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Have eczema on scalp. What is the cause and treatment required?

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Practicing since : 2006
Answered : 2015 Questions
My dermatologist says that I have eczema on my scalp. Can you have atopic eczema on your scalp (dry scalp) and it just be plain old eczema and not Seborrhoeic dermatitis? It is at my hairline (itchy patches) and throughout my hair (i have sore, itchy spots).

Please advise as I don't know how to treat this. My dermatologist recommended olive oil on the scalp??

Posted Thu, 28 Mar 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 4 hours later
Thanks for writing to us.
The cause for scalp eczema could be many( seborrheic dermatitis, atopic eczema, irritant or allergic dermatitis etc)
Atopic eczema in adults usually involves flexors or skin creases. Scalp involvement is rarely seen. I guess as you have history of urticaria and dermographism, it might have led your doctor to think that it could be due to atopy.
In seborrheic dermatitis, you get itchy red scalp with greasy pale yellow scales that may go beyond the hair line. Sometimes involvement of eyebrows, eye lids, nasal folds and ear folds is seen( these areas also show redness with flakiness)
Allergic or irritant dermatitis may occur due to application of any hair product etc.

Whatever may be the cause, treatment remains the same for scalp eczema
1)use sebowash shampoo alternating it with nizoral shampoo.( that is use these to wash hair on alternate days) apply shampoo over scalp, let it remain for 5 to 10 minutes and then rinse
2) apply steroid lotion like flutivate e lotion( fluticasone lotion) over scalp in night.
3) use tab cetirizine if lesions are too itchy
4) use warm olive oil over scalp once in a week

Hopefully in two weeks you will notice good response. Once the eczema is controlled, stop fluticasone lotion, continue with shampoos twice in a week.

Hope that helps. Should there be any other query, feel free to write back.
Above answer was peer-reviewed by
Follow-up: Have eczema on scalp. What is the cause and treatment required? 4 hours later
Dr. Pathak,

Thank you for your reply. I just am confused because my dermatologist looked at my forehead and scalp and he said that I have "eczema." I asked him if he thought it was sebborheic dermatitis and he said no.

Then I had an appointment with my Primary Care for another issue and she looked at my scalp and hairline. She also said my scalp looks dry and that I have some eczema in other areas of my scalp.

I am prone to eczema and have dry skin. I do not have any scales, just red, itchy "dots" along hairline that itch and randomly look redder. Although, for the most part you can't tell that they are there because they go back to almost skin color. That's why you cannot see anything in my picture. I thought you could get eczema anywhere on your body?

Where can I get sebowash? Is it prescription?

Thanks again, XXXXXXX
Answered by Dr. Kalpana Pathak 16 hours later
Firstly eczema just denotes a red itchy scaly rash. It is a broad term and includes seborrheic dermatitis, atopic eczema ,irritant or allergic contact dermatitis etc as its various types. You can get eczema anywhere on your body. You can also get eczema over your scalp due to any preceding scalp cause like furuncles, lice infestation etc and it is known as secondary eczematisation.
Seborrheic dermatitis or atopic dermatitis is a type of eczema while all eczema is not seborrheic dermatitis or atopic dermatitis. Making a diagnosis of eczema is just broadly classifying the disease while specific diagnosis is defining what kind of eczema it is. I hope you got my point!

Anyways, whatever kind of eczema it is with the treatment I have suggested you will have a good response. Sebowash is a steroid shampoo by CIPLA pharmaceuticals as must be available OTC. Also avoid any hair treatment for a while and do not use any new hair products.

Let me know after few days if you are faring well. I shall be available for follow up.
Take care
Above answer was peer-reviewed by
Follow-up: Have eczema on scalp. What is the cause and treatment required? 11 hours later
Hi Dr. Pathak,

Thank you for your response. I just was under the impression that sebborheic dermatitis was fungal and atopic dermatitis was not.. That's why I am trying to figure out which one I have as I thought they were treated differently?

I also have heard horror stories about seb derm that it is very difficult to clear up so I was hoping that is not what I have. Would sebowash work better than something like Nizoral? I have tried Neutrogena T Gel and it didn't help me. Is it okay to use a steroid on my scalp?? Will the sebowash take away my symptoms? This has been going on for many months and I've noticed that my hair appears damaged in that area but I don't know if that's from using a flat iron too often or actually if it's new hair growth. Can you tell my looking at my picture of my hairline?

Would a special diet help? Do symptoms tend to improve when the weather warms up?

Thanks so much, XXXXXXX
Answered by Dr. Kalpana Pathak 16 hours later
Seborrheic dermatitis is a type of eczema which indeed has a fungal etiology . Seborrheic dermatitis isn't difficult to treat but once results are achieved, maintenance is required.
Sebowash is a steroid containing shampoo and is helpful in clearing any type of scalp eczema. Nizoral is an antifungal shampoo helpful specifically for seborrheic dermatitis or dandruff. Milder steroids can be used safely on scalp without causing any side effects. Steroid would not only treat eczema but induce hair regrowth to some extent. Once the eczema has cleared, you may also use minoxidil 2 percent solution to increase hair growth

Withhold any hair treatment, blow drying or straightening iron for a while. I am so sorry to say that the images attached are not clear enough for me to comment.

No special diet as such is required for eczema. However a diet XXXXXXX in protein, biotin, copper, selenium etc is said to be good for hair growth.
Eczema tends to improve in summers when the weather is warm.

The treatment that I suggested in my first post would cover all the probable causes for eczema. Start the treatment and let me know after a week about the results. I will be there for followup.

Hope that helps.
Take care
Above answer was peer-reviewed by
Follow-up: Have eczema on scalp. What is the cause and treatment required? 13 hours later
Dr. Pathak,

Thanks for your assistance. I cannot tell if I have new growth on my hairline or if it is damaged hair. If it is damaged from the eczema, how can I prevent this from happening again? (Please view my most recent picture). I would like my nice hair back!! Then again, maybe it's new growth??

Answered by Dr. Kalpana Pathak 8 hours later
The small hair seen looks like new hair growing back. Just control eczema with treatment suggested as sometimes this too can lead to hair damage. Once eczema has cleared off, you may apply minoxidil to induce faster hair growth.

Hope that helps.
Take care..
Above answer was peer-reviewed by
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