If you have a scalp, it’s going to itch at some point. But if the top of your head is severely itchy, you might actually have eczema on your scalp. Yup, it happens.
Eczema is a condition that can cause flare-ups of a red, scaly, itchy rash to appear on different parts of your body, according to the Mayo Clinic. The most common form of eczema is atopic dermatitis, which generally shows up on areas of your body like your hands, feet, ankles, wrists, neck, upper chest, eyelids, elbows, and knees, but it can be anywhere—including under your hair.
You might not think you can have eczema if you’re having issues only with your scalp, but it’s possible. While it’s likely that having scalp eczema also means that you have it elsewhere, it’s not a requirement. “Sometimes eczema can be seen only on the scalp,” Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, tells SELF.
Translation: If you’re dealing with intense scalp irritation, don’t assume you can combat it on your own—get to a dermatologist as soon as you can.
You would think you couldn’t miss having eczema on your scalp, but people with this condition often mistake it for something else. “Many times, patients just assume it is a consequence they have to live with from their hair products, or that they have a dry scalp,” Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and founder of Dr. Bailey Skin Care, tells SELF.
Here’s how to tell whether or not eczema is what’s really behind your irritated scalp…
What causes scalp eczema?
Eczema is a term that’s used to describe several different conditions, one of which is atopic dermatitis. All of these conditions are caused by a disruption in the skin barrier that usually keeps irritants out and hydration in. But if that barrier isn’t working properly, the skin can become dry, red, irritated, and sensitive to irritants and allergens. That barrier disruption may be driven by a gene variation, the Mayo Clinic says.
There are some triggers that your scalp is especially likely to come in contact with, like ingredients in your shampoo, conditioner, and hair styling products. If you brush your hair aggressively, wash your hair too frequently, or heat-style your hair often, those could also aggravate dry skin on your scalp or trigger eczema symptoms.
What are the symptoms of eczema on your scalp?
When your skin’s barrier is unable to function properly, that makes it difficult for the skin to keep moisture in. It also makes the skin more sensitive to potential irritants. So, according to the Mayo Clinic, the symptoms of eczema often include:
- very dry skin
- patches of reddish or brownish skin
- intense itching that gets especially bad at night
- sensitive or swollen skin after scratching
- flakes on your clothes or shoulders after scratching
- small bumps that might leak fluid
- thickened or cracked skin
What’s the difference between scalp eczema and scalp psoriasis?
There are a surprising amount of conditions that can cause an itchy scalp, so it’s important to be sure you know what you’re really dealing with. Seborrheic dermatitis, for example, is a major cause of dandruff and has an entirely different treatment plan than eczema.
Another possibility is psoriasis on your scalp. Eczema and psoriasis both cause patches of red, itchy skin, but they show up slightly differently. Unlike eczema, psoriasis is an autoimmune condition, and the inflamed skin patches that are caused by psoriasis tend to be thick and scaly, and they may be greyish in colour. These thickened patches are referred to as “plaques” and may be triggered by things like stress or a bacterial or viral infection.
If you’re not sure whether your scalp issue is due to eczema, psoriasis, or something else, it’s best to check with a dermatologist. But you can help narrow it down by thinking about the products you’ve used on your scalp recently and what, if anything, helps your scalp feel better. For instance, if you know you used a new shampoo in the past week, that could be triggering eczema.
It also helps to know about your family history because both eczema and psoriasis can have a genetic component. So, if you have a family member with one condition or the other, that makes it more likely that you have it too.
Here’s how to treat eczema on your scalp:
The first thing to do if you think you might have scalp eczema is to get a proper diagnosis from a board-certified dermatologist. They might prescribe certain treatments like drugs to reduce inflammation and calm an overactive immune system, according to the Mayo Clinic.
But there are some things you can do at home to help soothe your eczema, particularly when it comes to your hair-washing habits:
Avoid overwashing. For instance, if you experience the symptoms of eczema on your scalp, you might assume you have an especially bad case of dandruff, which can result in itching, scaliness, and flakes that drift down onto your clothes. In response, you might decide to wash your hair more often, but that can actually make things worse because it strips the scalp and hair of their natural moisturizing oils and can contribute to dryness and irritation.
Wash only with gentle shampoos and conditioners. Eczema is often triggered or worsened by irritant or allergic reactions, including reactions to harsh hair- or skin-care products. It’s possible for anyone to get this type of reaction—with or without eczema, Dr. Bailey says. But if you do have eczema, you are more susceptible to these reactions and they can trigger your eczema symptoms.
If a hair product might be causing contact dermatitis that worsens your eczema, your doctor will likely recommend that you ditch it and see where that gets you, New York City dermatologist Doris Day, M.D., author of Beyond Beautiful, tells SELF. They’ll likely suggest gentle shampoos, conditioners, and other hair products that won’t strip your scalp of moisture or otherwise make your eczema harder to handle.
Keep showers short and lukewarm. This is especially true if you take long, superhot showers, are shampooing frequently to battle what you think is dandruff, or are scrubbing vigorously to do the same. Using anything hotter than warm water can worsen eczema, as can exposing yourself to water for more than 10 to 15 minutes at a time, according to the Mayo Clinic. Plus, scrubbing hard at scalp eczema can scratch your skin, which might just make your condition worse.
Plenty of products at your local drugstore might promise to help with an itchy scalp, but using something like an over-the-counter dandruff shampoo won’t treat your eczema. It could even make it worse, depending on what’s in it. It’s really best to talk to your doctor, Dr. Day says: “In most cases, only prescription-based treatments really work.” Even if you don’t have scalp eczema, your doctor can identify what’s going on, offer treatment, and make your itchy scalp one less thing hanging over your head.