and ointments containing corticosteroids, are often prescribed to lessen inflammation. In addition, if the affected area becomes infected, your doctor may prescribe antibiotics to kill the infection-causing bacteria.

Other treatments include antihistamines to lessen severe itching, tar treatments (chemicals designed to reduce itching), phototherapy (therapy using ultraviolet light applied to the skin), and the drug cyclosporine for people whose condition doesn’t respond to other treatments.

The FDA has approved two drugs known as topical immunomodulators (TIMs) for the treatment of mild-to-moderate eczema. The drugs, Elidel and Protopic, are skin creams that work by altering the immune system response to prevent flare-ups.

The FDA has warned doctors to prescribe Elidel and Protopic with caution due to concerns over a possible cancer risk associated with their use. The two creams also carry the FDA’s “black box” warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe short-term use of Elidel and Protopic only after other available eczema treatments have failed in adults and children over the age of 2. It should not be used in kids under age 2.

Eczema: Prevention

Can eczema be prevented?

There are steps you can take to prevent eczema outbreaks:

  • Establish a skin care routine, and follow your doctor’s recommendations for keeping your skin healthy.
  • Wear gloves for jobs in which you have to put your hands in water. Wear cotton gloves under plastic gloves to absorb sweat, and wear gloves outside, especially during the winter months.
  • Use mild soap for your bath or shower, and pat your skin dry instead of rubbing. Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture. Reapply cream or ointment two to three times a day.
  • Take baths or showers with tepid (lukewarm) rather than hot water temperature.
  • Drink at least eight glasses of water each day. Water helps to keep your skin moist.
  • Try to avoid getting too hot and sweaty.
  • Wear loose clothes made of cotton and other natural materials. Wash new clothing before wearing. Avoid wool.
  • Avoid sudden changes in temperature and humidity.
  • Learn to recognize stress in your life and how to manage it. Regular aerobic exercise, hobbies, and stress-management techniques, such as meditation or yoga, might help.
  • Limit your exposure to known irritants and allergens.
  • Avoid scratching or rubbing itchy areas of skin.

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If you have a scalp, it’s going to itch at some point. That’s just part of being human. But if your scalp is often so itchy it makes you want to crawl out of your skin, you might have eczema. Yup, on the top of your head, of all places.

Eczema is a condition that can cause flare-ups of a red, scaly, itchy rash to appear on different parts of your body, according to the Mayo Clinic. It generally happens on areas of your body like your hands, feet, ankles, wrists, neck, upper chest, eyelids, elbows, and knees, but it can be anywhere—including under your hair.

You would think you couldn’t miss having eczema on your scalp, but people with this condition often mistake it for something else. “Many times, patients just assume it is a consequence they have to live with from their hair products, or that they have a dry scalp,” Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and founder of Dr. Bailey Skin Care, tells SELF. Here’s how to tell whether or not eczema is what’s really behind your irritated scalp.

Eczema is technically known as atopic dermatitis, and it can be a complete beast.

Dermatitis is a catch-all term for skin inflammation. Atopic dermatitis in particular might happen because of a gene variation that makes it difficult for the skin to stay adequately moisturized and provide protection from bacteria, irritants, and allergens, according to the Mayo Clinic. This can result in patches of dry, inflamed, burning, and itchy skin. These areas might ooze liquid and crust over if you scratch them, which is really just adding insult to injury.

If you experience these symptoms on your scalp, you might assume you have an especially bad case of dandruff, which can result in itching, scaliness, and flakes that drift down onto your clothes. In response, you might decide to wash your hair more often or use specialty anti-dandruff shampoos, but that can actually make things worse for a couple reasons.

One is that eczema is commonly associated with contact dermatitis, an allergic reaction that happens when your skin becomes red, itchy, and inflamed in response to a trigger. You can get this reaction even if you don’t have eczema and are using a shampoo, conditioner, or other hair product your skin doesn’t like, Dr. Bailey says. If you do have eczema and use a product your scalp isn’t into, you may be in for a world of irritation and sensitivity.

This is especially true if you take long, super-hot showers, are shampooing frequently to battle what you think is dandruff, or are scrubbing vigorously to do the same. Using anything hotter than warm water can worsen eczema, as can exposing yourself to water for more than 10 to 15 minutes at a time, according to the Mayo Clinic. Plus, scrubbing hard at scalp eczema can scratch your skin, which might just make your condition worse.

You might think you can’t have eczema if you’re only having issues with your scalp, but it’s possible. While it’s likely that having scalp eczema also means that you have it elsewhere, it’s not a requirement. “Sometimes eczema can be seen only on the scalp,” Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, tells SELF.

Translation: If you’re dealing with intense scalp irritation, don’t assume you can combat it on your own—get to a dermatologist as soon as you can.

Your dermatologist may be able to diagnose your eczema simply by looking at your scalp.

It’s really important to get the correct diagnosis, since there are other dermatological conditions that can cause an itchy scalp. Seborrheic dermatitis, for example, is a major cause of dandruff and has an entirely different treatment plan than eczema.

Eczema on the neck and the nape of the neck

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