Adobe StockSave this storySave this story
If you are wearing your hair in its natural texture, unmanipulated by heat or chemicals, but also managing scalp eczema, keeping your natural hair healthy can be a bit complicated. Between flakes that hide under coils, itches that show up mid-style, and products that promise moisture but deliver flare-ups instead, it’s easy to feel like your hair and your scalp are working against each other.
The good news is dermatologists say you don’t have to choose between embracing your natural texture and calming your scalp. Below, find doctor-approved tips on how to keep your eczema in check so your hair and scalp can look and feel their best
Meet the experts:
- Jeanine Downie, MD, a dermatologic surgeon in Montclair, New Jersey.
- Tanya Kormeili, MD, a board-certified dermatologist and founder of Derm & Rejuvenation Institute, based in Santa Monica.
- Nicole Negbenebor, MD, a board-certified dermatologist at University of Iowa Health Care.
- Purvisha Patel, MD, a board-certified dermatologist in Memphis.
- Heather Woolery-Lloyd, MD, FAAD, a board-certified dermatologist in Miami.
In this story:
- Understanding scalp eczema
- Why scalp eczema affects Black women more
- Identifying your triggers
- Treatment options
- Minimizing future flare-ups
Understanding scalp eczema
There are actually seven types of eczema, but a lot of the time when people say “eczema,” they are referring to atopic dermatitis, the most common of these inflammatory skin conditions. “Atopic dermatitis tends to run in families and causes sensitive, dry, and itchy skin,” explains Heather Woolery-Lloyd, MD, the director of the University of Miami Miller School of Medicine’s Skin of Color Division. The impacted patches are discolored and can be crusty, scaly, or oozy.
Atopic dermatitis affects the skin barrier, which Dr. Woolery-Lloyd describes using a brick-and-mortar analogy: Skin cells are the bricks, and the body’s natural lipids are the mortar holding them together. If you have atopic dermatitis, a genetic mutation can affect the structural proteins—including a notable one called filaggrin—that help maintain the skin’s structure, leaving the skin barrier compromised. Dr. Woolery-Lloyd likens this to cracked bricks with weakened mortar between them. This allows moisture to escape and irritants to sneak in. People with atopic dermatitis also have an overactive immune system, which can trigger inflammation. The result: an uncomfortable itch. Scratching may provide relief in the moment, but “it damages the barrier further, trapping people in a frustrating itch-scratch cycle,” Dr. Woolery-Lloyd says.
Atopic dermatitis can happen anywhere, including the scalp, but it isn’t the only form of eczema that shows up on the top of your head. Other possibilities are seborrheic dermatitis and contact dermatitis. Seborrheic dermatitis often occurs when your immune system overreacts to a type of natural yeast that lives on the skin, which triggers flaking and scaling. (Dandruff is actually a mild form of seborrheic dermatitis.) With contact dermatitis, a product like a soap or chemical irritates the skin or causes an allergic reaction, leading to symptoms like itching, discoloration, swelling, or even blisters.
Why scalp eczema affects Black women more
Many health care providers aren’t familiar with how eczema presents on darker skin, which can make getting a diagnosis more challenging. While eczema sometimes appears red or pink on fairer skin tones, it may look skin-colored, gray, darker, or lighter than the surrounding area on melanin-rich skin, says Nicole Negbenebor, MD, a clinical assistant professor of dermatology at the University of Iowa.
This failure to recognize the signs of eczema on darker skin is common partly because of medical training. Historically, the representation of melanin-rich skin in dermatology textbooks and clinical image databases has been lacking. Jeanine Downie, MD, a dermatologic surgeon in Montclair, New Jersey, adds that patients of color have also been underrepresented in clinical trials, leaving important gaps in understanding how conditions may present across different populations.
Diagnosing scalp eczema can be especially complicated, in part because it shares symptoms with other skin conditions. One of those conditions is tinea capitis, a fungal infection that Black women are at higher risk of developing. In fact, tinea capitis in Black children is often mistaken for seborrheic dermatitis, since the two conditions can look very similar. As a result, people of color may face delays in getting the correct diagnosis of whichever condition they actually have, which can significantly worsen symptoms either way.
Another factor is that hair-care practices common in the Black community can cause women of color to experience more severe scalp-eczema symptoms, Dr. Woolery-Lloyd says. For example, styling techniques like glue-in extensions can irritate an already inflamed scalp, and layering multiple products, common in textured hair-care routines, increases the likelihood of encountering a trigger ingredient that causes a flare-up.
But all of that doesn’t mean you’re doomed to struggle with an itchy, flaky scalp for the rest of your life. Here is what dermatologists want you to know.
First things first: Identify your triggers
Not every natural hairstyle or styling product plays nicely with an eczema-prone scalp, and being aware of the most common triggers can help you know what to look out for. Remember, though, that the below list isn’t exhaustive. If you’re trying a new product, test it first. Placing a dab behind the ear and leaving it on for 24 to 48 hours can help catch a problem ingredient early.
Fragrances and essential oils
“These are some of the most common triggers for scalp-eczema flares,” says Dr. Negbenebor. Even products marketed as “natural” or “clean” can be irritating, and it’s a misconception that natural ingredients are always safer, she adds. While almost any fragrance or essential oil could do you wrong, depending on your triggers, Tanya Kormeili, MD, a board-certified dermatologist and founder of Derm & Rejuvenation Institute, based in Santa Monica, points to a few known irritants to watch for: tea tree, cinnamon, and rosemary.
Heavy oils and butters
Natural-hair routines can lean hard on oils, and sadly, that may work against you. Purvisha Patel, MD, a board-certified dermatologist in Memphis, says the yeast that often drives seborrheic dermatitis needs warmth and moisture to thrive, and many textured-hair staples, that include thick ingredients like shea butter and cocoa butter, can trap sweat and heat against the scalp, which may worsen the condition, Dr. Negbenebor explains. Switching to a lighter product like SEEN Restore Scalp Serum, which has a National Eczema Association Seal of Acceptance, may help improve your symptoms.
Preservatives and adhesives
The acrylates, latex, or solvents often used in hair-bonding glues can act as potent irritants when applied directly to an already irritated scalp, says Dr. Woolery-Lloyd. Preservatives like methylisothiazolinone, common in water-based products like hair masks, leave-in serums and treatments, and styling products to extend shelf life, can be similarly aggravating.
Adhesives from wigs and weaves are another common trigger worth watching, along with the tape and glue used in some bonding or tape-in methods.
Know your treatment options
Plain dandruff and a more inflamed seborrheic dermatitis flare-up aren’t always easy to tell apart on your own, but the timeline is a good clue. Dr. Negbenebor’s rule of thumb: a drugstore medicated shampoo like Head & Shoulders should start resolving ordinary dandruff within several days to a week. If it doesn’t or if you’re also seeing inflammation, thick crusts, cracking, or bleeding, that’s a sign you’re dealing with something more than mild dandruff and it’s time to bring in a dermatologist rather than continuing to troubleshoot on your own.
This is not the time to wait things out. Dr. Downie says she’s seen delayed treatment allow mild eczema to spread and intensify, becoming more uncomfortable, painful, and disruptive to daily life. Each case is unique, but here’s where dermatologists tend to start when treating these conditions.
Steroid-free topicals
For patients who need active treatment, Dr. Woolery-Lloyd’s first recommendation during a flare is a topical nonsteroidal (a.k.a. steroid-free) anti-inflammatory, a newer class of prescription medication that calms irritation without the skin-thinning risks steroids carry with long-term use. When someone is experiencing a scalp flare, she favors a lightweight, alcohol-free foam formula that works across hair types and textures without weighing it down or disturbing the style.
Medicated and antifungal shampoos
Special shampoos—available both over the counter and by prescription—contain active ingredients to fight eczema-related flaking and inflammation. They can be especially helpful if you have seborrheic dermatitis, since many contain antifungals, which stop the growth of yeast. Your dermatologist can recommend which you should try, but some drug store options include ketoconazole (found in Nizoral Anti-Dandruff), selenium sulfide (Selsun Blue), salicylic acid (Ouai Anti-Dandruff Shampoo), zinc pyrithione (the active ingredient in most Head & Shoulders formulas), and coal tar (MG217 Therapeutic Shampoo).
Make sure to talk with your doctor about the best way to use these shampoos with your hairstyle. For instance, when people have their hair in scalp-covering protective styles like cornrows and flat twists for weeks at a time, Dr. Negbenebor suggests applying a medicated treatment shampoo directly to parted sections, massaging it in, letting it sit for five minutes, and then rinsing with water.
Gentler products
This goes for everyone with scalp eczema, but especially those with contact dermatitis: dermatologists commonly recommend simplifying your routine, using fewer products overall, and less frequent product changes, since this makes it easier to identify what might be triggering a flare. Look for options that are hypoallergenic and fragrance-free with the National Eczema Association Seal of Acceptance. (Research shows many products labeled “hypoallergenic” or “fragrance-free” that haven’t been endorsed by the organization don’t always live up to their claims.)
Diet and gut health
It’s not just what goes on the scalp that matters. Gut inflammation can make skin inflammation worse, and some research suggests an anti-inflammatory eating pattern, one that includes probiotic foods like yogurt and kimchi and limits highly processed, high-sugar foods, may support skin health as well. Some dermatologists also recommend a probiotic supplement as a low-lift addition to an eczema-management routine, alongside topical treatment.
Minimize future flare-ups
While treating active eczema can go a long way toward providing relief, there are also steps you can take to help prevent flares in the first place. In addition to avoiding your known triggers, here are some other things you can do.
Limit tension and traction
Tight styles aren’t just something to avoid until your scalp calms down—they’re worth limiting as an ongoing precaution. That’s because tension and eczema, while technically separate issues, feed off each other, Dr. Downie says. During an active flare the added strain of a tight style may worsen existing inflammation, and even on a calm scalp, tension can be enough to trigger a new flare. The combination of tension and eczema can also lead to a condition called traction folliculitis, Dr. Downie says. This causes small but often painful red pustules that cluster at the places where the hairstyle is pulling the tightest.
Reduce style duration
Protective styles buy back time, cut down on daily manipulation, and let natural hair rest between wash days, which is why they’re such a staple. But the styles themselves can introduce their own triggers, from adhesives in wigs and weaves to tension at the hairline from tight braids or twists. Protective styles aren’t off-limits, but they do require a different maintenance routine: Sticking to lower-tension installs, avoiding heavy oils or products that can trap yeast and buildup underneath, and making sure you don’t go too long between washes can all help reduce flares.
Dr. Woolery-Lloyd suggests keeping styles in for two to four weeks rather than stretching them closer to two months (we know, we know) and skipping heavy edge control or gel applied directly to the scalp.
Be strategic when using synthetic hair
You can still incorporate synthetic hair into your style, but add in a pre-rinse step first to minimize the strands’ impact on your eczema. Rinsing helps strip away the alkaline preservative film that often coats synthetic braiding hair. Even human hair can contain irritating processing chemicals that you should rinse out before installation, says Dr. Woolery-Lloyd.
Nail your wash schedule and technique
How often you wash your hair matters, and you don’t want to wait until your scalp feels greasy or itchy to suds up. As a general rule, Dr. Downie recommends washing hair at least once a week, regardless of hair type, and washing more often if you live in a hot, humid climate or exercise frequently.
When it comes to prescription-strength medicated washes specifically, her rule of thumb is once a week when you aren’t experiencing a flare and upping that to two or three times a week if you are (though very curly hair may warrant less frequent washing to avoid overdrying the scalp). Many medicated shampoos can be drying, so Dr. Downie recommends following up with a deeply hydrating shampoo and conditioner on days you aren’t using a medicated formula. SEEN has a nourishing fragrance-free line endorsed by the National Eczema Association, as does Odele.
For more stubborn cases of eczema, a prescription clobetasol shampoo can also be effective. After washing with it, Dr. Downie suggests reaching for a deep conditioner to help replenish moisture. A good option endorsed by the National Eczema Association: SEEN Conditioner, Fragrance-Free, which can be rinsed out or used as a leave-in treatment.
The moisturizing step matters more than you might think for curly and coily hair types. “The scalp may produce more sebum, but hair follicle shape, type, and curl pattern often make it difficult for scalp oil to travel down the shaft toward the ends,” Dr. Downie says. That’s why scalp cleansing and hair moisturizing are both essential; it’s not just one or the other.
And whenever you wash your wigs, weaves, or braids, dry the roots completely afterward, as damp hair left for hours creates a humid environment yeast thrives in.