How Scalp Atopic Dermatitis Differs From Eczema, Psoriasis, and Seborrheic Dermatitis

How to differentiate, identify, and treat scalp atopic dermatitis.

Atopic dermatitis—aka eczema—can make your skin feel dry, red, and itchy. And, unfortunately, your scalp isn't immune to the effects of this condition, even though it's covered in hair. But atopic dermatitis isn't the only skin condition that can affect your scalp. Other conditions include psoriasis, eczema, and dandruff. Here's what you need to know about scalp atopic dermatitis, including how it's different from other scalp conditions like psoriasis and dandruff, how to spot it, and how it's treated.

The term "atopic" means something that is sensitive to allergens and "dermatitis" describes skin irritation.

Itching Dry Head Scalp And Long Hair

AndreyPopov/Getty Images

What Is Scalp Atopic Dermatitis?

"It's an intrinsic defect of the skin barrier," Dendy Engleman, MD, FAAD, a board-certified dermatologist in New York, told Health. Essentially, people with eczema have super sensitive skin, and the condition can cause patches of very itchy, red skin that look dry and cracked.

Atopic dermatitis most commonly appears on the arms—specifically the area in front of or inside the elbow—or behind the knees. But you can get it anywhere on your body, said Dr. Engleman, including on your scalp.

Scalp atopic dermatitis is eczema that affects the skin on top of your head. "It's rarer, but we do see patients who have [eczema] on their scalp," Emma Guttman-Yasky, MD, PhD, the Waldman professor of dermatology and immunology and system chair department of dermatology at the Icahn School of Medicine at Mount Sinai, told Health.

Patients who have severe eczema on many other parts of their bodies can often get it on their scalp, Dr. Guttman-Yasky added.

Eczema vs. Psoriasis and Seborrheic Dermatitis

What many people think is scalp eczema—or atopic dermatitis—is often actually one of two other conditions, Dr. Guttman-Yasky said: psoriasis or seborrheic dermatitis—aka dandruff.

They're often mistaken for each other because they have very similar symptoms—red, itchy, dry patches of skin. But the three conditions are different. Here's a quick overview:

  • Atopic dermatitis: an inflammatory skin disease that causes rashes to break out over certain parts of the body. It is triggered by a mix of genetic and environmental factors. It makes the skin incredibly sensitive, added Dr. Engleman, and more at risk of infections.
  • Psoriasis: a chronic condition that causes itchy, scaly patches on the skin, including the scalp. There are a few different subtypes, but the most common type of psoriasis causes dry raised patches covered in scaly skin. It's believed to be caused by a faulty immune response, which forces skin cells to grow faster than normal. Genetics can also play a role.
  • Seborrheic dermatitis: an inflammatory condition caused by yeast overgrowth on the scalp. It can occur in hair-bearing areas, said Dr. Engelman, including the scalp, eyebrows, and chest. It can cause skin flakes, patches of greasy skin covered with scales, and itching, and is typically treated with antifungal medications.

Symptoms

All three conditions—atopic dermatitis, psoriasis (and scalp psoriasis), and seborrheic dermatitis—can present similarly with itchy, dry patches of skin. Here are some of the symptoms most closely related to scalp atopic dermatitis, specifically.

  • Extreme itchiness: This is the hallmark of any form of atopic dermatitis, said Dr. Guttman-Yasky. "The patients with eczema on the scalp, they will itch it," to the point of leaving wounds that bleed on their scalp, Dr. Guttman-Yasky added. "If it doesn't itch, it's unlikely to be eczema."
  • Skin flakes: Like seborrheic dermatitis, Dr. Guttman-Yasky said, scalp atopic dermatitis can cause skin flaking. This can be due to the dryness of the skin there, or from people scratching at the itchy skin for relief.
  • Temporary hair loss: This can sometimes happen with scalp eczema, said Dr. Guttman-Yasky. "But usually when we treat them well, [the hair] should come back because the follicles should still be there," Dr. Guttman-Yasky added.
  • Thick patches: After years of scratching, a person with atopic dermatitis can develop permanent patches of skin that are thicker than the surrounding skin. However, this might be trickier to spot on your own scalp if covered by lots of hair.
Atopic-Dermatitis-on-Scalp-sebderm6__WatermarkedWyJXYXRlcm1hcmtlZCJd
DermNet NZ

Atopic Dermatitis Causes

Atopic dermatitis is generally a complex condition with a variety of causes and risk factors, said Dr. Engleman. It's often genetically inherited, Dr. Engleman noted, so if your mom or dad has it, you're more likely to develop it too. People with eczema also often have genetic mutations that affect how effective the skin barrier is at protecting you from germs, irritants, and other pathogens, Dr. Engleman added.

Eczema also seems to be influenced by something called the atopic triad, Dr. Engleman said—seasonal allergies, asthma, and eczema. Basically, people with eczema often also have seasonal allergies and/or asthma. Environmental factors such as pollution can also play a role.

No matter the cause, the end result is that people with eczema have super sensitive skin that overreacts to things that aren't supposed to be irritating, said Dr. Engleman. In the case of the scalp, the eczema flareup just happens to occur on the scalp. Having an existing flare-up of eczema affecting large parts of your body can potentially eventually involve the scalp, according to Dr. Guttman-Yasky.

Treatment and Prevention

Because it can easily be confused with other skin conditions, your first order of business if you think you have scalp eczema is to see a board-certified dermatologist. They can properly diagnose you and provide the correct treatment—which will require a prescription.

Dr. Guttman-Yasky said that it is common to prescribe a combination of topical steroids (which are potent anti-inflammatories) and salicylic acid (a common skin-care ingredient used to facilitate skin cell growth, unclog pores, and more) for people with true atopic dermatitis on their scalps. This combo helps remove any scaly buildup caused by eczema while combatting itchiness, Dr. Guttman-Yasky noted.

If a patient's eczema is all over their body, not just their head, or is particularly severe, Dr. Guttman-Yasky said that a dermatologist might opt for a systemic course of steroids.

Your dermatologist might also recommend you change some aspects of your hair-care routine to help reduce itching and reduce the risk of future flare-ups. "We recommend mild shampoos with a minimum amount of preservatives," Dr. Guttman-Yasky said because those kinds of ingredients can be irritating to sensitive, eczema-prone skin.

Look for brands that say they are preservative-free, or look at the label to make sure it doesn't have any of the following:

  • Parabens
  • Formaldehyde
  • Formaldehyde-releasing ingredients like DMDM hydantoin

People who have or frequently get scalp eczema should also avoid going overboard on hair treatments, like tons of blow drys or regular bleaching, Dr. Guttman-Yasky added. These treatments are harsh and could unnecessarily irritate a sensitive scalp.

A Quick Review

While it may be less common than seborrheic dermatitis or psoriasis, atopic dermatitis on the scalp can still happen—and requires a dermatologist's help. "It's hard to differentiate these [conditions] and you need to go to a specialist," Dr. Guttman-Yasky said.

So if you have unbearable itching on your head (or any other part of your body, for that matter), consider it time to book an appointment with your derm. Your scalp will thank you for it.

Was this page helpful?
Sources
Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020;101(10):590-598.

  2. American Academy of Dermatology Association. Atopic dermatitis.

  3. American Academy of Dermatology Association. Causes of psoriasis.

  4. American Academy of Dermatology Association. Seborrheic dermatitis.

  5. American Academy of Dermatology Association. Eczema types.

  6. Marenholz I, Esparza-Gordillo J, Lee YA. The genetics of the skin barrier in eczema and other allergic disordersCurr Opin Allergy Clin Immunol. 2015;15(5):426-434. doi:10.1097/ACI.0000000000000194

  7. Kapoor R, Menon C, Hoffstad O, Bilker W, Leclerc P, Margolis DJ. The prevalence of atopic triad in children with physician-confirmed atopic dermatitisJ Am Acad Dermatol. 2008;58(1):68-73. doi:10.1016/j.jaad.2007.06.041

  8. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitisExpert Rev Clin Immunol. 2017;13(1):15-26. doi:10.1080/1744666X.2016.1212660

  9. Egeberg A, Griffiths CEM, Williams HC, Andersen YMF, Thyssen JP. Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adultsBr J Dermatol. 2020;183(1):128-138. doi:10.1111/bjd.18622

Related Articles