Eczema (also called dermatitis) is an umbrella term for a group of common conditions that cause swollen, itchy, irritated, thick, or discolored skin.
There are seven kinds of eczema: atopic dermatitis, dyshidrotic eczema, contact dermatitis, discoid or nummular eczema, neurodermatitis, seborrheic dermatitis, and stasis dermatitis.
A few forms of eczema can cause symptoms on the scalp.
The most common form of eczema involving the scalp is seborrheic dermatitis.
It affects parts of the body with oil-producing sebaceous glands, including the face, head, chest, upper back, genitals, and armpits.
It is not contagious, and is very common: Up to 10% of Americans suffer from symptoms.
In infants, it is commonly called cradle cap.
Seborrheic dermatitis causes greasy, thick, or scaly patches that look yellow, red, or paler than the skin surrounding them.
Atopic dermatitis, or atopic eczema, can also occur on their scalp.
This type of eczema causes dry, red, itchy, and inflamed skin.
Excessive itching can lead to cracked, irritated, bleeding skin, and even infection.
Contact dermatitis can also affect the scalp.
There are two kinds of contact dermatitis: irritant contact dermatitis and allergic contact dermatitis.
Irritant contact dermatitis is the more common condition.
It occurs when someone’s scalp comes into direct contact with an irritating chemical or substance, such as harsh cleaning chemicals or certain metals.
Allergic contact dermatitis occurs when an object or substance causes an allergic reaction that triggers the immune system.
This leads to symptoms or rash, itching, and potentially blisters or fluid drainage.
Allergic contact dermatitis is the skin reaction to poison ivy, for example.
Hair dye and other hair products can trigger either type of contact dermatitis on the scalp.
If you or your child is experiencing scalp eczema, some treatments can help you manage symptoms and soothe skin for the long term.
In this article, I’ll explain what causes scalp eczema, the symptoms you or your child may experience, and how a doctor or healthcare professional will diagnose it.
I’ll outline some risk factors and triggers for eczema on the scalp, as well as some treatment options and prevention tips.
And I’ll tell you when you should see a doctor about your condition.
What Causes Scalp Eczema?
The exact cause of eczema is still unknown.
Dermatologists believe it is related to the immune system, family history, and environmental factors.
The condition affects both adults and young children, and can get better over time or become a life-long condition.
Seborrheic dermatitis, the most common form of eczema on the scalp, is related to a hypersensitive immune system’s inflammatory response to Malassezia, an ordinarily harmless type of yeast that naturally occurs on human skin.
For most people, Malassezia is a natural part of the skin’s microbiome.
It thrives in areas with excess oil (sebum), and after it feeds, it leaves behind a chemical called oleic acid.
When people are sensitive to oleic acid or develop an overgrowth of this natural yeast, their immune system can overreact.
This excessive immune response is thought to lead to the classic symptoms of seborrheic dermatitis.
For those with atopic dermatitis, irritant contact dermatitis, or allergic contact dermatitis, exposure to specific environmental triggers may cause scalp eczema to flare.
These can include fragrances or dyes, excessive dryness, and other factors.
Tracking your symptoms to identify what initiates and exacerbates them can help you reduce symptoms over time.
What Are The Symptoms Of Scalp Eczema?
Symptoms of scalp eczema can vary depending on your age, general health, underlying cause, and severity of the condition. For some, the disease is just a mild nuisance.
For others, it can cause significant symptoms that interfere with daily life.
Depending on the condition causing their symptoms, people with scalp eczema often experience:
- Greasy patches of thick, yellow, pink, or red scales
- Flaky skin, or scales that flake off when they are scratched
- Crusty skin
- Itchy scalp
- Dry scalp
- Red skin
- Burning skin, tender skin, or skin pain
- Infection-prone skin
- Thick, leathery skin
- Cracking skin
- Blisters or bumpy rash
“Scalp eczema” may not be limited to the scalp.
Symptoms may appear on the head or hairline, on the sides of the nose and cheeks, on the eyelids, eyebrows, ears, upper chest and back, genitals, and underneath the breasts.
An infant with cradle cap may have symptoms on their scalp, face, upper chest, back, and sometimes in the diaper area or armpits.
People who have weakened immune systems are more likely to develop severe cases, with symptoms of eczema appearing on multiple parts of their body.
Scalp Eczema vs. Dandruff
Dandruff is a common skin condition with symptoms limited to the scalp, hairline, eyebrows, and facial hair.
It can result in an itchy scalp or scaly, crusty patches on the skin that flake off when they are scratched.
In general, dandruff causes small, dry flakes, but not the thick, greasy patches and flakes of scalp eczema.
However, there is some overlap.
Most dandruff is a mild form of seborrheic dermatitis, but occasionally, irritant contact dermatitis, allergic contact dermatitis, or other skin conditions like ringworm or psoriasis cause similar symptoms.
Scalp Eczema vs. Scalp Psoriasis
Scalp eczema and scalp psoriasis can look very similar, but a trained dermatologist or other healthcare provider will be able to tell the difference and suggest the correct treatment.
It sometimes requires a skin biopsy to tell the difference.
Patients with both conditions can have red, scaly skin, but those with psoriasis have thicker, drier skin, and silvery scales.
People with psoriasis may experience soreness or pain as a part of their condition, and may find that their skin is more challenging to treat than those with eczema.
If you or your child are experiencing symptoms of seborrheic dermatitis—or another form of scalp eczema—make an appointment with a trained healthcare provider to help manage your condition.
A dermatologist or your primary care physician can help determine the cause of your symptoms and suggest the right treatment.
At your appointment, your doctor will ask you questions about your scalp condition, family history, and any allergic reactions you may have to environmental triggers.
They will note your symptoms and examine your skin, and may take a small biopsy.
Once you have a diagnosis, your doctor may recommend an appropriate mix of prescription medications, over-the-counter products, and lifestyle changes to treat symptoms and give you long-term control over the condition.
For some, this is a chronic condition that can cause long-standing symptoms or recurrent flare-ups even with treatment.
Even in these cases, there are treatment options that can minimize flare-ups and keep your symptoms manageable.
Risk Factors and Triggers
Although anyone can develop eczema at any age, symptoms of seborrheic dermatitis most often affect infants, or people 30-60 years old.
For adults, scalp eczema can be triggered by stress, hormonal changes, exposure to cold or dry air or changing temperatures, certain medications, and exposure to strong fragrances, dyes, or other irritants.
Certain chronic diseases put you at higher risk for developing eczema:
- Heart attack
- Parkinson’s disease
Patients with a family history of atopic dermatitis, allergies, hay fever, or asthma are more likely to develop atopic dermatitis on their scalp or other areas of their body.
Common triggers include:
- Household detergents and cleaning chemicals
- Soaps and shampoos
- Food allergies
- Wool, polyester, nylon, and nickel
- Hormonal changes
Those who regularly work with chemicals (including hairstylists) or come into contact with cosmetics, nickel, harsh soaps, fragrances, or poison ivy are also at risk for irritant or allergic contact dermatitis.
If you have scalp eczema, you don’t have to manage it on your own.
There are several products designed to treat scalp eczema including shampoo, topical creams, and hair care products with active ingredients to improve your condition.
Talk to your doctor or healthcare provider about the best eczema treatment plan for you, especially before using any new products.
If you are diagnosed with eczema of the scalp, your provider may prescribe medicated creams, lotions, gels, or pills to help you counteract your condition.
Common medications include:
- Topical corticosteroids: Topical steroids can calm skin inflammation and irritation. These are available in over-the-counter and prescription forms.
- Medicated shampoo: These are available in prescription and over-the-counter forms, and include several types of dandruff shampoos and coal tar treatments like T-Gel.
- Antihistamine medications: Patients with contact dermatitis may find that taking an antihistamine like diphenhydramine (Benadryl) helps reduce inflammation and skin irritation.
- Oral antibiotics: When a patient has infected blisters, or an oozing, tender, or painful scalp, their provider may suggest an oral antibiotic or an antibiotic cream to treat any bacterial infection that may be complicating their condition. Oozing or blisters due to contact dermatitis do not typically need an antibiotic.
- Antifungal medications: Antifungal shampoo, liquid, cream, may be used to treat seborrheic dermatitis. Sometimes an oral antifungal may be used. These include over-the-counter and prescription options.
- Oral steroids: In severe cases, patients may benefit from taking an oral steroid.
Natural remedies can help heal your scalp if you have a mild case of eczema and augment a doctor-recommended treatment plan if you have a more severe condition.
Talk to your doctor before trying any home remedies.
- Washing with baking soda or apple cider vinegar: If contact or atopic dermatitis is causing scalp eczema and even hypoallergenic options seem to irritate the scalp, a mixture of warm water and baking soda, followed by diluted apple cider vinegar, can cleanse hair without aggravating the skin. For some, though, these can cause irritation, so speak with your healthcare provider before trying any home remedies, especially if you have raw or irritated skin.
- Moisturizing with coconut or mineral oil: Some experts suggest applying coconut or mineral oil overnight as a scalp moisturizing treatment. Olive oil used to be recommended, but is no longer considered an effective option. These can cause irritation or allergies in some cases, so try a small area first, and speak to your healthcare provider.
Living a healthy lifestyle can help you reduce symptom flare-ups.
Tracking and avoiding the substances that trigger your symptoms can also help you keep your condition controlled.
- Eat a healthy diet
- Get plenty of physical activity
- Meditate and manage stress
- Avoid fragrances, dyes, and harsh detergents or soaps
- Avoid hair and skin products with alcohol or other harsh ingredients
- Test hair dye and other new products on a small area of skin before applying to your scalp
- Wear cotton clothing and other natural fibers
- Stay well-hydrated
- Avoid tobacco smoke, vaping, alcohol, and recreational drugs
- Avoid exposure to known allergens
Depending on your condition, you may benefit from special eczema shampoo, antifungal shampoo, or shampoo that is hypoallergenic or has mild ingredients.
A healthcare provider can suggest the right shampoo for you.
Common active ingredients include:
- Amino acids: These help improve the skin’s natural barrier.
- Beta-hydroxy acid: This acid helps dissolve excess oil and remove dead skin cells. It can be particularly helpful to patients who have seborrheic eczema.
- Coconut oil: This oil can moisturize the scalp (but can cause irritation or worsening symptoms in some).
- Piroctone olamine: This antimicrobial agent can help soothe itch and address flaking.
- Pyrithione zinc (Zinc pyrithione): An antifungal, antimicrobial, and antibacterial ingredient, pyrithione zinc addresses eczema, psoriasis, and dandruff.
- Salicylic acid: This acid breaks down dead skin cells to reduce dry, flaky scalp and control itching.
- Coal Tar: When used in shampoo, this ingredient soothes the scalp and helps the body shed dead skin cells.
If you are sensitive to specific ingredients or fragrances, or you are shampooing your infant’s head, it is best to use a baby product that is mild, tear-free, and non-medicated (unless your provider recommends otherwise).
There is no way to prevent scalp eczema completely, but if you have the condition, you can take steps to reduce your chances of experiencing a flare-up:
- Avoid chemical irritants or other triggers
- Manage stress as much as possible
- Stay hydrated
- Eat a healthy diet
- Avoid tobacco smoke and vaping
- Exercise regularly
- Moisturize your skin and scalp
Getting an accurate diagnosis and following your healthcare provider’s recommendations is best to prevent eczema symptoms.
When To See a Doctor or Healthcare Provider
Scalp eczema may be chronic, but patients can successfully manage symptoms with the proper diagnosis and treatment plan.
If your condition is disrupting your life or causing you to be uncomfortable, embarrassed, or anxious, call your primary care provider or a provider specializing in skin conditions and make an appointment to be evaluated.
If your scalp begins to display red streaks, ooze pus, or crust over, that may be a sign of an infection that requires immediate medical intervention to address. ‘
Also, if you have itchy skin and begin to develop a fever, tightness in your chest, cough, wheeze, begin to lose your voice, or have swelling or tingling in your face, tongue, lips, or throat, you are experiencing a medical emergency.
Call 9-1-1 or go to your nearest hospital.
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