Friday, May 20, 2011

Managing eczema on your scalp

Scalp eczema doesn’t get much press, but a lot of us live with the problem every day. Me, for example: I own virtually no dark-colored tops, because a snow of skin flakes shows up within seconds. I comb my hair, or what’s left of it (hey, I’m a 40-year-old man) not to straighten tangles, but to clear up any rogue scabs. And I’ve had to develop my own regimen for scalp care because nobody ever handed me a pamphlet.

Eczema on your scalp is the same as it is everywhere else, except for two complications.
  1. most people have hair on their heads, which makes it difficult and unsightly to apply thick creams and ointments
  2. it’s right out in the open where everyone can see. You can hide it only with long hair, and long hair makes it difficult to treat the scalp.
So how should we treat it? Pretty much as we do “normal” eczema. You have to clear up infection with antiseptics; reduce the inflammation; and moisturize as much as possible. And any concerns about how your hair looks are secondary. You’re not Fabio or Catherine Zeta-Jones, so get over it.

I keep my hair very short. I use a #2 buzzer on my head. I can get away with this because I’m a man in a job where hairstyle doesn’t matter. The #2 keeps my hair short enough that I can apply steroid creams or ointments but long enough that other people can’t see my sores or scabs easily.

Steroid ointments (say, fluocinonide 0.05%, my “strong” option) come with warnings about folliculitis. You’d think this would be a problem on the scalp, but I haven’t found it to be. I try to use it sparingly, though.

Many shampoos and conditioners brag about their moisturizing properties, but they refer to what they do for your hair, not your scalp. In my experience, both shampoos and conditioners have detergents that dry out my scalp to a painful degree, and fragrances that irritate it. What to do?

Go fragrance-free, for a start. Or as fragrance-free as you can; medicated shampoos seem all to come with masking fragrances to hide their smell. Options that I’m aware of are coal tar (say, T-Gel, Zetar, Polytar); zinc pyrithione (e.g. Head and Shoulders, Selsun Blue); and iodine (Betadine). I spent several years in the UK where Betadine is available as a shampoo. I haven’t seen it as a shampoo in North America, but Hidden B, who’s a veterinarian, has a bottle of it that she uses on dogs.

Let’s tackle these one at a time, and ignore any qualms about weird smells.

Zinc pyrithione (http://en.wikipedia.org/wiki/Zinc_pyrithione) is an antimicrobial that kills bacteria and fungi. It doesn’t work for me. This is probably because my primary problem is in the skin barrier, not a secondary infection. I may also have infections that it does or doesn’t clear up.

I remember Betadine being relatively pleasant, and leaving terrible brown stains on everything. I think it worked well because it didn’t have a very strong detergent component, and was much more a medical than a cosmetic product. I’m all in favor of this. Hey, maybe I should borrow some from Hidden B. Again, the active ingredient in Betadine is iodine, because it’s a broad-spectrum antimicrobial.

Coal tar works for me, but only in the strongest formulation. I use T-Gel Extra Strength and Polytar. In the past these have been difficult to find where I live in California, and I have bought them online from a Canadian source, but recently I’ve seen tar shampoos on the shelf in pharmacies here.

Coal tar’s a bit of an oddity. It is not a pure substance that can be easily quantified. It is a mixture of apparently up to 20,000 organic compounds, and it’s a traditional treatment for scaling skin diseases that reduces inflammation and itch and kills microbes. Which of the 20,000 compounds are doing what is anyone’s guess, and there have occasionally been claims that coal tar causes cancer. I don’t take these seriously because there has never been a conclusive study and if there were a large risk we’d know about it by now. (See a recent study here.) I think that it matters very much which brand of coal tar you use, because different brands are probably from different sources and contain different stuff.

What I DO take seriously is the increased sensitivity to UV that comes with using tar shampoo. The days I use it, I often find I get lightly sunburned on my face. Sunburn = cancer risk. So if I were going to spend a day outside, I’d be careful not to use tar shampoo that morning.

The more I learn about eczema, though, the more I understand that we might not want to use a strong antiseptic on our head too much. We probably have a flora of beneficial bacteria and fungi living on our scalps, and we ought to keep them healthy while killing off the S. aureus etc. that cause us so much grief.

Lastly, for moisturizing: every morning, and after I shower (which I do not do every day), I rub jojoba oil into my scalp. Jojoba’s a very light oil, and it doesn’t make my head too greasy. I think grapeseed or walnut oil would also do the job, but olive oil would be too heavy. Sometimes, when I have really dry skin, I have resorted to rubbing Eucerin into my scalp, but this is a bit gross.

What are your solutions to cooling itch and moisturizing on your scalp? I’d be interested to hear them.

36 comments:

  1. Hi,
    Through some research I've found this natural product that is some sort of old Tibetan herbal remedy. I've heard good things about it and just received my bottle of it today. My plan is to use sodium lauryl sulphate free shampoos (I feel could be the culprit) and treat with the champori. Hopefully I'll see a big improvement over time if not a complete curing of the condition.

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  2. "Champori"Is the product by the way: http://www.champori.com/ I believe it is distributed from somewhere in California.

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  3. Interesting, thanks, Patrick. I Googled Champori and read an informative thread from people using it for psoriasis (http://www.inspire.com/groups/talk-psoriasis/discussion/champori-1/). Results were certainly mixed, but that is true for drugs made by pharmaceutical companies too.

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  4. Thanks for the tips! Our son J. has exactly what you are describing: very dry, flaky and itching skin on his head. For a while he also had inflamed and oozing patches, which we treated with betaisodonna and antibiotic cream. Sun seems to improve the condition, too. We use hydrating cleaning lotion from CeraVe to wash his head about once a week and rub his scull with evening primrose oil for a few hours prior washing. When we wash we make sure that we "don't wash too thorough" so that some of the oil stays on. Did someone try to use egg-yolk to wash the head? I was hesitant to use it on J. because I was not sure about an egg allergy, but I know it does work as an alternative hair wash product (I use it myself from time to time).

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  5. Hi , As of today I put one part apple cider vinegar and one part water on my scalp and am leaving it in for a while before I rinse it out. It has stopped the itch for now I don't know how well it will work in the long run but I'm gojng to keep doing this for a while . The vinegar has an antbacterial affect on the eczema. I am also going to stop using store bought shampoos adn look for one in the Health Food store.

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  6. where in sf bay area can you buy pyrithione zinc 2% bar soap? Thanks

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  7. No idea! I don't use it myself. I know it can be difficult to track this sort of thing down. That's why I buy specialty stuff on the internet--like tar shampoo back when you couldn't find it on the shelves in California.

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  8. Hi!

    Came across your blog cos researching on scalp eczema - the more I read, the more confused I get! Dandruff, Seborrheic eczema all the same? I also read that it's a rash, n not dry skin so need to moisturize?! Man... I've got to ask a doctor to vet through my post on this, too much misinformation on the web!

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  9. Yes, please consult a derm doc. What I understand is that atopic dermatitis and seborrheic dermatitis are distinct conditions, and both are separate from generic dandruff which even people with "normal" skin can get from time to time. I can certainly say that I occasionally get breakouts of AD on my scalp and that they are associated with extremely dry skin that shampoos exacerbate.

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  10. Another suggestion:
    Try Homeopathic oral remedies to suit your unique constituion. When my 4 yr. old has a bad outbreak I give her a dose of either:
    sulphur 30C OR graphites 30C
    It aids it flushing impurities from the body.

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  11. I use papaya for my scalp. I find that this helps.

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  12. Papaya how? What form do you use it in and what do you do?

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  13. Hey! I've had eczema all over my body since I was a child. A year ago I quit dairy (I became vegan for ethical reasons) and after two months I was all cleared up! I haven't used any steroid cream for a year and I still can't believe that no dermatologist ever tested me for allergies or tried to eliminate the #1 food allergenic. Maybe you can give it a try for a few months?

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  14. About ten years ago I did a pretty rigorous food elimination program and dairy wasn't a problem for me. I also had allergy testing and it didn't show up. But it is a good idea and relatively easy to stop eating something for a bit if you think it's a problem.

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  15. I have discoid or numular eczema on my scalp and I have found that pure aloe vera gel is good on the scalp as it is good for skin and hair as well. It helps moisturize dryness
    and is also cooling so is very effective at stopping itching.
    Good luck guys.

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  16. I have SD on scalp which flares when stressed. Can't seem to resist urge to scratch which then leads to painful blleding areas. Been ongoing since childhood and very frustrating. I try ketoconazole shampoo and betacap scalp application but it never fully clears up because I always have patches on the same areas on my scalp. They do calm down and stop itching as much until another flare-up but they are always there.

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  17. Thank you for sharing! I enjoy keeping up to date and learning more about what's out there - so thank you for sharing your suggestions! I hope that your scalp eczema has gotten better since his post was written :)

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  18. Well, you know, it got better and now it's worse again. It's going to be the topic of my next post!

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  19. Finanaces prevent me from the only option(steroid lotion) that has worked in the past. Now I have bald and bloody patches, and am seeing my daughter start to develope the same condition. I will try some of the things mentioned here. Thank you.

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  20. Oil sits on my scalp and causes an oily, flaky sludge.
    Just as the article says, the scalp is just like the rest of your skin so I thought would try lotion because it disappears into your skin and it works! I moisturize my scalp with GoldBond Anti-Itch Lotion day and night. Other "regular" body lotions absorb too quickly and don't do much for long. Plus GoldBond has Menthol which feels so good. Be sure to part your hair and apply it directly to your scalp and rub it in; otherwise the GoldBond will dry flaky in your hair!

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  21. I have been SUFFERING since Feb 2013 with hives then eczema. The worst area is my scalp. I have long hair down to the lower part of my back and find myself waking up at night in a scratching fit. I went from Dermatologist...to Allergist...to Naturopath...back to Dermatologist and the only thing that has helped me recently is mixing coconut or grapeseed oil with Peppermint and Lavender essential oils. The peppermint really cools the skin and has given me some relief at night to get some sleep. The Lavender calms and is an antibacterial. Hopefully the oils will now heal my dry spots. Any other tips would be greatly appreciated and welcome...Christine

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  22. I think I have scalp eczema too. It's new for me this year. My scalp is so itchy in certain spots. It's' bumpy too. Luckily my hair covers it up I think I have scabs now from scratching.

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  23. Has anyone used tea-tree oil shampoo to help with this?

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    Replies
    1. Yes i am now. First i put apple cider vinegar and water in spray bottle. Saturate my scalp and let set 5 minutes. Then have added teatree oil to sls free shampoo and in cream rinse. I also mixed teatree oil in small bottle of almond oil. When i feel dry an itchy i massage it on my scalp. Helps alot and my hair has stopped falling out as much. Teatree promotes hair growth. I hope so cause my hair is past my waist.

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  24. scalp moisturizer During aging stage people are very much concerned about their wrinkles.

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  25. my 11 yr old son is itchy and his scalp when washed looks doughy... taking him to dr tomorrow to rule out other things. thanks for you page.. very helpful and calms a freaking patent.

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  26. Sooo I used to have this problem... I think. Was told that it was sebhorric dermatitis/atopic dermatitis. Changing my diet has helped quite a bit, but also going no shampoo! If the problem were severe, then it could be quite difficult. After 6 months of no shampoo, my hair has never looked better. I scrubbed every other day with baking soda and water, then conditioned with apple cider vinegar (rebalances ph of hair follicle). Look it up! Also, started a low nickel diet, which has helped dry skin and breakouts CONSIDERABLY. My mother has been diagnosed with nickel allergy, and apparently it can translate into food sensitivities. I could never wear earrings without breaking out!

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    Replies
    1. I just read about nickel allergy and wonder if that could be the source of my eczema. I really believe it is diet related and after nearly 3 months on an elimination diet I've seen improvement and then flare up, so it's been hard to isolate. But now that you mention it, I could only wear gold or silver earrings growing up. Cheap metals always caused a reaction.

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  27. Dr.D.M Mahajan has had over twenty years'experience in managing each kind of Scalp treatment Delhi hair or scalp issue. Case in point, he helps individuals enduring with scalp issue, for example, psoriasis, seborrhoeic dermatitis, folliculitis or from balding and diminishing initiated by hereditary hair loss, alopecia or through compound or physical damage.

    ReplyDelete
  28. Has anyone tried Naturally treated seaweed and made into a hair mask paste its suppossed to be fab for itchy skin condiditions. iam considering buying as Im using Paul Mitchell tea tree at the mo but have coloured hair so it really needs deep condiditoning to get a comb through! Let me know how you get on!

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  32. I have been using Nioxin shampoo and conditioner after a Nioxin scalp treatment/wash/condition at a Visible Changes. So far, I can say that the conditioner feels amazing...like an amped up cooling from mint or some such. It seems that my scalp is much cleaner, though I can see more of the root of the problem as in a flaky and pinkish scalp.

    I use to use Pentrax, which I loved. It had the strongest concentration of coal tar I had seen and didn't leave me smelling to much like a dog. Unfortunately, the coal tar scare I think got it pulled from shelves here.

    Most of the over the counter dandruff type shampoos cause a reaction with my skin and makes me smell like copper or zinc. Old pennies. Yick.

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