The scalp is an area of the body that can be affected by several types of eczema. The scalp may be dry, itchy and scaly in a chronic phase and inflamed (red), weepy and painful in an acute (eczema flare) phase.
Aside from eczema, there are a number of reasons why the scalp can become 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.
Types of eczema that affect the scalp
Seborrhoeic eczema (dermatitis) is one of the most common types of eczema seen on the scalp and hairline. It can affect babies (cradle cap), children and adults. The skin appears red and scaly and there is often dandruff as well, which can vary in severity. There may also be a rash on other parts of the face, such as around the eyebrows, eyelids and sides of the nose. Seborrhoeic eczema can become infected. See the National Eczema Society factsheets on Adult seborrhoeic dermatitis and Infantile seborrhoeic dermatitis and cradle cap for more details.
Atopic eczema is another common type of eczema that can affect the scalp at all ages. The skin is red, dry and itchy and can easily become infected, especially if scratched and when there is broken skin.
Allergic contact dermatitis can develop as a result of your body reacting to a particular substance to which you are allergic. Everyday items that can cause allergic contact dermatitis on the scalp include the following:
- Hair shampoos, conditioners, gels, sprays and other hair products
- Hair dyes, perm solutions
- Bathing caps, hair nets – especially those containing rubber
- Hair clips and headgear – especially those containing rubber or nickel.
See the National Eczema Society booklet on Contact dermatitis for more details.
Irritant contact dermatitis is a type of eczema that occurs when the skin’s surface is irritated by a substance that causes the skin to become dry, red and itchy. For example, shampoos, mousses, hair gels, hair spray, perm solution and fragrance can all cause irritant contact dermatitis. See the National Eczema Society booklet on Contact dermatitis for more details.
How is scalp eczema treated?
Treatment of scalp eczema will depend on the type diagnosed by your doctor. Below are possible treatments that may be prescribed:
Moisturising the scalp
The skin on the scalp requires moisturising just like the body, but it can be difficult to get beyond the hair to the scalp. Moisturising creams or spray-on oils can be applied to the scalp by parting the hair and massaging them into the skin (ointments are not suitable as they are grease-based and difficult to wash out). 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 (see section below on washing hair) 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 – for example, Elocon lotion® or Bettamousse® or Synalar® gel (although these might be too potent for a young child, in which case a mild topical steroid cream, such as 1% Hydrocortisone, would be prescribed. For older children, a moderate topical steroid such as Eumovate, may be prescribed for a short treatment burst). It is important to use topical steroids for a prescribed treatment course – usually 2 weeks. For more information, see the National Eczema Society factsheet on Topical steroids.
If scalp eczema extends onto the hairline and face, different strengths of topical steroids will be required, as less potent topical steroids are advised for the face.
If the scalp is scaly and inflamed, topical steroids combined with salicylic acid can be helpful (for example, Diprosalic® scalp application). If scalp eczema is infected, oral antibiotics may need to be prescribed.
Please note: we are not recommending particular prescription-only topical steroids but rather giving examples.
Washing the 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.
To obtain the information on this page in a PDF format, please download our Scalp eczema factsheet, below. For more information on haircare and eczema, please see the article from our magazine, Exchange, ‘Haircare and eczema’ (June 2018), below.