What Is Scalp Eczema, and How Do Treat It?

Eczema can affect any part of your body, including your scalp. Seborrheic dermatitis, the most common type of scalp eczema, causes scales and flaking on areas of your body with many sebaceous (oil) glands. Treatment typically includes medicated shampoos and moisturizers.

Eczema affects nearly 30% of people in the United States, and 4% have seborrheic dermatitis. Read on to learn what scalp eczema is and how to treat it.

Scalp Eczema Symptoms

Eczema is a general term that includes skin conditions that cause inflammation of the skin. Different types of eczema may affect your scalp, the most common being seborrheic dermatitis.

Seborrheic dermatitis symptoms include:

• Greasy and oily skin
• Itching
• Large plaques
• Redness
• Skin lesions with scales that are typically white and flaking or yellow and sticky

Symptoms vary based on skin tone. People with lighter skin may have skin lesions that are red and scaly. In contrast, people with darker skin might notice scaly lesions lighter than their natural skin tone.

Seborrheic dermatitis affects body parts with many sebaceous glands, which produce oil. In addition to your scalp, you may notice symptoms on your ears, eyebrows and eyelids, lips, the center of your chest, and the creases of your nose.

Other types of eczema that affect the scalp include atopic dermatitis and contact dermatitis. Both cause a dry, inflamed scalp that is itchy and painful. Your scalp might become infected if you scratch it too much.

Symptoms in Infants

Seborrheic dermatitis is known as cradle cap when it affects infants. You might notice thick brown or yellow scales on your infant's scalp that crust. Your infant may scratch their scalp, causing it to become red and bleed and crust. Those are signs of an infection.

What Causes Eczema on the Scalp?

The exact cause of scalp eczema, including seborrheic dermatitis, is unknown. Research has shown that people with eczema may have a genetic mutation that weakens their skin barrier. Your skin typically protects you against harmful substances. In contrast, allergens and irritants may cross the skin barrier and cause symptoms in people with eczema. That genetic mutation also leads to water loss, which drys out the skin.

An imbalance of microbes on the scalp may cause seborrheic dermatitis. Malassezia is a yeast (fungus) that usually lives on parts of your skin with many sebaceous glands. Some evidence suggests that seborrheic dermatitis symptoms occur when there's an overgrowth of Malassezia. Overactive sebaceous glands may also cause seborrheic dermatitis.

Risk Factors

Anyone can develop scalp eczema, but some are likelier than others. Your risk might increase if you have:

• Alcohol use disorder (AUD)
• Allergies to certain ingredients in haircare products (e.g., shampoos, conditioners, and hair dyes)
• Exposure to haircare and skincare products that contain alcohol
• Fatigue
• HIV/AIDS
• Nervous system disorders (e.g., brain injuries, Parkinson's disease, and stroke)
• Obesity
• Dry or oily skin
• Stress

Extreme weather changes and exposure to cold, dry air may trigger scalp eczema in some people. Taking showers or baths and swimming frequently may also dry out and irritate your scalp.

How Is Scalp Eczema Diagnosed?

A healthcare provider can diagnose scalp eczema based on your health history and symptoms. Still, it might be difficult to differentiate between different types of scalp eczema, Ross Levy, MD, a dermatologist at Northwell Health, told Health. You might have more than multiple types of eczema at one time.

You might require further testing to confirm or rule out different types of eczema and other skin conditions. Diagnostic tests include:

• Allergy skin testing: This helps determine if a certain substance is causing your scalp eczema. A healthcare provider will apply different allergens to your skin and see if you develop a reaction.
• Fungal culture test: A healthcare provider might use this test to rule out a fungal infection. They might collect blood, urine, or skin samples for testing.
• Skin biopsy: A healthcare provider will remove a small sample of the affected area for testing.

Treatments for Scalp Eczema

Eczema is long-lasting (chronic) and does not have a cure. Instead, the goal of treatment is to alleviate painful symptoms and reduce scales and flaking.

Scalp eczema treatments include:

• Moisturizers: Try using an emollient, a moisturizing ingredient, or a salicylic acid and tar solution to moisturize your scalp. Part your hair and then massage the treatment into your scalp. Work in sections.
• Phototherapy: This exposes your scalp to ultraviolet (UV) light to reduce symptoms. However, it is difficult to perform on the scalp unless a specific UV device with a comb attachment is used. Some people notice their symptoms improve after spending time outdoors during the warmer months.
• Topical steroids: Short-term use of topical steroids, such as 1% hydrocortisone, made for the scalp to help tame flares. Only use this treatment for no longer than two weeks. Contact a dermatologist if your symptoms persist for longer than that.

What Is the Best Treatment for Eczema on the Scalp? 

Medicated shampoos are among the best treatments for scalp eczema. These treatments are easy to use and might also prevent flares.

Look for shampoos with ingredients like:

• Ketoconazole
• Salicylic acid
• Selenium sulfide
• Tar
• Zinc pyrithione

Those ingredients help reduce scales and yeast. Of note: Tar shampoos might cause discoloration in people with lighter hair or bleach- and color-treated hair. You might also wash your hair with an emollient, a moisturizing ingredient that soothes and softens the skin, mixed with water if you have medium to thick hair. Emollient may make your hair appear greasy if it's fine.

How To Prevent Scalp Eczema

Scalp eczema symptoms often come and go. Although there's no cure, you can take steps to help prevent flares and complications like infections and hair loss.

Ways to prevent scalp eczema include:

• Avoid triggers: Make a note of what causes your symptoms to flare, such as certain haircare products, cold weather, or hot showers. Take precautions to avoid those triggers as much as possible.
• Choose your haircare products carefully: Avoid scented shampoos and conditioners or ones that contain alcohol or detergents. Limit your use of other products, such as gels and sprays.
• Do not scratch: It's important not to itch your scalp, said Dr. Levy. Scratching might cause irritation that leads to infections and hair loss.
• Keep your scalp warm in cold weather: Cold, dry weather may irritate your scalp. Wear a hat if you are outdoors.
• Minimize your stress: Scalp eczema can be uncomfortable. As a result, you may become stressed, which worsens symptoms. Try deep breathing or meditation to help alleviate stress. 
• Talk to a dermatologist: Make sure that you use medicated shampoos or other treatments as often as a dermatologist instructs you. 
• Wash your scalp gently: Try showering or bathing and washing your hair only as needed. Massage medicated shampoo into your scalp gently when you wash your hair. Rinse it thoroughly.

A Quick Review

Scalp eczema, most commonly caused by seborrheic dermatitis, causes inflammation of the scalp. You might have rashes or white or yellow scales that are flaking or sticky. Symptoms often come and go; certain substances, such as cold weather, haircare products, and hot showers, can trigger flares.

Talk to a dermatologist if you have scalp eczema. They might advise medicated shampoos, moisturizers, or light therapy. Topical steroids may alleviate flares. Avoiding triggers, not scratching your scalp, and gently washing your hair help prevent flares.