Eczema on the scalp can be a stubborn condition that persists for years, though it can come and go without warning. While the condition cannot be completely cured, symptoms of it can be managed through various treatments that aim to:
- Remove scales
- Reduce itching
- Calm the inflammation that is causing redness and swelling
The primary target of treatment should be the scalp and not the hair. Always part the hair and apply medications directly to the scalp. Avoid hot oil massages and heat drying because it may exacerbate your eczema.
Treatment of scalp eczema may include:
- Moisturizing the scalp with creams and spray-on oils.
- Applying coconut oil (available in most pharmacies) to the scalp.
- Treating the flares with massage treatments (use coconut oil but never olive oil).
- Washing the hair with medicated shampoos as prescribed by the dermatologist.
Additionally, treatment can also be applied during flares of eczema on the scalp, including:
- Topical antifungal cream or medicated shampoo for mild cases of eczema.
- Topical steroids can be beneficial on the scalp.
- Alcohol-based topical steroids may cause a stinging sensation
- A lotion, mousse, or gel preparation may be a comfortable option.
- Use topical steroids for two weeks only.
- Topical steroids of different strengths may be used if the scalp eczema extends to the hairline and face.
- Topical steroids combined with salicylic acid can be beneficial if the scalp is scaly and inflamed.
- Oral antibiotics may be prescribed if scalp eczema is infected.
|Product||Dosing frequency||Side effects||Cost for generic (brand)*|
|Coal tar shampoo||Two times per week||Inflammation of hair follicles (folliculitis), skin rash (contact dermatitis), sensitivity to light (photosensitivity)||$5 for 130 mL|
|Selenium sulfide shampoo||Two times per week||Alopecia, hair discoloration, irritation||$7 for 325 mL|
|Tea tree oil shampoo||Daily||Irritation, contact dermatitis||$14 for 473 mL|
|Zinc pyrithione shampoo||Two times per week||Irritation||$5 for 420 mL|
|Loprox (ciclopirox one percent shampoo)||Daily initially, then two times per week||Burning, skin rash, itching||$59 ($527) for 120 mL|
|Nizoral (ketoconazole two percent shampoo)||Daily initially, then two times per week||Irritation, itching, and high sensitivity to sunlight||$16 ($63) for 120 mL|
|Luxiq (betamethasone valerate 0.12 percent foam)||Two times daily||Stinging, itching, patches on the skin (hypopigmentation), thinning of the skin (skin atrophy)||$88 ($274) for 50 grams|
|Clobex (clobetasol 0.05 percent shampoo), alternating with ketoconazole two percent shampoo||Each two times weekly, alternating medications, for up to two weeks||Burning, redness, folliculitis, hypopigmentation, itching, skin atrophy||$144 ($644) for 118 mL|
|Capex (fluocinolone 0.01 percent shampoo)||Daily||Burning, dryness, hypopigmentation, skin atrophy||NA ($364 for 120 mL)|
|Synalar (fluocinolone 0.01 percent solution)||One or two times daily||Burning, cough, fever, hypopigmentation, pruritus, runny nose, skin atrophy||$32 ($289) for 60 mL|
For infants, treatment for eczema on the scalp may include:
- Emollients to help loosen scales, such as mineral or olive oil, petroleum jelly
- Removing scales by rubbing with a cloth or infant hairbrush
- Ketoconazole one to two percent two times daily for two weeks
What are the different types of eczema that affect the scalp?
The scalp is an area of the body that can be affected by different types of eczema. The characteristics of the scalp during the chronic and acute phases of eczema are:
- Chronic phase: Dry, itchy, and scaly.
- Acute (eczema flare) phase: Inflamed, weepy, and painful.
The different types of eczema that affect the scalp include:
- Seborrheic eczema: It is the most common type and can affect babies (cradle cap), children, and adults. The skin appears red and scaly, and dandruff is present as well.
- Atopic eczema: The scalp skin becomes red, dry, and itchy and can get easily infected.
- Allergic contact dermatitis: It develops due to the body reacting to a particular substance to which a person may be allergic.
- Irritant contact dermatitis: It occurs when the skin surface is irritated by a substance that causes it to become red, dry, and itchy.
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Clark GW, Pope SM, Jaboori KA. Diagnosis and Treatment of Seborrheic Dermatitis. Am Fam Physician. 2015 Feb 1;91(3):185-90.https://www.aafp.org/afp/2015/0201/p185.html
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