Scalp Eczema – What You Need to Know

Quick Summary: Understanding Scalp Eczema

What is Scalp Eczema?: Scalp Eczema is caused by both genetic and environmental factors. It manifests as itchiness, dryness, and flakiness of the skin. Common types include Seborrheic Dermatitis, Atopic Dermatitis, and Contact Dermatitis. Identifying your specific type is crucial for effective management.

Key Treatments: Strategies for treating scalp eczema include emollients for moisturising, gentle hair products, and medicated treatments like Ketoconazole shampoo and topical corticosteroids. Regular check-ups with healthcare professionals can help you find the right treatment plan.

Self-Care Tips: Adhering to your treatment regime, maintaining a balanced diet, managing stress, and minimising scratching of the scalp are all vital steps towards improving your condition and preventing hair loss.

Hair Loss Insights: Scalp eczema can lead to hair loss primarily through continuous scratching of the scalp. This physical trauma can damage hair follicles. A hair transplant is a viable option for those with well-managed eczema, however consulting with surgeons experienced in dealing with sensitive conditions is essential for success.

Key Takeaway: Managing scalp eczema effectively involves a combination of tailored treatments, diligent self-care, and professional guidance. Finding what works best may take time, but with the right approach, maintaining a healthy scalp, minimising hair loss, and exploring treatments like hair transplants are all possible.

What is Scalp Eczema? 

Scalp eczema is a condition that makes your scalp itchy, dry, and flaky. There are a few types of this condition, but Seborrheic dermatitis is the most common, affecting about 4% of adults, with a higher prevalence among men as reported by the National Eczema Society. It can show up as dandruff or cradle cap in babies, affecting both appearance and comfort. Though it doesn’t always lead to hair loss, severe scratching, or a buildup of certain yeasts due to eczema can impact hair health. 

Maintaining a healthy scalp is important, not only for managing conditions like scalp eczema, but also for ensuring the success of hair transplant procedures. A well-cared-for scalp provides the best environment for new hair growth and supports the overall effectiveness of hair restoration efforts. This article explores some of the common causes of scalp eczema, their symptoms, management, and how to prevent possible hair loss from this condition.

Understanding Causes of Scalp Eczema and Symptoms

Scalp eczema can manifest in various forms, distinguished by their causes and the symptoms they produce. Here’s a closer look¹:

Seborrheic Dermatitis:

This scalp condition often appears as reddened, or discoloured skin covered with flaky white or yellow scales. It’s a common cause of dandruff, although dandruff can have other origins too. Seborrheic dermatitis may arise from too much oil production and the growth of Malassezia, a yeast-like fungus naturally found on the scalp. It is also influenced by other factors like diet, microbiome and weak immunity.² This condition can affect anyone, from infants (where it’s known as cradle cap) to adults and may vary in appearance across different skin tones. It can also extend beyond the scalp, affecting areas like the eyebrows and nose.

Atopic Dermatitis:

More commonly known as atopic eczema, this often runs in families with a history of allergies and asthma, showing up as dry, itchy skin that can appear red in lighter skin tones and brown, purple, or grey in darker skin tones. Commonly it affects areas like the back of the knees, neck, and inside the elbows in adults, as well as the scalp. Researchers are still figuring out the exact cause, but it seems linked to an unusual immune response by the body, made worse by a weakened skin barrier. Things like your environment and weather, stress, and touching irritating substances can trigger flare-ups.

Contact Dermatitis:

Contact dermatitis can be caused by direct contact with an irritant or allergen, leading to itchy, discoloured skin. Common culprits include hair products, dyes, rubber in swimming caps or hair nets, and metals in hair accessories.¹ Distinguishing between allergic contact dermatitis (caused by an allergic reaction to substances like nickel or cosmetics) and irritant contact dermatitis (from non-allergic reactions to substances like shampoos or hair sprays) is crucial for proper management.³

Other conditions that cause symptoms similar to those of scalp eczema include:

Psoriasis: Although not a type of eczema, scalp psoriasis causes itchy, scaly patches similar to those seen in eczema. It results from an immune reaction that speeds up skin cell production, leading to flaky, itchy, and thick patches of skin.

Tinea Capitis (Scalp Ringworm): This fungal infection shares eczema-like symptoms, such as scaly patches and potential hair loss. It’s contagious, spreading through direct skin contact or by using shared items like hats or combs.

Management of Scalp Eczema

It is best to first understand the cause of your scalp eczema. Booking a visit with your GP, or a skin specialist (dermatologist), is the best way to get a proper diagnosis. Treatments include keeping your scalp moisturised, switching to gentler hair care products, and avoiding anything that triggers your eczema. Below is a quick overview of the current ways to manage the different types of scalp eczema:

1. Seborrheic Dermatitis⁴

• Over-the-Counter Treatments
  • Ketoconazole shampoo (Daktarin, Dandrazol, Nizoral): Start with 2-4 weekly uses, applying just to the scalp, then reduce to once every two weeks for upkeep. Be careful, as it can dry out and weaken hair shafts of certain hair types, like chemically treated or tightly coiled hair, leading to breakage.⁵
  • Other shampoos : They may contain pyrithione zinc for yeast control, selenium sulphide to reduce fungus, tar to slow scalp cell growth, and salicylic acid to remove scales and help the scalp be treatment ready.
  • Sebco ointment: You can massage into the scalp and leave for 2-4 hours to help thicker scale or crust build up.
• Medical treatments
  • Topical corticosteroids: Doctors may prescribe steroids to apply onto the scalp to help reduce inflammatory symptoms like itchiness and rashes.

2. Atopic dermatitis⁶

• Over-The-Counter Treatments
  • Pain Relievers: For pain and swelling, you can take common medicines like Tylenol or ibuprofen.
  • Antihistamines: These help with itchiness. Some include cetirizine, diphenhydramine, and loratadine.
  • Emollients: These are moisturising treatments to reduce water loss and protect skin. Options include ointments (for very dry skin), creams or lotions (for less dry skin), and soap substitutes. Apply liberally and frequently, especially after bathing.
  • Mild Corticosteroids: A gentle steroid cream like Hydrocortisone can help with the redness and itching. You can find it as a gel, cream, lotion, or ointment at the store. Just use it as the package says or as your doctor tells you.
• Medical Treatments
  • Prescription Topical Corticosteroids: If the milder creams don’t work, your doctor might prescribe a stronger one for tougher symptoms.
  • Spot-treatment with corticosteroid Injections: Doctors can directly inject a special medicine into specific eczema patches for targeted relief.
  • Oral corticosteroids: Sometimes taken as pills for a short time (5-7 days) to quickly reduce severe symptoms. However, oral steroids come with more risks of side effects when used long term. 
  • Systemic Immune Response Medication: These medications work throughout the body – Dupilumab is a special kind of shot for severe skin conditions that haven’t improved with other treatments, helping to calm down inflammation.
  • Medicated Bandages/Wet Wraps: In really tough cases, doctors might recommend special wraps or bandages that keep the skin moist and help soothe itchiness.

3. Contact Dermatitis⁷

• Identify and avoid allergens or irritants: 
  • Seek advice from a pharmacist, GP, or dermatologist on minimising contact.
• Over-the-counter treatments:
  • Emollients: As for atopic dermatitis, these moisturising treatments can effectively help manage the condition by hydrating the skin and reducing flare-ups.
• Medical treatments:
  • Topical Corticosteroids: For inflammation and itchiness, use prescribed strengths according to the affected area’s sensitivity.

Topical Corticosteroids for Scalp Eczema

Since it’s a common treatment for scalp eczema, here’s a quick overview on corticosteroids.⁶

What They Do: These creams or ointments are applied to the skin to calm soreness and reduce inflammation quickly.

How to Apply: Spread a thin layer on the affected skin as instructed, typically no more than twice daily. Always put on your moisturiser (emollient) 30 minutes before the steroid cream for full absorption.

Different Strengths: Your doctor will prescribe a strength based on how severe your eczema is and where it’s located. Options include:

• Mild (like hydrocortisone) for minor irritation.
• Moderate (like betamethasone valerate) for more persistent areas.
• Strong (higher doses of betamethasone) for tougher cases.
• Very strong (like clobetasol) for the most severe symptoms.

Regular Check-Ups: If you’re using these creams often, regular visits to the doctor are key to ensuring the treatment is still right for you, and that you’re applying the correct amount.

Tips on applying topical treatments for scalp eczema

Treating conditions like scalp eczema or psoriasis can be tricky with hair in the way, making it hard to get the treatment right on your scalp. The good news is, there are different kinds of treatments, such as foams, gels, shampoos, or sprays, designed to make this easier as mentioned above.

Choosing the Right Form: For emollients, consider lighter options like E45 lotion, Doublebase gel, or a spray-on like Emollin for less mess and easier application. For targeted relief, using corticosteroids, specific gels, mousses, and foams such as Elocon lotion, Bettamousse, or Synalar gel are designed for scalp application.¹ Certain formulations will come with a nozzle attached to the medication allowing for direct application to the scalp through long hair.

How to Apply: Simply part your hair to reveal the scalp, then gently massage in your treatment.¹ This helps make sure the medication gets to where it needs to go. To boost its effect, putting on a shower cap after you apply your treatment can help enhance the treatment’s penetration and effectiveness — just remember to only keep it on as long as your doctor says.⁸

Talk to Your Doctor: Since everyone’s hair and scalp needs are different, have a chat with your doctor about which treatment form might be the easiest and most effective for you. Finding the right one can really help you stick with your treatment plan.

For helpful tips on eczema-friendly hair care, you may find this patient leaflet from the National Eczema Society helpful. Additionally, if you’re searching for products gentle on eczema-prone skin, the National Eczema Association (US) offers a good directory.

Self-care tips for scalp eczema

It’s always good to adopt healthy habits to boost your treatment’s success and keep your condition from getting worse. Here’s what you can do:

1. Follow your treatment plan: Keeping up with your treatment can help you lead a more comfortable life, reducing eczema’s impact. Remember to moisturise regularly, steer clear of triggers, and choose gentle skin products.
2. Take care of your diet: Although the link between diet and eczema is still under investigation, maintaining a healthy diet is always beneficial. Emerging research suggests potential benefits of vitamin D and probiotics for eczema management, but conclusive evidence is pending.^{9, 10} Incorporating anti-inflammatory foods such as leafy greens, whole grains, nuts, fish, and berries into your diet might help, provided you’re not allergic to them.
3. Try and manage your stress: Stress can make eczema worse, so we highly recommend carving out time to relax each day. Whether it’s through meditation, yoga, or regular exercise, find a healthy stress-reduction technique that soothes you.
4. Control scratching: It’s tempting to scratch during a flare-up but try to rub gently with your fingertips instead. This can help avoid making your eczema worse and protect your hair and scalp from damage. 

Scalp Eczema and Hair Loss

Scalp eczema itself isn’t the real culprit behind the temporary hair loss or thinning people experience. It’s really the non-stop scratching of the scalp that does the damage. With constant head scratching, you end up damaging your hair follicles, which will in turn affect their healthy hair structure and growth cycle. So, our advice would be to do your best to ease eczema itchiness with gentle methods mentioned earlier, rather than scratching. This way, you protect your hair follicles and keep your hair healthy. You may also find our quick scalp care guide in another blog post on scalp psoriasis helpful for your journey to a healthier scalp.

Can you consider a hair transplant with Scalp Eczema?

If you’re dealing with scalp eczema and thinking about a hair transplant surgery for hair loss, here’s what you need to know: Your eczema’s condition—how well it’s managed and its severity—plays an important role in whether a hair transplant is a good treatment option for you. It’s crucial to talk it over with expert hair transplant surgeons, who understand the nuances of performing such procedures on sensitive scalps. They can use specific techniques and tools, and give you detailed care instructions after the surgery, ensuring everything goes smoothly.

If your eczema is under control, and you’re in the hands of experienced professionals, a hair transplant could be a choice worth considering for getting your hair back.

Conclusion

In conclusion, managing scalp eczema effectively requires a combination of carefully selected treatments, mindful self-care practices, and an understanding of how to gently manage symptoms without causing further irritation or hair loss. By following your treatment plan, maintaining a healthy diet, reducing stress, and avoiding the urge to scratch, you can keep your scalp healthy and minimise the impact of eczema on your daily life. If you’re thinking about a hair transplant and have scalp eczema, it’s crucial to have your condition under good control first. It’s also important to talk with surgeons who have experience with sensitive conditions — just like our expert team. Don’t hesitate to reach out to our clinic to learn more about your options, we’re here to help and support you through your journey.

References

1. National Eczema Society. Scalp Eczema 2022. https://eczema.org/information-and-advice/types-of-eczema/scalp-eczema/  (accessed April 9, 2024). 
2. Leroy, A. K., Cortez de Almeida, R. F., Obadia, D. L., Frattini, S., & Melo, D. F. (2023). Scalp Seborrheic Dermatitis: What We Know So Far. Skin appendage disorders, 9(3), 160–164. https://doi.org/10.1159/000529854
3. NHS. Overview: Contact Dermatitis. NHS Choices 2023. https://www.nhs.uk/conditions/contact-dermatitis/ (accessed April 9, 2024). 
4. Primary Care Dermatology Society P. Seborrhoeic eczema (syn. seborrhoeic dermatitis). Primary Care Dermatology Society 2024. https://www.pcds.org.uk/clinical-guidance/seborrhoeic-eczema (accessed April 9, 2024). 
5. Elgash, M., Dlova, N., Ogunleye, T., & Taylor, S. C. (2019). Seborrheic Dermatitis in Skin of Color: Clinical Considerations. Journal of drugs in dermatology : JDD, 18(1), 24–27. Available from: https://jddonline.com/articles/seborrheic-dermatitis-in-skin-of-color-clinical-considerations-S1545961619P0024X/ 
6. NHS. Atopic Eczema Treatment. NHS Choices 2023. https://www.nhs.uk/conditions/atopic-eczema/treatment/ (accessed April 9, 2024). 
7. NHS. Contact Dermatitis Treatment. NHS Choices 2023. https://www.nhs.uk/conditions/contact-dermatitis/treatment/ (accessed April 9, 2024). 
8. Tanoko M. How to treat scalp eczema during a flare. National Eczema Association 2022. https://nationaleczema.org/blog/ask-the-ecz-perts-scalp-eczema/ (accessed April 9, 2024). 
9. Schlichte, M. J., Vandersall, A., & Katta, R. (2016). Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatology practical & conceptual, 6(3), 23–29. https://doi.org/10.5826/dpc.0603a06 
10. Flohr C. Diet and Eczema. National Eczema Society 2023. https://eczema.org/information-and-advice/living-with-eczema/diet-and-eczema/ (accessed April 9, 2024).