About scalp eczema
The scalp is an area of the body that can be affected by several types of eczema. Types of eczema that can affect the scalp include: seborrhoeic dermatitis, atopic eczema, allergic contact dermatitis and irritant contact dermatitis. The scalp may be dry, itchy and scaly in a chronic phase and inflamed (red), weepy and painful in an acute (eczema flare) phase. Apart from eczema, there are a number of other conditions that can make the scalp dry and itchy (e.g. psoriasis, fungal infection, ringworm, head lice etc.), so it is wise to get a firm diagnosis if there is uncertainty.
How is it treated?
Treatment of scalp eczema will depend on the type diagnosed by your doctor. Below are possible treatments that may be prescribed:
Moisturising creams or spray-on oils can be applied to the scalp by parting the hair and massaging them into the skin. Medical emollients in lotion, gel and spray-on oil forms, for example, Diprobase lotion, Doublebase gel, and 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; as an alternative, non-fragranced mineral oil (baby oil) is recommended.
People often prefer to moisturise the scalp in the evening, using a cotton turban or shower cap to keep the moisturising cream or oil in overnight, and then rinse the product out in the morning. If the scalp is very scaly, a salicylic acid and tar preparation (for example, Cocois or Sebco) can also 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 an old pillowcase! In the morning, simply shampoo out the treatment.
In the acute phase of scalp eczema (i.e. when the eczema flares) 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. Some have an alcohol base, which can cause stinging, so a lotion, mousse or gel preparation may be a more comfortable option.
If the scalp is scaly and inflamed, topical steroids combined with salicylic acid can be helpful.
What can I use to wash my hair?
If you have dry, itchy skin and scalp eczema, normal shampoos containing detergents and fragrance are likely to irritate your scalp. Therefore, it is important that you either find a less irritant shampoo (e.g. E45 Dry Scalp Shampoo or Eucerin DermoCapillaire Calming Urea Shampoo) or simply use water with the optional addition of bicarbonate of soda mixed into a thin paste or an emollient bath oil.
Conditioners can also irritate the scalp, so are best avoided. Avoid all shampoos and hair products that are fragranced, as these will cause irritation and possibly allergy. Use hair dryers on cool settings; hot air will increase dryness and itching.
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; T-Gel 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 flaking in seborrhoeic dermatitis of the scalp (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.
For more information on scalp eczema, please see our Scalp eczema factsheet