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How Do You Treat Eczema on the Scalp?

Eczema is a skin condition that causes dry, itchy, scaly, red skin, which can also include the scalp. Treatment for eczema on the scalp includes home treatment (moisturizers, salicylic acid and tar preparation, medicated shampoos), topical steroids, ultraviolet light therapy (phototherapy), injectable medications, immunosuppressive drugs, oral antihistamines, and antidepressants/antianxiety medications.
Eczema is a skin condition that causes dry, itchy, scaly, red skin, which can also include the scalp. Treatment for eczema on the scalp includes home treatment (moisturizers, salicylic acid and tar preparation, medicated shampoos), topical steroids, ultraviolet light therapy (phototherapy), injectable medications, immunosuppressive drugs, oral antihistamines, and antidepressants/antianxiety medications.

Eczema is a skin condition that causes dry, itchy, scaly, red skin. 

There are several types of eczema that commonly occur on the scalp: 

Eczema is a chronic condition that can worsen (flare) and also go into periods with no symptoms (remission). Eczema on the scalp is treated with home treatments and medications.

Home treatment for eczema on the scalp includes:

  • Moisturizing the scalp
    • Apply emollient creams, lotions, or gels, or spray-on oils to the scalp 
      • Coconut oil or non-fragranced mineral oil (baby oil) 
      • Petroleum jelly
    • For a scaly scalp, a salicylic acid and tar preparation may also be applied and left in place for at least 4 hours or overnight 
    • Use a shower cap to keep the product in overnight, and rinse out the product in the morning
    • Scalp treatments are messy, so use an old pillowcase
  • Washing the hair
    • Avoid regular shampoos that contain detergents and fragrance which can irritate the scalp
    • Use a less irritating shampoo
    • Use hair dryers on cool settings; heat can increase itching and dryness 
    • Medicated shampoos may help manage scalp eczema
    • Seborrheic dermatitis of the scalp is treated with shampoos designed to reduce yeast and flaking 
      • Ketoconazole shampoo (Nizoral)
      • Shampoos containing selenium sulphide or zinc pyrithione
      • Use once a week to help prevent adult seborrheic dermatitis (not recommended for other types of eczema)

Treatment for flares includes:

  • Topical steroids for the scalp 
    • Betamethasone valerate 0.12% foam (Luxiq)
    • Clobetasol 0.05% shampoo (Clobex)
    • Fluocinolone 0.01% shampoo (Capex)
    • Fluocinolone 0.01% solution (Synalar)
  • Topical steroids combined with salicylic acid 
  • Oral antibiotics if there is a scalp infection
  • Oral steroids (e.g., prednisone) may be used for a short period to treat a severe flare of eczema of the scalp
  • Ultraviolet light therapy (phototherapy) 
    • May increase the risk of skin cancer, and is recommended only for people with severe eczema who do not respond to other treatments
  • Injectable medications 
    • Biologics: dupilumab (Dupixent) for adults with moderate to severe eczema that has not responded to other treatments
  • Immunosuppressive drugs 
  • Oral antihistamines for itching 
  • Antidepressants or antianxiety medications
    • The symptoms of eczema of the scalp can cause people to become anxious or depressed

What Are Symptoms of Eczema on the Scalp?

Symptoms of eczema on the scalp include: 

  • Intense itching of the skin
    • Itching may be worse at night
    • Scratching may worsen the itching
    • Scratching can also lead to infection 
      • Signs of infection include painful red bumps that may contain pus
  • Patches of red, inflamed skin
  • Scalp dryness
  • Small bumps
  • May be accompanied by dandruff (seborrheic eczema)
  • May also be a rash on other parts of the face, such as around the eyebrows, eyelids and sides of the nose

Eczema on the scalp may be accompanied by eczema on other parts of the body:

  • In infants, eczema also commonly occurs on the front of the arms and legs and cheeks
  • In children and adults, eczema also commonly affects the back of the neck, the elbow creases, the backs of the knees, the face, trunk, wrists, and forearms

What Causes Eczema on the Scalp?

The cause of eczema is not fully understood but genetics appear to play a strong role. Most people who have eczema have a genetic abnormality in the outermost layer of the skin, called the epidermis, which causes it to be less strong and more permeable. 

A family history of eczema is a risk factor for developing the condition. 

Triggers that may aggravate scalp eczema symptoms may include:

  • Cold or dry environments
  • Sweating
  • Emotional stress or anxiety
  • Rapid temperature changes
  • Exposure to certain chemicals
  • Hair shampoos, conditioners, gels, sprays, mousses, and other hair products
  • Hair dyes, perm solutions
  • Cleaning products, including soaps and detergents
  • Perfumes and cosmetics
  • Bathing caps and hair nets, especially those that contain rubber
  • Hair clips and headgear, especially those that contain rubber or nickel
  • Wool or synthetic fibers
  • Dust or sand
  • Cigarette smoke

How Is Eczema on the Scalp Diagnosed?

The diagnosis of scalp eczema is usually made based upon a person’s medical history, symptoms, and a physical examination of the scalp.

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References
https://www.uptodate.com/contents/eczema-atopic-dermatitis-beyond-the-basics?search=scalp%20eczema&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://eczema.org/information-and-advice/types-of-eczema/scalp-eczema/

https://www.aafp.org/afp/2015/0201/p185.html