Scalp Eczema and Hair loss: How to Prevent and Treat the Problem

Introduction

Scalp eczema is a common skin condition often accompanied by dandruff. The scalp can become dry, scaly, red, itchy, and painful when suffering from an eczema flare-up. It has also been associated with mild hair loss.

Multiple types of eczema can cause scalp eczema, so identifying the cause is key to successful management or treatment. 

The most common causes of scalp eczema are seborrheic dermatitis and allergic contact dermatitis. Combined, seborrheic dermatitis and dandruff are estimated to affect 50% of the adult population at some point in their lives, and this can sometimes cause temporary hair loss.¹ This is often completely reversible.

What is Eczema?

Causes

Eczema, also known as atopic dermatitis, is a common skin condition caused by the dysfunction of a crucial layer of the skin called the stratum corneum. As a result, the skin cannot hold as much water and thus looks dry, and the skin releases inflammatory proteins (cytokines) which create red and inflamed skin that contributes to the itching sensation.² Eczema is more common in children than adults and is called cradle cap when present on the scalp. 

Seborrheic dermatitis (a type of eczema) is thought to be caused by a yeast called Malassezia, and elements of the immune response. The eczema is concentrated in areas called sebaceous glands, with the presentation of greasy, yellowish cell build-ups called plaques present on the scalp.¹ 

A type of eczema can be developed after direct contact with a substance causing an allergic reaction. This is called contact dermatitis. This is common on the scalp if there is an allergy to fragrances in shampoos, conditioners, or hair dyes. It causes the appearance of red, itchy, dry, and cracked skin.

Symptoms

The most common, generalised eczema symptoms are:

• Redness/inflammation

• Dryness and scaliness

• Itchy skin 

• Rash

For scalp eczema, specifically, the most common symptoms are:

• Itching

• Dandruff

• Blistering, and/or Weeping

• Scalp painful to the touch

Who is prone to it?

Those who already suffer from sensitive, dry skin are at risk of atopic dermatitis if they don’t moisturise and care for the skin appropriately. 

Those who commonly experience allergic reactions to the skin are also at an increased risk for scalp eczema or seborrheic dermatitis. 

Some immunosuppressive conditions such as HIV, and some genetic disorders such as Down’s syndrome, can also increase your risks of seborrhoeic dermatitis.

Treatments

If there is a suspicion the scalp eczema is being caused by an allergic reaction:

• Immediately discontinue current hair products and monitor the scalp to identify what might be causing the contact dermatitis.

• Replace current shampoos with unscented, preferably anti-dandruff, formulation shampoos to avoid allergy and irritation. 

• To stop the scalp from itching, a non-drowsy antihistamine can be taken, or a drowsy antihistamine can be taken at night to prevent scratching while asleep.³

For those that already suffer from eczema, it is recommended to visit the GP who may prescribe topical steroids to manage the condition and treat flare-ups. It is important to use the topical steroids for the prescribed course only and under the doctor's referral, which can range from 3 days to 2 weeks, depending on the severity of dermatitis and the potency of the steroid.³

For seborrhoeic dermatitis sufferers:

• Use prescription antifungal shampoos such as 2% Ketoconazole shampoo.

• Before shampooing, apply warmed olive/mineral oil for 5 minutes to loosen the crusting of the scalp.

• Excessive itching of the inflamed scalp can also cause a scalp infection, which can be treated by antibiotics and antihistamines prescribed by your GP to reduce the itching.³

Can Eczema cause Hair Loss?

There has been some evidence that eczema can indeed cause hair loss. Seborrheic dermatitis does not cause hair loss or hair thinning itself, but some hair loss is seen due to excessive itching of the scalp. This can lead to damage to the hair follicles and the prevention of hair growth in an unhealthy scalp environment. This hair thinning/loss can be reversible and temporary.

Other causes of mild, temporary hair loss include:

• Around 3-4 months after an allergic contact dermatitis flare-up, a process called telogen effluvium can occur. This is the temporary, excessive shedding of hair, which has been documented after exposure to hair dye.⁴

• Research indicates that sufferers of alopecia areata are also likely to be suffering from hypersensitivity reactions such as atopic dermatitis. 

• Alopecia areata, meaning patchy baldness, is an autoimmune disorder. Female pattern hair loss is a form of androgenetic alopecia caused by hormones called androgens. Androgenetic alopecia can also affect males. 

• This condition causes hair to thin and recede which can severely interrupt a person's emotional wellbeing. 

• It has been suggested that inflammatory skin disorders of the scalp such as eczema can interrupt hair growth but there is no solid evidence to support this.

Preventing Eczema Flare-ups

One of the best ways to avoid eczema flare-ups and treat the condition is by moisturising the scalp to prevent it from becoming dry and inflamed³:

• Medical emollients, rather than ointments, are recommended as they are much easier to apply and wash out of the hair without causing build-up. 

• Part the hair in several places and apply medical emollient as necessary per day.

• A more natural treatment is coconut oil, which is also an effective option for treating eczema and an excellent natural moisturiser.

• Avoid using high temperatures on hair appliances and while showering, as hot air can further irritate and dry the scalp, causing itching.

Summary

Overall, scalp eczema can be a difficult, painful, and often embarrassing condition and can feel difficult to manage. Following this guide and consulting the GP, can lead to it being treated or managed successfully and may lead to a restored and healthy scalp.