How is this different from dandruff?

An irritated scalp may be the sign of eczema. This condition, also called dermatitis, has several forms.

For example, seborrheic dermatitis is a form of eczema that’s commonly found on the scalp. This chronic form primarily develops on oily areas of your skin, so it may also affect your face and back.

In addition to flaking skin, seborrheic dermatitis may cause:

  • redness
  • scaly patches
  • swelling
  • itchiness
  • burning

Seborrheic dermatitis usually develops during puberty or well into adulthood. When infants develop this condition, it’s known as cradle cap. Cradle cap usually goes away on its own by the time the infant reaches 1 year of age.

Contact dermatitis can occur at any time of life and anywhere on the body. It happens when a foreign object or substance causes irritation or an allergic reaction on the skin. You may also experience a rash or hives with this condition.

Atopic dermatitis usually affects young children. Although its symptoms are similar to seborrheic dermatitis, you may find that the affected areas also ooze and weep. Atopic dermatitis generally occurs in other areas of the body, but it’s possible for it to appear on the scalp.

Keep reading to learn more about what may be causing your dermatitis and how to find relief.

What causes scalp eczema and who’s at risk?

It isn’t clear what causes seborrheic dermatitis, but it may be due in part to:

  • genetics
  • hormonal changes
  • atypical responses from the immune system to something that is eaten or comes in contact with the skin, similar to a type of allergic reaction

You may be more susceptible to seborrheic dermatitis if you:

  • have a preexisting condition affecting your immune system such as HIV, an organ transplant, or Parkinson’s disease
  • have another skin condition such as acne, rosacea, or psoriasis
  • have depression
  • take certain medications containing interferon, lithium, or psoralen

Seborrheic dermatitis is something that lasts a lifetime. You may find that it occurs when you are exposed to certain triggers. These include:

  • stress
  • illness
  • hormone changes
  • harsh chemicals

Contact dermatitis typically develops after your skin comes into contact with a toxic material. For example, the ingredients in certain hair-care products, your brush, or even a hair accessory can cause a flare-up. One study found that nickel, cobalt, balsam of Peru, and fragrance were the most common irritants contributing to scalp eczema.

It isn’t clear what causes atopic dermatitis, but environmental factors may be to blame. This includes things like heat, sweat, and cold, dry weather.

What treatment options are available?

Treatments for scalp eczema will vary based on the type you have. If you know what triggers your eczema, you can make certain lifestyle changes to reduce your risk.

But if lifestyle changes and over-the-counter (OTC) medications aren’t enough, see your doctor. You should also see your doctor if you’re experiencing severe pain, swelling, or other unusual symptoms.

Lifestyle changes

Work with your doctor to determine what’s triggering your flare-ups. In some cases, you may find it beneficial to keep a notebook where you list when you had a flare-up and what activities or environments you were in that day.

For example, you may want to take note of:

  • what you ate
  • what the weather was like
  • whether you were feeling any stress, and what it was about
  • when you last washed or style your hair
  • what hair products you used

Once you identify your triggers, you can work to avoid them.

Shampoos and other hair products

If your eczema isn’t the result of an avoidable irritant or environmental trigger, dandruff shampoo may be beneficial.

Look for shampoos containing:

  • zinc pyrithione
  • salicylic acid
  • sulfur
  • coal tar
  • selenium sulfide
  • ketoconazole

Try using a dandruff shampoo every other day, and follow the label’s directions. Use regular shampoo on the days you skip the dandruff shampoo.

Keep in mind that coal tar may darken lighter hair colors. Coal tar can also make your scalp more sensitive to the sun, so wear a hat when outside.

Once the eczema has cleared, you may be able to cut back to using the dandruff shampoo just once or twice a week.

Medications

Seborrheic and atopic dermatitis can be treated with an OTC or prescription corticosteroid cream or another topical steroid like:

  • mometasone (Elocon)
  • betamethasone (Bettamousse)
  • flucinolone acetonide (Synalar)

You should only use these medications when the condition has flared. Extended use may lead to side effects.

If your eczema doesn’t respond to steroid creams, your doctor may recommend topical medications like tacrolimus (Protopic) or pimecrolimus (Elidel). Your doctor may go a step further and prescribe an oral antifungal medication, such as fluconazole (Diflucan).

For contact dermatitis, you may want to try an antihistamine if the product you encountered caused an allergic reaction. Treating the skin may require a topical corticosteroid. Your doctor may prescribe an oral steroid like prednisone (Rayos) if your scalp eczema is severe.

If your eczema has become infected, your doctor will prescribe an antibiotic in topical or oral form.

When to see your doctor

You should see a doctor if your condition worsens or appears infected.

Symptoms of infection include:

  • severe itchiness
  • new burning sensations
  • blistered skin
  • fluid drainage
  • white or yellow pus

Your doctor will examine your skin, discuss your medical history, and ask about any other symptoms and possible causes. The visit may even include tests. You may find that the condition is not eczema but is rather something else, such as psoriasis, a fungal infection, or rosacea.

Outlook

Although eczema is chronic, there are many options for symptom management. After your initial flare-up is under control, you may go weeks or months without experiencing any symptoms. Talk to your doctor about what treatment options are available for you.

How to prevent flare-ups

There are a number of things you can do to reduce your risk of flare-ups.

If you aren’t sure what type of scalp eczema you’re experiencing, see your doctor. They can work with you to identify the type and establish a set of prevention methods tailored to your needs.

You should

  • Learn what factors may contribute to your scalp eczema and limit your contact or avoid them entirely.
  • Wash your hair with warm — not hot or cold — water. Both hot and cold water can dry out your scalp and cause irritation.
  • Use gentle shampoos, conditioners, styling creams, gels, and even hair dye. If you can, opt for fragrance-free versions.
  • Talk to your doctor about incorporating stress-reduction techniques if stress is a trigger. This may mean breathing exercises, meditation, or even journaling.
  • Avoid scratching if you’re having a flare-up. This can make your symptoms worse.