Hair care for eczema of the scalp
This page has been written to help you understand more about seborrheic dermatitis (eczema of the scalp). It gives you information about its causes and provides useful hints and tips about hair care that will allow you to manage this condition. Finding the right hair care routine, products and style is key to managing your eczema effectively.
What is seborrheic dermatitis
Seborrheic is a term used to describe how this type of eczema affects greasy, oily areas on the body such as the scalp. This can also apply elsewhere, such as the upper chest and on the face.
For those who have seborrheic dermatitis, the affected area, such as the scalp, can become red and flaky with symptoms of itch and dandruff.
Seborrheic dermatitis is caused by a yeast called Malassezia furfur, which is present on normal skin. People with seborrheic dermatitis have a higher amount of this yeast on their skin. This breaks down the sebaceous secretions resulting in the overproduction of irritating fatty acids. These acids increase the sensitivity of the scalp, resulting in the redness and flaking with symptoms of itch and dandruff.
Managing eczema of the scalp
Avoid scalp irritants
Some shampoos, conditioners and hair styling products can make any form of eczema worse, particularly on the scalp.
Most cosmetic shampoos contain sodium lauryl sulphate (SLS), which is a harsh detergent. SLS is designed to remove grease with a soapy lather. Shampoos without SLS tend not to lather but can still clean the hair.
As a rule, people with scalp eczema should avoid shampoos containing SLS as it can be extremely irritating to the scalp, particularly scalp eczema. To check if the cosmetic shampoo contains SLS, please read the product label. It is a legal requirement that all ingredients that make up the product are listed.
Other irritants to avoid:
- Fragranced or scented products, including essential oils.
- Tree nuts oils (such as almonds and macadamia nuts), particularly if there is a history of nut allergy.
- Preservatives called methylisthiazolinone (also known as MI, limonene and linalool). To check if the cosmetic shampoo contains MI, limonene and linalool, please read the label on the product. As mentioned previously, it is a legal requirement that all ingredients that make up the product are listed.
Alternatives to shampoo
If you find that most shampoos irritate your scalp, you can wash your hair with emollients. Lotion forms of emollients are advised as they mix well with water but they may leave your hair slightly greasy. Below are some options:
- Medicated shampoos - Tar based shampoos, such as Capasal™ therapeutic shampoo and T/gel®, shed dead cells from the top layer of the skin and slow down the growth of skin cells. However, if you have light-coloured hair, these types of shampoos can cause discolouration and make your scalp more sensitive to sunlight.
- Shampoos containing salicylic acid help to lift and reduce the scaling.
- Ketoconazole shampoo help to kill the fungus, on the scalp, that causes dandruff. These include Dandrazole and Nizoral®).
- Selenium sulphide shampoos such as Dercos DS, contain an antifungal agent but can also discolour the hair and scalp.
- Shampoos that are fragrance free and moisturising are useful for dry scalps. For example, E45 dry scalp shampoo and Eucerin® dermocapillaire shampoo.
- If you have an infected scalp, Dermol® 500 lotion can be used as a shampoo. It contains an antibacterial agent that may help in reducing the bacterial count on your skin and prevent reinfection.
Alternatives to conditioners
Conditioners are made to stick to the hair and keep it smooth and shiny. As conditioners do not wash out during rinsing, they are more likely to irritate scalp eczema.
An alternative to cosmetic hair conditioner is to use diluted cider vinegar (mix 100 ml of apple cider vinegar with 500 ml of water in a spray bottle), this can be used to create a shine on your hair. It is thought that the enzymes from the fermented apple, close and smooth the hair cuticle, the protective layer that locks in vital natural oils, proteins and moisture.
If your hair is prone to tangles or knots, another suggestion is to use a spray mineral oil diluted in warm water. Mineral oil eliminates tangles and works as an antistatic, preventing the build-up of static electricity or reducing its effects.
A special detangling comb can be helpful as it will get through the hair that is not conditioned and prevent knotting.
Modifying hairstyling products
Hair gels, hairsprays and setting lotions can help produce a shine and reduce frizz but they can also cause irritation to the scalp. It is therefore a good idea to keep hair care simple by using only shampoos that suit you and try to stop or reduce the number of other products used.
You could then reintroduce hairstyling products individually to try and work out which may be causing the irritation.
Keep your hairdryer on a low/warm setting. The hot setting will dry your scalp, resulting in itching and irritation.
Hair colouring and bleaching
Hair colouring is a known cause of irritation for people with eczema, especially permanent hair colourants containing an ingredient called paraphenylenediamine (known as PPD). This should be avoided.
Semi-permanent hair colourants or tints do not generally contain PPD.
If you use hair colourants at home, be sure to check the ingredients list.
Unfortunately, there are no hair colourants specifically recommended for people with eczema.
A good hairdresser will always do a skin test before using a colourant on your hair. This is a small patch of colourant placed behind your ear. You will need to remove the colourant after 48 hours and check the area for any reaction. If the skin underneath the small patch is red and raised, this indicates a sensitivity to that particular colourant. It should therefore not be used.
If you are using hair colourant at home, you should still proceed with caution and do your own patch test, either behind your ear or on the inside of your arm.
You can use a cotton bud to dab a little hair colourant onto your skin then cover it with a non-allergenic tape. Leave the test patch on for 48 hours.
The principle is the same as a test applied by your hairdresser. If the skin underneath the patch is red and raised, this indicates a sensitivity to this particular colourant and therefore should not be used.
Hair bleach removes the natural synthetic pigment of the hair. Allergy to hair bleach is possible and people with eczema are more likely to be irritated by hair bleach, especially as there will be direct contact with the scalp.
Hairdressers should not use bleach on sensitive scalps or if the client has eczema.
Bleaching the hair can also cause significant damage to the hair shafts, resulting in damage and breakage of the hairs. Bleached hair can appear to lack lustre and shine.
Perming
Generally, people with eczema are advised not to have their hair permed, as all perm solutions usually cause irritation.
However, some people with eczema may be able to tolerate acid perms. These are slightly less irritant than alkaline perms which should be avoided by people with eczema.
Chemical relaxers
There are a number of chemical hair straightening products (called relaxers) which are used by people with tight curls. The relaxer can be a lotion, cream or ointment and works by breaking the mechanical bonds of the hair shaft, disrupting the shape and reconstructing the hair bonds. A relaxer has to be applied at the lowest point of the hair near the scalp.
Some people may be allergic to the chemicals in relaxers and some can get scalp burns from using these products. A scalp-based protectant cream can be used to prevent burning, although this can also cause irritation.
Due to the possible irritating nature of all of these products, it is advised that they should not be used if you have scalp eczema, or should only to be used with great care.
For more information, please view the British Association of Dermatology’s leaflet about Caring for afro-textured hair at:
https://cdn.bad.org.uk/uploads/2023/07/19174038/Caring-for-Afro-textured-hair-PIL-July-2023.pdf
Electrical hair straighteners and curling tongs
These are usually very hot and the heat is likely to irritate eczema, causing itching and dryness.
You need to be very careful when using straighteners or tongs as a scalp burn can be very painful and could damage the skin barrier, causing an eczema flare.
Hair loss and eczema
Eczema can result in patchy hair loss, thinning and poor hair quality. This hair loss is usually reversible.
You can prevent further hair loss through eczema by drying your hair naturally or with a hairdryer on a cool setting. This will help to keep the scalp cool and reduce itching symptoms.
Hair loss can also be caused by braiding and weaving, causing trauma to the hair follicles and hair shaft abnormalities. If you have scalp eczema, loose hair styles would be better.
Summary
Finding the right hair care routine, products and styles for you is key to managing your eczema effectively. Please follow the advice given on this page.
When using any topical products such as shampoos, conditioners and / or styling agents, please make sure you have read the instructions about how to use them, as the method of application may vary from product to product.