Understanding Scalp Eczema: Symptoms, Causes & Treatment

Types of Scalp Eczema

Scalp eczema can show up in a few different ways, each with its own symptoms and triggers. Here are the main types:

Seborrheic Dermatitis

• The most common type of scalp eczema, characterised by greasy, yellowish flakes and red, inflamed skin.
• Frequently appears along the hairline, eyebrows and behind the ears. It can also affect oily areas like the face and chest.
• Linked to the overgrowth of a yeast called Malassezia, which thrives on the natural oils produced by the skin.

Atopic Dermatitis (Eczema)

• Can affect the scalp and other areas like the face, elbows and knees.
• Triggered by allergens (dust mites, pet dander, pollen), extreme temperatures, stress, irritants (harsh soaps, certain fabrics). Hot water can also worsen symptoms by stripping the skin of natural oils.
• A consistent moisturisation routine prevents dryness. Wearing soft, breathable clothing helps minimise flare-ups.

Contact Dermatitis

• Occurs when the scalp reacts to allergens such as hair dye, shampoo or styling products.
• Inflammation, itching and potentially blistering or oozing in severe cases.
• Chemical ingredients in hair products (e.g., fragrances, preservatives like parabens, alcohol-based products), plant-based substances or metals like nickel are its common irritants.

Symptoms of Scalp Eczema

Here are the most common symptoms of scalp eczema you should be aware of:  

• Greasy/Oily Patches: Seborrheic dermatitis makes your sebaceous glands work overtime, causing oily patches that form scales and flakes, usually on the hairline, ears and eyebrows.
• Persistent Itching: You’ll often find yourself itching and scratching just makes it worse, especially with stress or changes in the weather. In some cases, you might feel itchy without any visible flakes which is common with atopic or contact dermatitis.
• White/Yellowish Scales: Seborrheic dermatitis causes greasy flakes that resemble dandruff and they can spread beyond the scalp, often becoming more noticeable when the weather gets colder.
• Redness/Inflammation: Your skin can get irritated, looking red and inflamed which can be sore and make your scalp more sensitive, raising the risk of infection.
• Dry Patches/Flaking: Eczema can lead to rough, dry patches that make your scalp feel tight, particularly in colder weather.
• Crusting: In severe cases, dryness and scratching can cause crusts to form, leading to open skin that can become infected.
• Hair Loss: Constant itching and inflammation can result in temporary thinning or shedding. However, once the inflammation settles, hair usually grows back.
• Burning/Stinging Sensation: Inflamed skin can cause a burning or stinging feeling, which can get worse with stress or other triggers, especially during flare-ups.

Causes and Risk Factors

Several factors contribute to the development of scalp eczema. Here are the main causes that can influence the condition: 

• Genetic Predisposition: If eczema, asthma or allergic conditions run in your family, you’re more likely to develop scalp eczema. Your genes affect how your immune system responds to triggers in the environment, making you extra sensitive to allergens and irritants.
• Hormonal Changes: Hormonal changes, especially during puberty, pregnancy or menopause can trigger or make eczema worse. These changes can weaken your skin’s natural barrier. Some people find their symptoms improve during pregnancy while others may notice menopause makes things worse.
• Environmental and Lifestyle Factors:
  • Extreme Weather: Hot, cold or dry weather can upset your scalp. Winter air dries it out, while summer heat can boost oil and flake production.
  • Chemical Exposure: Household chemicals, cleaners and air fresheners can irritate your scalp. Opting for natural, non-toxic alternatives can make a big difference.
  • Air Pollution: Dust, smoke and chemicals can damage your skin’s barrier, causing flare-ups.
  • Sweat and Friction: Sweat and tight hats can irritate the scalp. Try to avoid wearing tight headgear for long periods and wash off sweat quickly.
  • Diet: Dairy, processed foods and foods high in sugar or fat can trigger inflammation. Eating a balanced and anti-inflammatory diet can help keep flare-ups in check.
  • Immune System Dysfunction: When your immune system goes into overdrive, it reacts to harmless substances, causing redness, itching and swelling. Both your genes and the environment play a role in this response.

Treatment Options

The appropriate treatment plan should be determined by a doctor to help control symptoms and improve your scalp’s health. Here are some common options that may be considered:

Medical-Grade Shampoos

• Aromase: Aromase is made to treat scalp eczema, seborrheic dermatitis and dandruff. It uses natural ingredients like tea tree oil to calm the scalp and reduce inflammation, while Glycyrrhetinic Acid acts as its main anti-fungal component. It helps balance your scalp’s pH, moisturises the skin and targets irritation.
  Be sure to follow the instructions to avoid dryness or irritation.

Medicated Shampoos

• Coal Tar Shampoos: Coal Tar shampoos slow down skin cell turnover, helping control excessive flaking and scaling, especially for seborrheic dermatitis or psoriasis.
• Ketoconazole 2% (e.g., Nizoral): Ketoconazole tackles the overgrowth of Malassezia yeast, easing symptoms of seborrheic dermatitis and other types of scalp eczema. Frequent use of Ketoconazole shampoo may cause scalp dryness so it’s best to alternate it with a gentler shampoo. While Ketoconazole effectively helps manage seborrheic dermatitis, incorporating a milder option can support overall scalp health.

Prescription Medications*

• Calcineurin Inhibitors: Medications like Tacrolimus (Protopic) and pimecrolimus (Elidel) suppress the immune response, reducing redness, irritation and itching. These non-steroidal treatments work well for sensitive areas of the scalp.
• Antifungal Agents: Doctors may prescribe oral antifungals like fluconazole for severe cases.
• Oral Medications: For severe cases, doctors may prescribe oral steroids (e.g., prednisone) or immune-modulating drugs like methotrexate or cyclosporine to control inflammation. They should only be used short-term and under medical supervision due to potential side effects.

*Prescription medications should always be used under the supervision of a healthcare professional, as they may cause side effects or interact with other medications you are currently taking.

In-Clinic Scalp Treatments

ScalpCleanEx 

Terra ScalpCleanEx is a non-invasive 5-step treatment for individuals with oily scalp conditions, including those suffering from scalp pimples, seborrhea and seborrheic dermatitis.

It offers natural anti-bacterial, probiotic and anti-inflammatory benefits without medication side effects.

Hydrafacial Keravive

Hydrafacial Keravive is a 3-step scalp treatment designed to promote a healthier, hydrated scalp. It aims to:

• Gently remove debris and stimulate scalp circulation.
• Deliver a proprietary blend of growth factors and proteins to address scalp imbalances.
• Include a take-home Peptide Complex spray for ongoing scalp nourishment.

Low-Level Laser Therapy

Low-level laser light therapy (LLLT) is a treatment that utilises low-intensity red laser light to stimulate hair growth. It targets the scalp to enhance blood circulation, accelerate healing and reduce inflammation in conditions such as contact dermatitis or seborrheic dermatitis.

Lifestyle Changes

• Consistent Sleep Routine: Aim for 7-9 hours of sleep to support immune health and reduce eczema symptoms.
• Hydration: Drink plenty of water to maintain skin hydration and moisture.
• Good Scalp/Shampoo Routine: Use gentle, hydrating shampoos and avoid harsh chemicals to keep the scalp healthy.
• Limit Alcohol and Caffeine: Excess alcohol can dehydrate the body and worsen inflammation and flare-ups. While evidence on caffeine’s impact is limited, some individuals have reported improvements after reducing their intake. You may refer to this study. 

How to Prevent Scalp Eczema Flare-Ups

Managing scalp eczema, including seborrheic dermatitis, requires a multifaceted approach to manage symptoms. Here are 5 ways to prevent flare-ups:

• Maintain a Consistent Scalp Care Routine: Use mild, fragrance-free shampoos and conditioners designed for sensitive skin or eczema. Avoid products with harsh chemicals, sulphates and fragrances. Wash your hair regularly with lukewarm water, not hot, to maintain scalp health.
• Avoid Known Allergens and Irritants: Avoid triggers like smoke, pollution, harsh weather and certain foods or personal care products. Steer clear of products containing alcohol, parabens or artificial dyes that can irritate sensitive skin.
• Understand the Role of Dairy Proteins: Dairy proteins are often linked to inflammation in conditions like seborrheic dermatitis and eczema. While the evidence is debated, a number of patients who cut out dairy report symptom relief.

  Triggers include fresh milk, whey, casein protein shakes, yoghurt and hard cheeses, but plant-based protein shakes offer a non-inflammatory alternative. Hidden dairy in tea, coffee and processed foods can also contribute, so careful avoidance is key.

• Manage Stress: Stress can trigger flare-ups by increasing cortisol levels, which worsen eczema. Cortisol, a key stress hormone, triggers the inflammatory response during stressful situations which can convert into other hormones like DHEA-S, a male hormone linked to female pattern hair loss.

  Remember, cortisol isn’t the only stress hormone at play; noradrenaline and dopamine also influence the body’s response to stress. Use relaxation techniques like deep breathing, meditation and yoga to manage these stressors.
  Therapy or counselling can also provide coping strategies to reduce the impact of stress on your skin and overall well-being.

• Keep the Scalp Moisturised, Especially in Cold Weather: Cold weather can dry and irritate the scalp. Use a gentle, fragrance-free moisturiser or oil and consider products with soothing ingredients like aloe vera or jojoba oil.

  Protect your scalp with a soft hat in cold weather and use a humidifier indoors to maintain moisture levels and prevent dryness.

When to See a Healthcare Provider

You should consult a healthcare provider if:

• Your scalp eczema is accompanied by fever, fatigue or swollen lymph nodes.
• You experience severe redness, pain or signs of infection, such as pus or swelling.
• Frequent flare-ups interfere with daily life or self-esteem.
• Treatments cause unexpected side effects like burning or irritation.
• You notice significant hair loss or thinning.
• Persistent itching causes skin damage or disrupts your sleep.
• The eczema spreads to other parts of your body.

Final Thoughts

Scalp eczema can significantly impact your quality of life but it is manageable with the proper treatment. Medical-grade shampoos, prescription medications and in-clinic treatments are available to soothe symptoms and prevent flare-ups. Always consult a healthcare provider for personalised advice and treatment plans.

At Terra Medical, we provide scalp treatments designed to address conditions like scalp eczema. This includes ScalpCleanEx, HydraFacial Keravive and low-level laser light therapy, all of which are tailored to promote scalp health. Contact us today.

FAQs About Scalp Eczema