How Scalp Atopic Dermatitis Differs From Other Skin Conditions

Atopic dermatitis—aka eczema—can make your skin feel dry, red, and itchy. Unfortunately, your scalp isn't immune to the effects of this condition, even though it's covered in hair. But atopic dermatitis isn't the only skin condition that can affect your scalp. Other conditions include psoriasis and dandruff.

Here's what you need to know about scalp atopic dermatitis, including how it's different from other scalp conditions like psoriasis and dandruff, how to spot it, and how it's treated.

What Is Scalp Atopic Dermatitis?

The term "atopic" means something sensitive to allergens, and "dermatitis" describes inflammation or irritation (-itis) of the skin (derm).

"It's an intrinsic defect of the skin barrier," Dendy Engleman, MD, FAAD, a board-certified dermatologist in New York, told Health. Essentially, people with eczema have super sensitive skin, and the condition can cause patches of very itchy, red skin that look dry and cracked.

Atopic dermatitis is often seen during childhood but can show up at any age. It can be found in the elbows, the bend of the knee, the neck, the ankles and feet, the skin around the eyes, the hands, and the scalp.

Scalp atopic dermatitis is eczema that affects the skin on top of your head. "It's rarer, but we do see patients who have [eczema] on their scalp," Emma Guttman-Yasky, MD, PhD, the Waldman professor of dermatology and immunology and system chair department of dermatology at the Icahn School of Medicine at Mount Sinai, told Health.

Patients who have severe eczema on many other parts of their bodies can often get it on their scalp, added Dr. Guttman-Yasky.

Eczema vs. Psoriasis and Dandruff

What many people think is scalp eczema—or atopic dermatitis—is often actually one of two other conditions, said Dr. Guttman-Yasky: psoriasis or seborrheic dermatitis—aka dandruff.

These conditions are often mistaken for each other because they have very similar symptoms—red, itchy, dry patches of skin. But the three conditions are different. Here's a quick overview.

• Atopic dermatitis is an inflammatory skin disease that causes rashes to break out over certain parts of the body. A mix of genetic and environmental factors triggers it. It makes the skin incredibly sensitive, added Dr. Engleman, and more at risk of infections.
• Psoriasis is a chronic condition that causes itchy, scaly patches on the skin, including the scalp. There are a few subtypes, but the most common type of psoriasis causes dry, raised patches covered in scaly skin. It's believed to be caused by a faulty immune response, which forces skin cells to grow faster than normal. Genetics can also play a role.
• Seborrheic dermatitis is an inflammatory condition caused by yeast overgrowth on the scalp. It can occur in hair-bearing areas, said Dr. Engelman, including the scalp, eyebrows, and chest. It can cause skin flakes, patches of greasy skin covered with scales, and itching and is typically treated with antifungal medications.

Symptoms

All three conditions—atopic dermatitis, psoriasis (and scalp psoriasis), and seborrheic dermatitis—can present similarly with itchy, dry patches of skin. Here are some of the symptoms closely related to scalp atopic dermatitis.

• Extreme itchiness: This is the hallmark of any form of atopic dermatitis, said Dr. Guttman-Yasky. "The patients with eczema on the scalp, they will itch it," to the point of leaving wounds that bleed on their scalp, added Dr. Guttman-Yasky. "If it doesn't itch, it's unlikely to be eczema."
• Skin flakes: Like seborrheic dermatitis, scalp atopic dermatitis can cause skin flaking, said Dr. Guttman-Yasky. This can be due to the dryness of the skin there or from people scratching at the itchy skin for relief.
• Temporary hair loss: This can sometimes happen with scalp eczema, said Dr. Guttman-Yasky. "But usually when we treat them well, [the hair] should come back because the follicles should still be there," added Dr. Guttman-Yasky.
• Thick patches: After years of scratching, a person with atopic dermatitis can develop permanent patches of skin that are thicker than the surrounding skin. However, this might be trickier to spot on your scalp if covered by lots of hair.

Atopic Dermatitis Causes

Atopic dermatitis is generally a complex condition with a variety of causes and risk factors, said Dr. Engleman. It's often genetically inherited, noted Dr. Engleman, so if your mom or dad has it, you're more likely to develop it too. People with eczema also often have genetic mutations that affect how effective the skin barrier is at protecting you from germs, irritants, and other pathogens.

Eczema also seems to be influenced by something called the atopic triad, said Dr. Engleman—seasonal allergies, asthma, and eczema. People with eczema often also have seasonal allergies and/or asthma. Environmental factors such as pollution can play a role too.

No matter the cause, the result is that people with eczema have super sensitive skin that overreacts to things that aren't supposed to be irritating, said Dr. Engleman. In the case of the scalp, the eczema flare-up happens to occur on the scalp. Having an existing flare-up of eczema affecting large parts of your body can potentially eventually involve the scalp, according to Dr. Guttman-Yasky.

Treatment and Prevention

Because it can easily be confused with other skin conditions, eczema is not something you should self-diagnose. If you think you have scalp eczema, it's a good idea to see a board-certified dermatologist. These experts can properly diagnose you and provide the correct treatment—which will require a prescription.

Dr. Guttman-Yasky said that it is common to prescribe a combination of topical steroids (potent anti-inflammatories) and salicylic acid (a common skin-care ingredient used to facilitate skin cell growth, unclog pores, and more) for people with true atopic dermatitis on their scalps. This combo helps remove any scaly buildup caused by eczema while combatting itchiness, noted Dr. Guttman-Yasky.

If a person's eczema is all over the body, not just the head, or is particularly severe, Dr. Guttman-Yasky said that a dermatologist might opt for a systemic medication.

A dermatologist might also recommend you change some aspects of your hair-care routine to help reduce itching and reduce the risk of future flare-ups. "We recommend mild shampoos with a minimum amount of preservatives," said Dr. Guttman-Yasky. Ingredients like perfumes and fragrances can be irritating to sensitive, eczema-prone skin.

Look for brands that say they are preservative-free, or look at the label to make sure it doesn't have any of the following:

• Fragrance
• Formaldehyde
• Formaldehyde-releasing ingredients like DMDM hydantoin

People who have or frequently get scalp eczema should also avoid going overboard on hair treatments, like tons of blow-dries or regular bleaching, added Dr. Guttman-Yasky. These treatments are harsh and could unnecessarily irritate a sensitive scalp.

A Quick Review

While it may be less common than seborrheic dermatitis or psoriasis, atopic dermatitis on the scalp can still happen—and requires a dermatologist's help. Without the aid of a skin specialist, it's hard to tell these conditions apart from one another based on your symptoms.

So if you have unbearable itching on your head (or any other part of your body, for that matter), make an appointment with a dermatologist or other healthcare provider.