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FAQ: What about scalp eczema?
The scalp is skin, typically hairy skin, and like all skin, it can be affected by atopic eczema.
The same principles apply to scalp eczema that we recommend for atopic eczema elsewhere. If the eczema has been present for longer than a few days it may require The Combined Approach. Eczema of the scalp is particularly prone to becoming chronic. The scalp can be neglected as the eczema can be hidden by hair. Scalp eczema can also be awkward to treat with creams or ointments.
Moreover, the scalp is a great place for habitual scratching. Even without atopic eczema the head gets more than its fair share of scratching - we scratch our heads to think, don't we? - and there is even a skin diagnosis, Tycoon's Cap, which may be an occupational hazard for bankers, and other city types, but it is possible for anyone with atopic eczema.
The Combined Approach to scalp eczema has the same three levels of treatment as for atopic eczema elsewhere:
Because the scalp is usually hairy, the skin of the scalp can be naturally oily - but some scalp skin is dry, and eczema both dries skin out, and dry skin leads to eczema. The same moisturizer that is used for the body can be used for the scalp. Parting the hair and dabbing small amounts at the root level all over the area to be treated may be feasible. Leaving it for 15 minutes will allow it to penetrate and spread over the surrounding area, before combing and brushing the hair. To encourage spreading, rather than using an ointment or cream, a lotion or oil may get better results.
The coconut has always been a popular source of emollient: oleum cocos nucifera, or coconut oil. But all sources of moisturizer for the scalp may be considered:
personal preference can be more important than practitioner's prescription!
Just like the rest of the skin, with eczema, care needs to be taken washing the scalp. Soaps and shampoos remove oils and leave the skin dry. Find a shampoo that is formulated for dry hair and frequent use, and consider one with a conditioner, bearing in mind that conditioners contain moisturizers, and will treat the scalp as well as the hair. Atopic skin being sensitive, it is often best to use simple products, without fragrances and preservatives. Hopefully trial and error will allow what suits best to be discovered.
It is essential to use a topical steroid. The same preparation that is used for the body (Grade II: Potent) can be used on the scalp. Manufacturers have formulations for the scalp, some with an alcohol base (these can sting), and some with a moisturizer base. As with the body, it is important to use the topical steroid as prescribed, and not to stop too soon.
Habit reversal eliminates scratching for long enough for healing to occur: natural healing, aided by the presence of emollient and topical steroid. The same technique is used as for scratching elsewhere. The scalp is however both a favourite place for scratching, and easily forgotten when progress is assessed. For the best results using The Combined Approach, all areas of chronic eczema need successful treatment.
Please share your experience with atopic eczema of the scalp: