Scalp eczema
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Types of eczema that affect the scalp
Introduction
The scalp can be affected by several different types of eczema. Scalp eczema may be dry, itchy,
scaly and inflamed (showing as red on lighter skin tones and areas that are lighter or darker in
colour than the surrounding skin on darker skin tones). In an eczema flare phase, it may also be
weepy and painful.
Apart from eczema, there are a number of conditions that can cause the scalp to become dry and itchy (for example, psoriasis, fungal infection, ringworm and head lice). It is important to get a firm diagnosis if there is any uncertainty.
Types of eczema that affect the scalp
Seborrhoeic dermatitis 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. See National Eczema Society’s factsheets on Seborrhoeic dermatitis in adults and Seborrhoeic dermatitis and cradle cap in infants for more information.
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. For an allergy to develop, repeated exposure to the chemical is required over a period of time, usually months or years. Everyday items that can cause allergic contact dermatitis on the scalp include the following:
- Shampoos, conditioners, gels, sprays and other hair products
- Hair dyes, perm solutions, hair extension glue
- Swimming caps, hair nets – especially those containing rubber
- Hair clips and headgear – especially those containing rubber or nickel.
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). For example, shampoos, mousses, hair gels, hair spray, perm solution and fragrance can all cause irritant contact dermatitis. See National Eczema Society’s booklet, All about Contact Dermatitis, for more information on allergic and irritant contact dermatitis.
Treatment
Treatment of scalp eczema will depend on the type diagnosed by your doctor. Below are possible treatments that may be prescribed.
Moisturising the scalp
The skin on the scalp requires moisturising just like the body, but it can be difficult to get beyond the hair to the scalp. 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. Coconut oil is another option, which, like emollient creams, can be bought in pharmacies. 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.
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 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.
Treating flares
When scalp eczema flares up, the treatment is similar to treatment for other body areas. Try to treat the scalp and not the hair – part the hair and massage treatments onto the scalp.
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. It is important to use topical steroids for a prescribed treatment course – usually up to 2 weeks. For more information, see National Eczema Society’s factsheet on Topical steroids.
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.
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.
To obtain the information on this page in a PDF format, please download our Scalp eczema factsheet, below. For more information on haircare and eczema, please download the article from our magazine, Exchange, ‘Haircare and eczema’ (June 2018), below.