How to Treat Scalp Eczema

Eczema is a skin disease caused by a decrease in sebum secretion and a lack of moisture. Skin is healthy when it maintains a balance of these ingredients, creating a barrier against environmental influences, irritation and infection. Scalp eczema can be caused by atopic dermatitis or atopic dermatitis. It is also known as dandruff, oily skin psoriasis, if the disease occurs in infants, it is often called “buffalo dung”. ^{[1] X Trusted Source Mayo Clinic Go to Source} These types of dermatitis can also cause eczema on the face, chest, back, underarms, and in the groin area. ^{[2] X Source of Research} Although diseases are uncomfortable and make you feel less confident when communicating, they are not contagious and they are not caused by poor hygiene. ^{[3] X Trusted Source Mayo Clinic Go to the Source} Understanding the causes and symptoms of eczema will help you treat it.

Table of Contents

Know the symptoms and causes

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Look for common symptoms. Eczema causes problems for the scalp and any infected skin, with common symptoms being flaking (dandruff), itching, redness, scaling, oily patches, and hair loss. ^{[4] X Trusted Source Mayo Clinic Go to Source}

The inflammation leads to red patches of skin, high levels of fatty acids, which in turn cause the skin to become oily and yellow in color in some people. ^{[5] X Research Sources Clark GW, Pope SM, Jabari KA. Diagnosis and Treatment of Seborrheic Keratosis. Am Fam Physician. 91(3), 2015:185-190.}
In infants, it commonly occurs on the scalp as red, dry, and scaly patches of skin, which in severe cases can form thick white or yellow greasy scales.
Other skin diseases such as fungal infections, psoriasis, dermatitis, and skin tuberculosis have similar manifestations to scalp eczema, but they differ in the location and layer of the infected skin. ^{[6] X Research Sources Clark GW, Pope SM, Jabari KA. Diagnosis and Treatment of Seborrheic Keratosis. Am Fam Physician. 91(3), 2015:185-190.}
If you are not sure if your symptoms are true of scalp eczema, you should see a doctor. They help you determine the cause and assess the severity to decide if intervention is needed.

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Know the causes of eczema. Besides reducing sebum secretion and lack of moisture, many doctors believe that there is a fungus called Malassezia furfur that is also linked to atopic eczema. ^{[7] X Source of Study} Malassezia fungus is found on the outer surface of the skin. In people with scalp eczema, this fungus attacks the outermost layers of the skin and secretes substances that increase fatty acid production. This causes inflammation and makes the skin drier, leading to the shedding of the outer layer of the skin.

If eczema is atopic, meaning your family has a predisposition to developing eczema, the culprit may not be a fungus. Doctors say many people develop atopic eczema because of a defect in the protective layer of the skin, caused by a modified gene in the protein that makes up the skin’s structure. ^{[8] X Research Sources}

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Identify risk factors. It is not well known why some people develop atopic eczema while others do not, but there are several factors that increase the risk of the disease, including: ^{[9] X Research Sources}

Overweight or obese?
Tired
Environmental factors (such as dry weather)
Stress
Other skin problems (like pimples)
Certain health conditions such as stroke, HIV, Parkinson’s disease, or head injury

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Avoid using alcohol-based skin and hair care products. Alcohol strips the skin of its protective oil layer and causes it to become dry. This aggravates the flaking and itching, which can contribute to oily eczema. ^{[10] X Research Source}

Gentle when cleaning skin and scalp. Do not scrub hard! While washing your hair, gently massage the skin with your fingers. The purpose is to clean the hair but at the same time not remove the oil from the scalp.

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Do not scratch the itchy skin. We often want to scratch when a certain part of our body feels itchy, but you should not scratch the eczema affected skin areas as this will only irritate them more and cause them to bleed.

It can even lead to a secondary infection if you scratch too much.

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The disease is likely to recur. Rarely can you “cure” this disease completely with a single treatment. Scalp eczema appears and goes away with treatment, but it will recur and you must continue the treatment process. Fortunately, we have many treatments that can be carried out over the long term. ^{[11] X Research Source Alavian CN, McEnery-Stonelake M. Keratosis, Seborrheic. The 5-Minute Clinical Consult Standard 2015. Philadelphia: Wpters Kluwer Health, 2015, 3572–3580.}^{[12] X Trusted Source Mayo Clinic Go to Source}

Treating Eczema of the Scalp with Over-the-Counter Medicine (adults)

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Talk to your doctor or pharmacist first. Even over-the-counter (OTC) drugs can affect certain health conditions, so it’s best to consult your doctor or pharmacist before taking them. ^{[13] X Research Source}

If you have allergies, have a medical condition, are taking other medications, are pregnant or breast-feeding, always tell your doctor before starting any course of treatment.
Medicines should not be given to children without first consulting a pediatrician. Treating scalp eczema in children is a different process and will be covered in this article.

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Use OTC pharmaceuticals. There are many over-the-counter scalp eczema shampoos and oils available. Those are the natural treatments you should choose first before using a prescription shampoo. You can use them every day for a long time.

These shampoos are not allowed for children! You must only use them on adult scalps.

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Wash your head properly. Regardless of what shampoo or conditioner you are using, there are always some general guidelines that you should follow. Scrubbing the scalp too hard or using alcohol-based shampoos can make the skin condition worse. ^{[14] X Research Source}

First wet your hair with warm (not hot) water.
Apply shampoo evenly to the scalp and hair, massage gently so that the shampoo penetrates the scalp. Do not rub or scratch your scalp, as this will cause the scabs to bleed or even become infected.
Leave the shampoo on your head for the time recommended on the package, usually at least 5 minutes.
Rinse the head completely with warm (not hot) water and pat dry with a clean towel.
Shampoo containing coal tar can be toxic if swallowed. Avoid contact with eyes or mouth.
Certain medications, such as shampoos containing ketoconazpe, may be more effective when you alternate them with another product twice per week. ^{[15] X Trusted Source Mayo Clinic Go to Source}

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Use a shampoo containing selenium sulfide. This type of product kills the fungus that is likely the cause of scalp eczema. If the fungus is gone, the dryness, inflammation, or itching of the skin will not progress further and the disease is likely to go away.

Common side effects include dry or greasy hair or scalp. Less common side effects are hair discoloration, hair loss, or scalp irritation. ^{[16] X Research Source}
You must use this oil for at least two weeks to see the effect.

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Use tea tree oil products. Tea tree oil (scientific name is Melaleuca alternifpia ) has natural antifungal properties that help treat scalp eczema. A clinical study showed a significant reduction in the condition when using a shampoo containing 5% tea tree oil. ^{[17] X Research Source Satchell AC, Saurazen A, Bell C, Barnetson RS. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatp. 2002;47(6):852–855.} The only common side effect is scalp irritation. ^{[18] X Trusted Source PubMed Central Go to Source}

This product can be used every day.
Do not take tea tree oil as it is toxic. Avoid contact of essential oils with eyes or mouth.
Tea tree essential oil has both antigonadotropic and gonadotropic properties, which have been linked to breast development in prepubertal males. ^{[19] X Research Sources Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med.2007;356(5):479–485}

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Massage the scalp with egg oil. Egg oil has a natural immune serum that can help treat scalp eczema when used regularly.

This product must be used twice weekly and left overnight for a minimum of one year.
Egg oil is rich in Omega-3 Docosahexanoic fatty acids that can promote the formation of new epithelial cells.

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Use a shampoo containing zinc pyridine. Most anti-dandruff shampoos use zinc pyrithione as the active ingredient. Scientists don’t know exactly why it works for scalp eczema, although it has antifungal and antibacterial properties. ^{[20] X Trusted Source PubMed Central Go to source} In addition zinc pyrithione slows down the production of skin cells, thereby reducing the formation of flaky skin. The only side effect is scalp irritation.

You can use this product three times per week.
Look for shampoos that contain 1-2% zinc pyridine. ^{[21] X Trusted Source PubMed Central Go to Source} Zinc pyrithione is also found in some topical cream products. ^{[22] X Research Source}

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Try a shampoo containing salicylic acid. This product can loosen the outer layers of skin that are about to be peeled off the scalp, effective salicylic acid content at 1.8 to 3%. The only side effect is skin irritation.

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Use a drug containing ketoconazpe. Ketoconazpe is very effective in treating scalp eczema. It is in many OTC pharmaceuticals, as shampoos, foams, creams, and gels. In addition, ketoconazpe is also included in the pharmaceutical products sold by the doctor’s prescription. ^{[23] X Trusted Source PubMed Central Go to source}

OTC medications are milder than prescription shampoos and creams. ^{[24] X Research Sources}
There are some side effects such as changes in hair smoothness, hair discoloration, scalp irritation, oily or dry scalp or hair. ^{[25] X Research Sources}
The shampoo is effective and safe when it contains 1-2% ketoconazpe, even safe for babies. You can use it twice daily for two weeks. ^{[26] X Research Resources Peter RU, Richard-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazpe shampoo: results of a multicentre, double-blind, placebo-contrpled trial. Br J Dermatp. 1995;132(3):441-445.}

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Apply raw honey to your hair. Although not a shampoo, raw honey has antibacterial and antifungal properties. ^{[27] X Trusted Source PubMed Central Go to Source} It can treat itching and flaking skin. Raw honey cannot cure eczema, but it can help scalp lesions heal faster. ^{[28] X Research Source}^{[29] X Research Source Al-Waili NS. Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Eur J Med Res. 2001;6(7):306-308.}

Dilute raw honey in warm water with a ratio of 9 parts honey to 1 part water. ^{[30] X Trusted Source PubMed Central Go to Source}
Wipe this solution on the eczema affected skin for 2 to 3 minutes, do not rub or wipe vigorously. Rinse with warm water.
Every other day you can wipe honey on the itchy skin and leave it on for 3 hours. Rinse with water after 3 hours has elapsed. ^{[31] X Source of Study} Continue this regimen for 4 weeks. ^{[32] X Trusted Source PubMed Central Go to source}

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Try using a shampoo containing coal tar. This shampoo helps to reduce the rate of skin cell production on the scalp, it also inhibits the growth of fungus and softens the scales on the scalp. However, this product is not as safe as other OTC medications, so you should try other options first. ^{[33] X Trusted Source PubMed Central Go to Source}

Use a shampoo containing coal tar for a period of four weeks.
Possible side effects are scalp itching, localized hair loss, contact dermatitis of the fingers, and skin discoloration. ^{[34] X Trusted Source PubMed Central Go to Source}
You should consult your doctor before using a shampoo containing coal tar. You must not give it to children, pregnant or breastfeeding women. The product also interacts badly with some medications or causes allergies. ^{[35] X Research Source}

Treatment of scalp eczema in infants and children

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Wait for the disease to heal on its own. For many babies and children, scalp eczema clears up on its own within a few weeks, in some cases it takes months. ^{[36] X Research Sources} Although this condition may look uncomfortable on the surface, most young children feel fine. ^{[37] X Research Source}

If the eczema doesn’t go away on its own, you should consult your pediatrician for treatment.
Just like eczema in adults, eczema in children may go away after treatment but then return. ^{[38] X Research Sources}

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Use other treatments for children. The treatment for infants and children under two years of age is different from that for adults. Do not use OTC adult medications on children under 2 years of age. ^{[39] X Research Sources Clark GW, Pope SM, Jabari KA. Diagnosis and Treatment of Seborrheic Keratosis. Am Fam Physician. 91(3), 2015:185-190.}

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Remove scabs by massaging your baby’s scalp. Scalds on a baby’s scalp can easily come off when you gently massage them with your fingers or a washcloth. You must first wet the baby’s hair and then gently wipe the scalp with a towel. Do not rub the skin vigorously! ^{[40] X Research Source}

Avoid using sharp skin cleaning tools such as brushes, loofahs or sponges. ^{[41] X Trusted Source National Eczema Association Go to Source}

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Use baby shampoo. Shampoos for adult eczema may be too strong for a baby’s sensitive skin. You should use baby shampoos like Johnson & Johnson’s or Pigeon. ^{[42] X Research Source}

Brush your baby’s hair every day.
Shampoos containing 1-2% ketoconazpe are effective and safe for infants, although you should talk to your pediatrician before using them. You can use it twice daily for two weeks. ^{[43] X Research Resources Peter RU, Richard-Barthauer U. Successful treatment and prevention of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazpe shampoo: results of a multicentre, double-blind, placebo-contrpled trial. Br J Dermatp. 1995;132(3):441-445.}

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Apply oil to the scalp. If massaging is not able to remove the scales, you should apply pure petroleum jelly or mineral oil to the scaly skin. ^{[44] X Research Sources Poindexter GB, Burkhart CN, Morrell DS. Therapies for Pediatric seborrheic dermatitis. Pediatr Ann. 2009;38(6):333-338.} Avoid using olive oil. ^{[45] X Research Sources}

Let the oil soak into the skin for a few minutes, then wash your hair with baby shampoo and rinse with warm water. Finally, brush your baby’s hair as usual.
The scalp must be thoroughly rinsed with water after each oil application, otherwise the oil will accumulate and make the condition worse.

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Bathe your baby every day. You should bathe your baby with warm (not hot) water every 2-3 days, and each bath time should not exceed 10 minutes.

Avoid using irritants such as strong soaps, effervescent agents, Epsom salts or other additives in bath water. They can irritate your baby’s skin and make eczema worse. ^{[46] X Trusted Source National Eczema Association Go to Source}

Treating Eczema of the Scalp with Over-the-Counter Medicine

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Consult your doctor about prescription medications. Patients who do not respond to OTC medications or who are not satisfied with the results can take the medication prescribed by their doctor. They will apply stronger treatments including the use of creams, lotions, shampoos if OTC shampoos are not effective. ^{[47] X Research Sources Schwartz JR, Rocchetta H, Asawanonda P, Luo F, Thomas JH. Does tachyphylaxis occur in the long-term management of scalp seborrheic dermatitis with pyridine zinc-based treatments? Int J Dermatp 48(1), 2009:79-85.} Treatment with ultraviolet light is also an option. ^{[48] X Trusted Source PubMed Central Go to Source}

Antifungal shampoos (available by prescription) and topical corticosteroids are very effective, but they are expensive and can cause negative side effects with long-term use. These two products, along with other prescription shampoos, should only be used when OTC medications don’t work.

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Use an antifungal shampoo. The most common over-the-counter (OTC) shampoos for scalp eczema are antifungal shampoos, most of which contain 1% ciclopirox and 2% ketoconazpe. ^{[49] X Trusted Source PubMed Central Go to Source}

The most common side effects include skin irritation, burning sensation, dry skin, and itching.
These shampoos can be used daily or at least twice weekly during the treatment period. Always follow the directions on the package or your doctor’s prescription.

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Use a shampoo containing corticosteroids. This product helps to reduce inflammation, itching and flaking of the scalp. Typically, corticosteroid shampoos have the following ingredients: 1.0% hydrocortisone, 0.1% betamethasone, 0.1% clobetasp, and 0.01% fluocinpone. ^{[50] X Trusted Source PubMed Central Go to Source}

Side effects that often occur after long-term use include thinning of the skin, itching, burning sensation, loss of skin pigment cells (skin loses color so the complexion looks brighter). If used only for a short time, almost no one will experience side effects. ^{[51] X Trusted Source Mayo Clinic Go to Source}
These shampoos contain steroids, and some of them can get into the bloodstream. If you have diabetes or are sensitive to steroids, discuss this complication with your doctor.
Be aware that corticosteroid shampoos are often more expensive than other products.
You can wash your hair daily or twice daily for the indicated time.
Try using an antifungal shampoo at the same time as a corticosteroid shampoo for better results. Consult your doctor about combining the two. ^{[52] X Research Sources Ortonne JP, Nikkels AF, Reich K, et al. Efficacious and safe management of moderate to severe scalp seborrhoeic dermatitis using clobetasp propionate shampoo 0.05% combined with ketoconazpe shampoo 2%: a randomized, contrpled study. Br J Dermatp. 2011;165(1):171-176.}

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Using other prescription medications. For scalp eczema, shampoo is the most commonly used form of treatment. You can also try using a cream, lotion, oil, or foam that contains one or more of these medicinal ingredients.

Antifungal medications called azpe tails are very effective for scalp eczema. Of these, ketoconazpe is the most commonly used and has been shown to be effective in many clinical trials. ^{[53] X Trusted Source PubMed Central Go to Source}
Another popular type is ciclopirox, which is a hydroxy pyridine-based antifungal. It is available in the form of a cream, gel or solution. ^{[54] X Trusted Source PubMed Central Go to source}
Corticosteroids are also sold as creams or ointments. ^{[55] X Trusted Source Mayo Clinic Go to Source}

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Light therapy. Light therapy, also known as phototherapy, can sometimes be effective with scalp eczema. ^{[56] X Sources of study} Often people will use a combination of drugs during treatment, such as psoralen. ^{[57] X Trusted Source Mayo Clinic Go to Source}

Since phototherapy requires you to be exposed to ultraviolet light, there is also a risk of skin cancer. ^{[58] X Research Sources Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: A review of the literature. Int J Dermatp. 2005;44(5):355–360.}
This treatment usually only applies when the cause of the eczema is atopic dermatitis, or when the dermatitis develops and spreads. ^{[59] X Trusted Source PubMed Central Go to Source} UV rays cannot be exposed to infants or young children. ^{[60] X Trusted Source Mayo Clinic Go to Source}

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Ask your doctor about other treatment options. There are several other ways to treat scalp eczema, but they are only last resort because of the potential for serious side effects. However, if all the methods you have tried have failed, you should consult your doctor about these options. ^{[61] X Trusted Source Mayo Clinic Go to Source}

Creams or lotions containing tacrpimus (Protopic) and pimecrpimus (Elidel) can also be used to treat eczema. However, they increase the risk of cancer and are more expensive than corticosteroids. ^{[62] X Trusted Source PubMed Central Go to source}
Terbinafine (Lamisil) and butenafine (Mentax) are oral antifungal medications for scalp eczema, ^{[63] X Trusted Source PubMed Central Go to source} but they interfere with the action of certain enzymes, causing allergies or liver problems. ^{[64] X Trusted Source Mayo Clinic Go to Source} So these two drugs are of limited use in the treatment of eczema. ^{[65] X Research Sources Berk T, Scheinfeld, N. Seborrheic Dermatitis. P F. 2010;35(6):348-352.}

Warning

This article is not intended to be a substitute for advice, diagnosis or treatment by a medical professional. Always consult your doctor before starting any treatment, including over-the-counter medications.

Steps

Know the symptoms and causes

Treating Eczema of the Scalp with Over-the-Counter Medicine (adults)

Treatment of scalp eczema in infants and children

Treating Eczema of the Scalp with Over-the-Counter Medicine

Warning

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