Eczema can affect any part of your body where there is skin — but when it affects your scalp, it can look like seborrheic dermatitis, aka dandruff. Despite the unavoidable (and annoying) itching, flaking signs of scalp irritation, the cause is less determined and can differ from person to person. Eczema is just one of the causes of scalp rash.
“Eczema refers to irritated and itchy skin, which can, in fact, be caused by many underlying factors,” New York City-based board-certified dermatologist Shereene Idriss explains. “To make matters more confusing, a person can have several conditions occur at once like seborrheic dermatitis, in addition to having eczematous dermatitis from an allergy.”
In other words, because eczema is a one-size-fits-all term that describes any form of irritated and itchy skin, you can suffer from multiple forms of eczema with different causes and treatments at the same time. What’s causing your scalp rash may not be what’s causing your eyelid eczema.
If your scalp is scratchy, do not fear. We spoke with several board-certified dermatologists on how to identify scalp eczema, what triggers and causes it, and what to do about it — at home or at the dermatologist’s office.
How do I know if I have scalp eczema?
One word: Flakes. “Scalp eczema can show up as red, irritated, flaky, and itchy patches and can resemble dandruff,” Idriss says. However, it rarely affects adults as much as it affects kids and babies. “Typically, when an adult complains of a dry, flaky scalp, it is typically caused by seborrheic dermatitis (dandruff), though psoriasis, eczema, and irritant or allergic reactions are also common,” Robert Finney, a New York City-based board-certified dermatologist. Fungal infections, autoimmune connective tissue disease, and other causes for this scalp flakiness are much rarer.
If your scalp feels and looks especially greasy, this is due to overproduction of sebum and it means you have seborrheic dermatitis or dandruff (not scalp eczema). Once you’ve ruled out lice as a cause for your itching and scratching, you can easily identify dandruff due to the white or yellow flakes that easily fall off your hair. (Avoid dark-colored tops while you’re treating your flaky scalp.)
Psoriasis, which is an inflammatory condition that can affect the skin and joints, may also manifest itself on the scalp as an itchy, flaky scalp. “Topical steroids, vitamin D analogues, and tar-based shampoos are the mainstay of therapy, but sometimes systemic medicines or local injections are needed,” Finney says. To find out whether you have psoriasis or dandruff, he advises seeking a dermatologist for an exam.
What causes it?
As with eczema found elsewhere on your body, it depends. “The cause can range from underlying medical conditions like Parkinson’s to an allergic reaction to a hair dye,” Idriss explains.
If the scalp rash is caused by an allergen that touches your skin, it’s referred to as allergic contact dermatitis. “It’s generally coming from a shampoo conditioner, dry shampoo, hairspray, or products that you’re using that are creating a reaction,” Connecticut-based board-certified dermatologist Mona Gohara says. When patients come to her about their scalp eczema, the first thing she finds out is whether they’ve been using any new or different hair-care products — or have recently dyed their hair.
Dandruff, one of the common symptoms of scalp irritation, can also be a result of underlying medical conditions that can disrupt the microbiome of the skin. People who suffer from dandruff generally produce too much sebum in their scalp due to a genus of fungi called Malassezia, which is naturally found in your skin microbiome, but wreaks havoc when there is too much of the fungi producing oleic acid waste.
Especially when the weather is warmer and more humid, and sweating causes oil to become trapped on the skin,” New York City-based board-certified dermatologist Joshua Zeichner explains. “This creates an environment that allows for overgrowth of yeast, driving inflammation.” People with Parkinson’s disease, for example, can develop oilier-than-usual skin on their face and scalp, which can lead to seborrheic dermatitis.
Unfortunately, when looking for soothing solutions, don’t reach for the hydrating conditioner right away. “Many people see flakes on the skin and think that they need to apply moisturizers or oils,” Zeichner says. “However, this actually can make matters worse, allowing even more yeast to grow in the oily environment.”
Should I treat scalp eczema differently than I would eczema on my body?
It’s less about treating scalp irritation differently from eczema on the rest of your body than figuring out whether your symptoms triggered by irritants or by underlying medical conditions that disrupt your skin’s balance. That can be difficult to figure out without seeking professional advice from a dermatologist. “Avoiding triggers is essential to minimize worsening of symptoms,” Idriss explains. “Hence, the importance of seeking help from a board-certified dermatologist who can help you narrow down the cause through various testing methods — in particular, patch-testing.”
Ultraviolet light therapy can be used to treat eczema on parts of the body that can be exposed to a safer variance of UV light for extensive periods of time, such as your hands. But on your eyelids, which are thin and cannot be exposed to UV rays, or on your scalp (which may be covered by hair), it may not work as a treatment. You can, however, use over-the-counter low-dose hydrocortisone cream, as recommended by Finney.
Hold off on the anti-dandruff shampoo — or any new hair treatment — until you’ve seen your dermatologist. Medicated rinses or shampoos may cause more harm than good due to the potential irritation from new ingredients. “You have to identify the cause before offering a treatment plan,” Gohara explains. “The cause drives the solution.”
Instead, she prescribes topical anti-inflammatories that are helpful for treating scalp eczema. Finney also recommends switching to a gentler shampoo. “Irritant contact dermatitis can occur on the scalp due to different ingredients in shampoos, including sulfates,” he explains.
What should I do if over-the-counter products aren’t cutting it?
“One of the worst things to do when you have presumed eczema is to try to treat it at home yourself, like putting on a topical antibiotic,” Gohara says. Common first aid kit essentials like Neosporin or even aloe vera will only “stoke the fire” and potentially exacerbate the eczema.
Once you’ve identified a culprit, there are very few over-the-counter options for topical steroids. Gohara almost always treats her scalp eczema patients with a prescription-strength topical steroid that reduces the inflammation.