What Is Eczema on the Scalp

There are many different types of eczema, one type is called seborrheic dermatitis, more commonly known as eczema of the scalp.

Seborrheic dermatitis (SD) is non-contagious, chronic (long-term), and recurrent (meaning symptoms come and go) inflammatory disorder. It most commonly affects adults, but a more short-term type of seborrheic dermatitis—known as cradle cap—can occur in infants.

The exact cause of seborrheic dermatitis is not known for sure. Still, there is some speculation that the condition may be linked to the rapid spread of a type of yeast-like fungi on the skin called Malassezia.

Eczema on Scalp Symptoms

Eczema on scalp involves symptoms around the hairline and behind the ears. The symptoms include:

• Redness in light skin tones
• Brown, purple gray, or ashen color in darker skin tones
• White or yellowish crusty scales on the scalp (that appear thick and greasy)
• Greasy, swollen skin
• A rash that can look like psoriasis (another type of skin disorder caused by an overactive immune system)

Symptoms of seborrheic dermatitis are commonly seen on the scalp, face, around the back of the ear, and in some instances, on the chest, under the arms and/or in the genital region.

Eczema on the scalp can occur anytime during a person’s lifespan, but it most commonly happens during infancy or during adulthood (in adults from the age of 30 through 60). 

When seborrheic dermatitis affects infants, the condition most commonly clears up on its own, but in adults, SD usually has a pattern of flareups with symptoms that can come and go for many years.

Infant Symptoms

In infants with seborrheic dermatitis the condition usually manifests as a form of the disease called cradle cap. Symptoms of cradle cap include scaly, greasy patches on the scalp; but the symptoms can also be seen on the buttocks (and are often mistaken for contact dermatitis).

Note, the medical term for diaper rash is contact dermatitis. If an infant is diagnosed with seborrheic dermatitis during the first few months of life, in most circumstances, it will go away within a year, and never recur. 

In infants, eczema on the scalp is often accompanied by atopic dermatitis. Atopic dermatitis is the medical term for the most common form of eczema which commonly occurs on the face, hands, elbows, and knees, but can involve any part of the body.

Usually, the eczema symptoms are more severe when an infant (or adult) has both conditions (atopic dermatitis and seborrheic dermatitis). When seborrheic dermatitis overlaps with atopic dermatitis, a condition can develop that some people refer to as head and neck dermatitis, this seems to be closely related to seborrheic dermatitis and it is treated similarly.

Teenage Symptoms

In teenagers, eczema on the scalp can occur in areas where the skin is oily (such as the scalp). Other areas where swelling, redness, and greasy scaling are commonly seen in teenagers are the sides of the nose, around the eyebrows, on the mid-chest, upper back, armpits, and groin area.

Once a teenager (or an adult) has SD, and then it goes into remission (when a condition is present but has no symptoms) it almost always returns again and again.

The rash may itch and cause some discomfort, but for most teenagers, it's the redness and scaling that tends to disturb them the most. Having a visible rash can really have an impact on self-esteem, particularly during adolescents.

Causes

The precise cause of seborrheic dermatitis is not well known. But, experts surmise that genes and hormones are very apt to play a role in its development.

In addition, yeast, which normally lives harmoniously on the skin can play a role in the development of seborrheic dermatitis. This is thought to happen when a specific type of organism—called Malassezia—begins to grow and multiply very quickly. This, in turn, is said to cause a person’s immune system to over-react, resulting in an inflammatory reaction.

But, unlike some other forms of eczema, SD is not linked with allergies. Just as in other types of eczema (such as atopic dermatitis) stress, as well as cold and dry weather can trigger flareups.

Risk Factors 

Although most people with seborrheic dermatitis are healthy, some experts report that SD is more likely to occur given certain circumstances. These include:

• An increase in oil production on the skin or scalp
• A high level of yeast (fungus) on the skin
• The presence of other skin conditions (such as acne, rosacea, and psoriasis)
• A weakened immune system (such as those with HIV or AIDS)

According to the National Eczema Association, some other factors can predispose a person to getting seborrheic dermatitis. These include:

• Those with diseases of the nervous system (such as Parkinson’s disease or epilepsy)
• People with depression, alcoholism, or eating disorders
• Those taking specific types of medication (including lithium, interferon, and more)
• People recovering from a stroke or a heart attack
• Some medications, including psoralen, interferon, and lithium, increase people’s risk of developing seborrheic dermatitis
• Specific medical conditions
• Common psychiatric conditions (such as depression, anxiety and eating disorders)
• Alcoholism
• Recovering from a stroke or heart attack

Diagnosis

Seborrheic dermatitis is said to be an easy condition to diagnose. This is due to the appearance of the affected skin, combined with where the condition appears on the body.

The dermatologist will do an examination to observe the affected areas. Next, a biopsy may be performed to rule out other types of skin disorders (such as psoriasis). A biopsy is often performed if the affected area of the scalp or skin does not respond favorably to treatment of seborrheic dermatitis. 

Skin Biopsy

A skin biopsy involves scraping off skin cells to be sent to a lab and examined under a microscope. The test is usually done in a physician’s office and results are often available in just a few days to up to two weeks.

Treatment

There are three major goals of treatment for seborrheic dermatitis, including:

• Removing the scales
• Reducing any itching
• Calming the inflammation (that causes redness and swelling)

Treating infants for cradle cap (seborrheic dermatitis) usually involves simply using a type of emollient (such as petroleum jelly or mineral oil) to gently loosen the scales.

Adults may require more complex treatment, including:

• Self-care to manage stress and prevent flareups
• Topical (on the skin) anti-fungal cream
• Medicated anti-fungal shampoo (such as prescription or over-the-counter brands)
• A topical corticosteroid (for reducing inflammation in more severe cases)
• A topical nonsteroidal cream (such as Eucrisa which is an anti-inflammatory cream for mild to moderate forms of eczema, for those who cannot use steroids)

Self-Care

According to the National Eczema Association, good self-care can help keep symptoms at bay. These include:

• Washing with a gentle cleanser containing zinc (2% zinc pyrithione) each day
• Using a gentle moisturizer (preferably one that doesn’t clog the pores)
• Staying on top of stress with healthy lifestyle habits (such as a daily workout, and meditation or other stress-reduction techniques)
• Getting adequate sleep each night

Study on Link to Mental Health/Other

Some experts report a link between certain personality traits and common mental health conditions (such as depression and anxiety) and seborrheic dermatitis. Some of these psychological factors are said to play a role in the onset, exacerbation (sudden worsening of symptoms), and remission of seborrheic dermatitis (SD). 

According to a 2017 study aimed at evaluating personality traits in people with common psychiatric conditions (such as depression) with SD, "We found statistically significantly higher rates of depression and anxiety in SD patients compared with the control group in the present study."

In addition, significantly more somatization [complaints of discomfort] and neurotic personality trait properties [such as moodiness, worry, fear, anger, frustration, envy, jealousy, guilt, depressed mood] were found among these patients,” wrote the study authors.

The data discovered in the study showed that people with seborrheic dermatitis were more likely to manifest their emotions; this was identified as the probable link between people with SD, specific personality traits and psychological stress.  Thus, some experts consider SD to be a psychosomatic disorder (an illness caused or worsened by a mental factor such as internal conflict or other stressors).

Coping

The research illustrates the importance of learning how to manage stress and use positive coping mechanisms to deal with eczema of the scalp. This includes addressing emotional symptoms, seeking support, adjusting one's lifestyle (such as employing a regular workout routing, and more.