Scalp Eczema

The scalp can be affected by several different types of eczema, including seborrhoeic dermatitis, atopic eczema, allergic contact dermatitis and irritant contact dermatitis.

Aside from eczema, there are a number of other conditions that can cause the scalp to become dry and itchy (for example, psoriasis, fungal infection, ringworm and head lice). It’s important to get a firm diagnosis if there is any uncertainty.

Symptoms

Dry, itchy, scaly and inflamed skin

On lighter skin tones, scalp eczema will appear red

On darker skin tones, it will show lighter or darker in colour than the surrounding skin

When scalp eczema flares, it may be weepy and painful

There may be dandruff, which can vary in severity

A rash may also appear on other parts of the face, such as around the eyebrows, eyelids and sides of the nose

Types of eczema that affect the scalp

If you aren’t sure what types of eczema you have, here are all of the types of eczema that commonly affect the scalp.

Seborrhoeic dermatitis  - This is one of the most common types of eczema seen on the scalp and hairline. It can affect babies in the form of cradle cap, as well as children and adults. In people with lighter skin tones, the skin appears scaly and red. In people of colour, affected areas may be scaly and lighter in colour than the surrounding skin and may have no redness. There is often dandruff as well, which can vary in severity. There may also be a rash on other parts of the face, such as around the eyebrows, eyelids and sides of the nose. Seborrhoeic dermatitis can become infected.

Atopic eczema is another common type of eczema that can affect the scalp at any age. The skin is dry, itchy and inflamed, and can easily become infected, especially if scratched and when there is broken skin.

Allergic contact dermatitis occurs when the immune system in the skin overreacts to a chemical that has, until this point, not caused any reaction.

Irritant contact dermatitis is a type of eczema that occurs when the skin’s surface is irritated by a substance that causes the skin to become dry, itchy and inflamed (not an allergic reaction).

Treatments

Emollients - Medical emollients can be applied to the scalp by parting the hair and massaging them into the skin. Ointment-based emollients are not suitable as they are grease-based and difficult to wash out. Emollients in lotion, gel and spray-on oil forms; for example, E45 lotion, Doublebase gel or the spray-on oil, Emollin, may be suitable.

Oils - Coconut oil can also be applied to the scalp. This can also be bought in pharmacies like emollient creams. It comes as a solid form that melts at skin temperature. Olive oil is no longer recommended as it has been found to damage the skin barrier.

Salicylic acid and tar - If the scalp is very scaly, a salicylic acid and tar preparation (for example, Cocois or Sebco) can be applied in the same way and left in place for at least 4 hours, but an overnight application is more effective. These scalp treatments are messy, so make sure you use a couple of old pillowcases to absorb the excess! In the morning, simply shampoo out the treatment.

Topical steroids - Topical steroids designed for use on the scalp can be prescribed. Lotion, mousse or gel preparations may be the most comfortable options for the scalp – for example, Elocon lotion, Bettamousse or Synalar gel. For young children, a mild topical steroid cream, such as 1% hydrocortisone, may be prescribed for a short treatment burst. For older children, a moderate topical steroid, such as Eumovate, may be prescribed.

All treatments

Triggers

Hair products – Try to avoid shampoos and other hair products (such as gels, sprays, hair dyes and perm solutions) that are fragranced, as these may cause irritation and possibly allergy.

Hair extensions – the glue in hair extensions can irritate the scalp, so they are best avoided

Headgear - Swimming caps and hair nets, especially those containing rubber along with hair clips which may contain rubber or nickel

All triggers

FAQs

Read the FAQ’s below for advice on washing hair and recommendations for shampoos.

If scalp eczema extends onto the hairline and face, different strengths of topical steroid will be required, as less potent topical steroids are advised for the face. If the scalp is inflamed and scaly, topical steroids combined with salicylic acid can be helpful (for example, Diprosalic Scalp Application). If scalp eczema is infected, oral antibiotics may need to be prescribed.

Please note: we are not recommending particular prescription-only topical steroids, but giving examples.

People often prefer to moisturise the scalp in the evening, using a cotton turban or shower cap to keep the emollient in overnight, and then rinse the product out in the morning (see the section below on washing hair).

If you have scalp eczema, normal shampoos containing detergents and fragrance are likely to irritate your scalp. It is important that you either find a less irritant shampoo (for example, E45 Dry Scalp Shampoo or Eucerin DermoCapillaire Calming Urea Shampoo) or simply use an emollient to wash your hair. Lotion emollients are advised as they mix well with water, but they may leave the hair slightly greasy and limp, especially if it is fine. Conditioners can also irritate the scalp, so are best avoided. Try to avoid shampoos and hair products that are fragranced, as these may cause irritation and possibly allergy. Use hair dryers on a cool setting; hot air will increase dryness and itch.

There are several medicated shampoos available for treating scalp problems, which may help in managing scalp eczema. However, these need to be selected carefully, and washed off thoroughly to avoid irritation. The following are examples: Dermax Therapeutic Shampoo contains a mild antiseptic, benzalkonium chloride, and helps to reduce scale. Neutrogena T/Gel Therapeutic Shampoo is a gentle tar shampoo. Capasal contains salicylic acid, coconut oil and tar, which may help a very scaly scalp.

Seborrhoeic dermatitis should be managed with shampoos especially designed to reduce the yeast element and characteristic flaking (for example, Ketoconazole shampoo and shampoos containing selenium sulphide or zinc pyrithione). Anti-yeast shampoos should be used once a week as an ongoing preventative measure for adult seborrhoeic dermatitis. It is neither necessary nor advisable to use anti-yeast shampoos for other types of eczema.

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