The most common type of scalp eczema is known as seborrheic dermatitis, and its most unwelcome symptom is dandruff. When a baby’s scalp gets this scaly, flaky skin, it’s often called cradle cap. (1)
Red and scalyFlakyGreasy or waxyVery itchy or feel like it’s burningOozing or have “weeping” lesionsCausing a discharge from the ear if eczema continues from the scalp into the ear canalCausing changes in skin color after healing (2,3)
Other skin conditions — such as psoriasis, allergic contact dermatitis (inflammation caused by an allergic reaction to a certain substance), atopic dermatitis (which often occurs in those with asthma or seasonal allergies), and folliculitis — may cause symptoms similar to those of scalp eczema. (4) People commonly confuse psoriasis and scalp eczema — but know that psoriasis usually has a whiter scale compared with scalp eczema, and psoriasis leads to sensitive skin patches that easily bleed when scratched. In some cases, scalp eczema and psoriasis can happen together. (5) Because seborrheic dermatitis is a condition related to the sebaceous glands, it can also appear in other oily areas of the skin, including the face (eyebrows, eyelids, and center of the face), ears, upper chest, upper back, armpits, and genitals. (3) There is a strong association between seborrheic dermatitis and yeast of the genus Malassezia, which are normally present in the skin but often overgrown in people with the skin condition. Scientists don’t fully understand the exact connection between the yeast and eczema symptoms, but research suggests that a nonspecific immune reaction may be to blame. That is, some interaction between Malassezia, their metabolites (substances produced during metabolism), and skin and immune cells results in an inflammatory reaction. (4,6) Importantly, once someone becomes sensitized to Malassezia, the yeast will always cause an immune reaction. (7) Some other potential triggers for scalp eczema:
Hormonal changesIllnessStressHarsh chemicals from detergents and soapsHeavy alcohol use or alcohol-based lotionsMedications such as psoralen (for psoriasis), interferon, and lithiumHeavy sweatingExposure to an allergen
You have an increased risk of developing scalp eczema if you have these conditions:
Nervous system disorders, including Parkinson’s disease, traumatic brain injury, stroke, and epilepsyHIV/AIDSOther skin conditions, like psoriasis, rosacea, or acneAllergies or a family history of allergies, like hay fever, asthma, and atopic dermatitisObesityDepression or eating disorders (2,8,9)
For example, you can usually treat irritation and an itchy scalp with a medicated, over-the-counter dandruff shampoo. The chemical ingredients in these shampoos can help ease the inflammation and get rid of flaky, scaly skin when used two or three times a week. Look for these items:
Salicylic acidCoal tarZincResorcinolKetoconazoleSelenium sulfide
Topical creams, ointments, or sprays made from these ingredients can also be applied to help calm the irritation and stop the flaking. If you have severe scalp eczema, your doctor may prescribe products containing stronger doses of the aforementioned medicines or medicines containing other ingredients, such as corticosteroids, ciclopirox, sulfacetamide sodium, Protopic (tacrolimus), or Elidel (pimecrolimus). (2,9) To manage scalp eczema and help prevent flare-ups, do your best to follow these recommendations:
Avoid exposure to any suspected irritants and allergens.Clean your scalp thoroughly, but avoid drying it out by using only a quarter-sized dollop of a gentle shampoo and warm, never hot, water.Manage stress well.Shampoo your hair after sweating heavily, such as after a workout, since perspiration can be a trigger.
Scalp eczema often responds to treatment, but it also often returns. For some people, exposure to the sun may improve symptoms. Be on the lookout for signs of a flare-up and start treatment right away. (2,8,9) But as always, consulting a professional can help you manage this skin condition. In particular, you may want to see a dermatologist to help identify the triggers for scalp eczema and get a prescription treatment if the remedies you’ve tried aren’t effective. Importantly, see your dermatologist as soon as possible if your eczema-related skin patches drain fluid or pus, form crusts, or become very red or painful. (9) Additional reporting by Diana Rodriguez.
