Causes of Scalp Eczema, Plus Treatment, Triggers, and Images

If you have a dry, itchy, or flaky scalp, you may have scalp eczema. This common condition has a few different causes. But no matter the cause, symptoms are the same — unwanted scalp flaking and an itchy rash.

Scalp eczema symptoms can range from mild to a truly uncomfortable nuisance. But whatever your symptoms, treatments are available and effective — provided you get the diagnosis right. 

And there’s the catch. There are different types of scalp eczema, and they need different treatments. And other rashes, like scalp psoriasis and scalp ringworm, can look a lot like dandruff too. So it’s important to get the right diagnosis before you start treatment. 

Types of scalp eczema

Many different types of eczema can affect the scalp. They may have similar symptoms, like flaking and itching, but they have different causes and different treatments. 

Seborrheic dermatitis (dandruff)

Seborrheic dermatitis is one of the most common types of scalp eczema, and it affects people of all ages. 

You may be more familiar with the term “cradle cap.” In infants, seborrheic dermatitis causes thick, greasy patches on the scalp that are red or yellow. 

In adults, mild seborrheic dermatitis is dandruff. When it’s more severe, it causes itchy and flaky patches on the scalp and around the hairline. These can be red, brown, or light in color. Severe seborrheic dermatitis can also cause a similar rash on other oily areas (like eyebrows, the chest, beard area, and around the nose and ears)

Atopic eczema (atopic dermatitis)

Atopic eczema (or atopic dermatitis) is a common chronic skin condition that affects about 3 in 10 people in the U.S. And most people just call it “eczema.” Anyone can get this type of eczema, but it’s more common in children and teens. And it tends to run in families. 

Atopic eczema usually causes an itchy rash in the folds of the skin, like the inner arms, neck, and the back of the knees. But it can also affect the scalp, which can seem a lot like dandruff. That said, this type of scalp eczema is more common in infants and toddlers than adults. So this may help get the diagnosis right. 

Atopic eczema also looks different. Unlike the greasy, yellowish flakes of dandruff, eczema usually causes scaly patches of pink, red, or brown skin. Eczema is also usually pretty itchy. And constant scratching can lead to thick and leathery skin. 

Contact dermatitis (allergic or irritant dermatitis)

Contact dermatitis is a type of eczema that happens when your skin reacts to something it comes into contact with. This can be an allergic reaction, like to poison ivy, nickel, or a preservative in your lotion. But it can be due to skin irritation, like when you use harsh soaps or chemicals on your skin. 

Contact dermatitis causes an itchy rash. It can happen anywhere your skin comes into contact with an allergen or irritant. That includes your scalp. 

If a shampoo or other hair product causes the reaction, the rash usually affects the whole scalp, including around the hairline. In fair skin, the rash can look red or pink. In darker skin, it can cause light-colored or brown-colored patches. Your symptoms and the rash should clear after you stop coming into contact with whatever is causing the reaction. 

What causes scalp eczema?

The causes of scalp eczema depend on the type of eczema. 

With the most common type, seborrheic dermatitis, the cause is not exactly clear. It seems skin oil production (sebum) and skin yeasts likely play a role in why some people get seborrheic dermatitis and others don’t.

The cause of atopic eczema is not entirely clear either. It’s likely that an intense immune reaction leads to the type of skin inflammation that occurs in this type of eczema. There are many factors that increase your risk of atopic eczema — whether on the skin or the scalp. These include:

• A family history of eczema, allergies, or asthma

• Genetic factors 

• Environmental factors (like climate, diet, and pollutants)

Finally, with contact dermatitis, the cause is an allergy or reaction to an irritant. Common culprits include harsh or harmful skin products, poison ivy, and nickel. 

What are the symptoms of scalp eczema?

All types of scalp eczema can cause an inflamed, itchy, and flaky scalp. You may be able to feel changes in your scalp with your fingers. Look for roughness, scaly skin, or bumps. 

With dandruff or seborrheic dermatitis, you may also notice:

• Eyebrow dandruff

• Large, oily flakes that come off your scalp

• Patches of oily or waxy skin

• Yellow or pink patches around the hairline in fair skin

• Darker or lighter patches around the hairline in darker skin

• Oily patches or flaking around the nose or beard area

• Flaking or oily skin in your ears

In some people, scalp eczema can be mild and barely noticeable. But for others, symptoms can be intense and affect quality of life. In some cases, severe scalp itching and scratching can cause a skin infection. This typically isn’t serious, but it can be uncomfortable and needs treatment with an antibiotic cream or pills. 

Get medical attention if you develop a fever or notice a change in the appearance of your scalp rash, like oozing, crusting, or pain. 

Is it scalp eczema or psoriasis?

Other skin conditions can cause scalp rashes. And because the treatments are different, it helps to get the diagnosis right. Psoriasis is one such condition. It’s a chronic autoimmune skin condition that commonly affects the scalp, but it can affect skin anywhere on the body. 

Like eczema, it can cause itchy and flaky skin that’s red or brown. Unlike eczema, psoriasis tends to cause plaques — thicker skin scales that can be harder to get rid of. And, if you have scalp psoriasis, you’re likely to have psoriasis elsewhere, too. Look behind and inside the ears as well as on your elbows and knees. 

Sometimes it can be hard to tell the difference between eczema and psoriasis, so you may need to see a specialist for help.

Scalp eczema treatment

The best treatment for scalp eczema depends on the type and how severe it is. For mild symptoms, OTC treatments may be enough. But if symptoms are more severe — or they’re not responding to OTC medications — then prescription-strength treatment may be needed. 

Here are some common treatments for seborrheic dermatitis and other types of scalp eczema. 

Seborrheic dermatitis treatment 

Dandruff is the mildest (and most common) form of seborrheic dermatitis. You can usually treat it with OTC medicated shampoos that get rid of flaking. Depending on your symptoms, you may use these shampoos daily or a few times a week. After your symptoms lessen, you use them once every week or two to prevent a relapse. 

Look for scalp eczema shampoo that has one or more of these ingredients: 

• Pyrithione zinc (like Head & Shoulders and DermaZinc)

• Selenium sulfide (like Selsun Blue shampoo and Head & Shoulders Clinical Strength)

• Ketoconazole (like Nizoral shampoo)

• Tar (like Medicasp Coal Tar Gel shampoo and DHS Tar) 

• Salicylic acid (like Neutrogena T/Sal and DHS Sal)

More serious seborrheic dermatitis may need prescription treatments. The following medications come in different scalp-friendly forms (like shampoos, foams, and liquids):

• Topical steroids, like Clobex and Capex, help soothe inflammation. 

• Antifungals, like ciclopirox or prescription-strength ketoconazole, help treat yeast overgrowth. Your healthcare provider may recommend taking an antifungal pill if your symptoms are severe or aren’t responding to other treatments. 

• Calcineurin inhibitors, like tacrolimus (Protopic) and pimecrolimus (Elidel), can be used “off-label” to help lessen inflammation. 

Treatment for other forms of scalp eczema 

If your eczema is caused by an irritation or allergic reaction to a product, avoiding that product will improve your symptoms and your rash. A healthcare professional can help you figure out if you’re reacting to a product or if something else is going on.

Treatment for scalp eczema caused by atopic dermatitis depends on how severe it is. For mild to moderate eczema, these products can help reduce inflammation and improve symptoms: 

• Topical steroids (shampoo, foam, or liquid)

• Calcineurin inhibitors, like Elidel or Protopic

• Eucrisa (crisaborole)

• Antihistamines, such as fexofenadine (Allegra)

More severe scalp eczema may need stronger treatments that work throughout the body. This includes different pills (like prednisone and Rinvoq) or shots (like Adbry and Dupixent).

No matter what type of scalp eczema you have, your provider can explain the risks and benefits of the different treatment options and help develop a treatment plan that works for you. 

What triggers scalp eczema?

Different triggers can make scalp eczema worse. If you’re dealing with seborrheic dermatitis or atopic eczema of the scalp, you can help keep your symptoms at bay by avoiding some common triggers, including:

• Stress

• Hormonal changes

• Illness

• Cold or dry temperatures

• Harsh detergents, chemicals or soap

You can’t avoid every trigger. Seasonal weather changes, for example, can trigger symptoms for some people. The same goes for some medical conditions, like HIV and Parkinson’s disease (for seborrheic dermatitis). 

How to prevent scalp eczema flare-ups

No matter what type of scalp eczema you have, here are some tips to avoid flare-ups:

• Keep your hair and scalp clean.

• Avoid harsh soaps and detergents.

• Use fragrance-free shampoo and avoid conditioners.

• Moisturize your skin and scalp (lotions, gel, and spray-on emollients work best).

• Avoid using olive oil (it can damage the skin barrier).

• Use the cool setting on your hair dryer. 

• Take steps to minimize stress as much as possible. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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