Thursday, 5 April 2012

Scalp matters: Treating dandruff and scalp eczema


Now that we know the difference between dandruff and scalp eczema as well as their cause, the next step is treatment or management. First though, if you believe that your dandruff is severe or if you think that you might actually have scalp eczema/seborrheic dermatitis, it is really important to have this diagnosed by a doctor. The reason is that in severe cases, the simplest treatments may not work effectively enough on their own and what you may require is a management plan.

Here are the methods used to treat dandruff and scalp eczema:

1. Avoid Natural Oils
If you have dandruff or scalp eczema, it is very important to know that many natural oils actually contain the oil that feeds the fungus Malassezia that causes the condition. This oil, oleic acid is present in the popular four natural oils -  coconut oil, shea butter, olive oil and castor oil. It would be worth your while avoiding using these oils so as to not exacerbate the condition.

2. Over the counter Anti-Dandruff Shampoos
These are the standard first treatment for dandruff. They are  very effective and routinely stop flaking and itching rapidly. The shampoo contains antifungal agents such as pyrithione zinc and ketoconazole which work on reducing fungus on the skin. Many dandruff shampoos require that you wash your hair between 3-5 times per week to help get the antifungal activity to the right level. After flaking and itching has stopped, it is indeed possible to go back to whatever your normal wash routine was using the antidandruff shampoo either as your regular shampoo or just alternating it with your regular shampoo. If this is not effective, a prescription strength shampoo may help.

3. Management of Scalp Eczema
For some people with scalp eczema, simple over the counter anti-dandruff shampoos may work but for others they will not. The best thing to do is to work out a management plan with your doctor. You will be able to try out and see which method of treatment works best for you. The options include prescription strength shampoos and anti itch creams for the vast majority of cases. In more specialised cases where there is no improvement, oral antifungal treatments and even steroid treatments can be considered. This is why it is important to get scalp eczema diagnosed.

4. Natural Treatments
The general problem with natural solutions is that they have not been studied in great detail. It would be nice to have a set formula and method of application but unfortunately the science is really lacking here. I am however including this section here for the experimentalists out there who are determined to get an alternative/natural medicine solution. Pure neem oil is thought to have antifungal properties (Current Science, pp1336-1345, 2002) and tea tree oil has been shown to reduce flaking but not itching in dandruff.  A raw honey/water solution was shown in one experiment to help stop dandruff within 1-2 weeks (the solution left on the hair for 3 hours) (Eur J Med Res 2001, pg 306-308,2001).

49 comments:

  1. Wow, this is interesting information. It's always said that coconut oil is good for the scalp. I can't get coconut oil anywhere near my scalp cause it causes itching, but I've been putting it on my husband's scalp cause he has dandruff. He also suffers from acne keloidalis nuchae. I would love some info on any natural oils or products good for dealing with that.

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    1. For the acne keloidalis, most dermatologists recommend prevention rather than cure. This means avoiding close shaves (including the beard if possible) and interesting for the neck area, avoiding tight shirts.

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  2. I have scalp eczema. As well as eczema all over my body.

    What works for my scalp: tea tree oil (I used to dilute it using olive oil, but I may have to try a new oil), honey (mixed with water or conditioner and left on scalp/face does wonders) and selsun blue (used once a week, and I put it on my dry scalp, let it sit for 10 minutes then rinse with water)

    Since it first started last year, it's gotten so much better, but I have tried everything, and my current routine seems to be working well.

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    1. Thanks for your input, I like readers sharing their successes so that others who are looking for something similar can get some ideas.

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    2. Thanks for the info. I have eczema also and will give this a try : )

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  3. Thanks a lot for this! I do have to deal with (not too much) with eczema on my body. Most likely, this is what effects my scalp to make it itching, flaky after washing my hair 3 to 4 days.

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  4. When you say avoid natural oils, do you mean on the scalp or in the hair?

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    1. Strictly speaking both. If it is on your hair it can travel down to your scalp. The test would be to try not using natural oils and see if the dandruff clears up or reduces significantly with an antidandruff shampoo. If it does then you can eliminate the oils, but if it does not change then the natural oils probably do not aggravate the dandruff.

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  5. I am torn, but I understand the evidence presented though. We always read about the good properties of oils - promote thickness, regrowth and the like. If it is one thing I always stress is that natural oils be used in moderation. So tip #1 for me is an eye-opener. I never knew of their specific aggravation of scalp eczema and dandruff.

    Knowledge is power!

    Thank you.

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  6. Oils on my scalp are a big no-no for me, especially coconut oil. I have used neem oil and it helps greatly, and I have tried a peppermint oil/vinegar spray(my favorite remedy so far). I currently use a prescription generic shampoo that does work. I wash my hair as it starts to itch or just before (once a week mostly). I hate when people say 'Oh you have dandruff/eczema? Do you oil your scalp' then they look at me weird when I say oiling my scalp most times make it worse.

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    1. How do u make n use the vinegar n pepper mint UOL mixture plz n tnx.

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    2. I fill between a quarter to a third of my spray bottle with vinegar, add a few drops of peppermint oil then fill the bottle with water. Alternately you could make peppermint tea and then mix it with the vinegar.

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    3. Question, do you spray on scalp after you shampoo and leave it in??

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  7. I might try the neem oil as I've been suffecring from scalp eczema for a while now and all of the hair products that I have seem to aggravate the condition as they all contain oils. It's an odd situation to be in because the only shampoo that works well on my scalp contains Ammonium Lauryl Sulphate which isn't great for my hair, so I use products that put moisture into my hair (most of them containing an oil or two somewhere in the ingredients) and then I know I should seal the moisture with an oil but that works against my scalp and the cycle goes on and on and on.

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  8. I will have to try Neem Oil, and I'd love to have that peppermint/vinegar mix recipe as well. I had to learn the hard way that oils on my scalp are a BIG no-no. I also learned that when I find it necessary to use a harsh medicated shampoo, washing my hair in (4) braids helps to minimize the impact on my hair and lets me get directly to my scalp a little easier.

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    1. Were do u get the neem oil from.. im from Philadelphia

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    2. Got mine at www.soapgoods.com but also check at wholefoods if they have stores in your area. It may be more expensive there though

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  9. Thank you for this! I have been struggling with SD for years and the last couple it has really been out of control. I've been using coconut, castor, grapeseed, and olive oil (not all at once) for the last two years. I will definitely be getting rid of these. I'm also going to follow this post to get other tips and natural remedies. I use to take an oral med but the side effects were terrible, plus I just hate medicine I always look for natural remedies.

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    1. Randi-Did it help you? I am also suffering SD for years. :(

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  10. I've been dealing with dandruff/SD since I was about 9 or 10. I've tried nearly everything out there - some of the old standbys either failing to work (Head and Shoulders) or abandoned when I went natural because they were petroleum-based (Dax, Sulphur-8). Right now I'm using Keracare's Dry and Itchy Scalp Moisturizing Shampoo and Conditioner, and it's working pretty well. I've also used this tea tree and neem oil shampoo bar that worked as well: http://www.chagrinvalleysoapandsalve.com/products/details/48/49/neem-tea-tree-body-hair-shampoo.

    My only issue is that my hair can't get by without oils! I've already started moving towards less oily products because of build-up (bye bye, Carol's Daughter) but if I eliminate them completely my hair will suffer. Could you suggest some oils/butters that are low in oleic acid? Or should I just avoid oils altogether?

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  11. I have had seb Dermatitis after getting a jerry curl at 9 years old. I have tried everything, but the only thing that worked for me was to eliminate all mineral oil products (as well as some other ingredients like triethanolamine which is in ecostyler gel, aloe vera, and slippery elm in kinky curly knot today) I do not put ANY oil on my scalp because anything makes my scalp itch. When I first went to the Dr He prescribed ketaconazole shampoo, and it worked. So I maintain by avoiding irritants etc.

    Now my skin which was also affected only healed up when I used Coconut oil exclusively!! I don't know why, but my eczema only flares when I use a product that has something that is an irritant to me. I am transitioning to natural, and my skin has never looked better!

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  12. That is very interesting. I have read that a few oils have anti-fungal properties (for example: coconut oil, flaxseed oil, primrose oil, mustard oil; tea tree, thyme or rosemary essential oil). So if scalp discomfort can be caused by an overgrowth of the fungus Malassezia, wouldn't it help to use oils with anti-fungal properties?

    If I am wrong please correct me, I am very interested to know if those oils truly have no anti-fungal properties.

    I would also like to add the mineral oil could actually preserve the life of fungus (http://www.ncbi.nlm.nih.gov/pubmed/6042871) and should probably be avoided from scalp use.

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    1. If your dandruff is caused by the malessezia fungus, then applying oil to it is like throwing gasoline on a fire! Malessezia is the only fungus which is lipophilic, i.e. it metabolizes fats and oils. So while oil will be effective against most fungus, malessezia is the exception.

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    2. Anonymous Nov 13th, just curious where you got your information? Product reactions vary. One article I came across (see reference info below) states that Malessezia furfur, the pathogen linked to or associated with conditions such as: pityriasis versicolor, seborrheic dermatitis, dandruff, atopic dermatitis, and psoriasis actually requireds long chain fatty acids for growth. Coconut oil is a medium chain fatty acid.

      Malessezia pachydermatis, also part of the Malessezia family, is said to be a non-lipid dependant isolate in the genus Malessezia. Growth of this species can occur without olive oil, but in some strains growth is ehanced by olive oil.

      There appear to be several different known species of the Malessezia family, some lipid dependent, some not---some with enhanced growth via oils, some not impacted by the presence of certain oils at all. It looks like the reactions to certain products such as coconut oil or olive oil would depend upon the strain of the species carried in an individual and the type of product used (Medium chain fatty acid vs long chaing fatty acid). I hope further research will continue on the usage of products such as olive and coconut oil specific to skin care, in addition to other oils as well.

      I'm still trying to learn as much as I can and have a long way to go in my personal research. Checking out the Coconut Research Center has been helpful too, along with Doctor Fungus . Org.

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  13. I have bad eczema on my scalp and about a year ago I started using coconut oil on my scalp because I thought the flakiness was occurring because my scalp was dry, however the oil made the situation much worse. Since reading this article about 2 weeks ago I have stopped putting any natural oils on my scalp, including my Carol's Daughter co-wash. In a old shampoo bottle I mixed raw organic honey, colloidal oatmeal and water which I use on my scalp. I use the Carol’s co-wash on the ends of my hair because it gets tangled. My eczema has since cleared up so much. I wash my hair once a week with this mixture.

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  14. I've recently received a diagnosis of scalp eczema...Dermatological products are SUPER expensive. So this is the regimen I've come up with. I've been using a prescription for ketoconazole and an anti-dandruff shampoo by Nairobi. The Nairobi has been a godsend! The other two products I use are from the Paul Mitchell line, awapuhi shampoo (doesn't contain any of the oils mentioned above) and tea tree conditioner. I do one wash with the awapuhi and dandruff shampoos mixed together, one wash with the ketoconazole, then condition with the tea tree...HUGE improvement...I got a lot of great information from the blogger, as well as other commentors...thanks to you all!

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    1. Thank you so much for your help! I was at a loss of what to use at this point...I'd like to get a haircut before Christmas! (-: Ordered the products you recommended. Wish me luck.

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  15. Wow I didn't know this! Thanks so much! I just joined a castor oil hair, eyebrow and eyelash challenge but now I'm scared to because I don't want to get itchy, flaky scalp! Do you think that combining castor oil with tea tree and neem oil may counteract this?

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  16. I do have another question! I've use emu oil and hemp oil in my hair with seemingly good success! Do you know if any of them harbor or contribute to fungal growth? I know emu oil is refined with heating to inhibit some type of microbial growth not sure which right now! Thanks

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    1. Emu oil is Anti Bacterial (or some times called as bacteriostatic i.e. it does not support microbial growth) I have experimented Emu oil on myself. since year I was suffering from high Dandruff issues , tried many methods , it was really annoying and that too I use to freak out scratching my head (;. One of my friend suggested me, to try EMU oil and I bought it online from http://www.multinaturals.com/
      Just for some one who want to try, let me write some notes on my method of usage:
      I took few drops may be 1 teaspoon of Emu Oil (lukewarm) and applied on my scalp. Massage it lightly for couple of minutes.
      When it comes to oil I apply a lot but my experience with emu oil ! you just need little. After applying and to seal in the moisture in my head, wrapped a towel (one can use a shower cap too) .After applying emu oil I generally do not wash my head for 30 - 45 minutes (note: After much usage I found that for good results, oil can be left on as long as overnight). I shower using use mild shampoo !! ( very important note : Avoid Shampoos what has SLS - Sodium Lauryl Sulfate). I had good results after 4 to 5 weeks and applying 3 to 4 times a week but for you it may depends how mild or severe dandruff you have.

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  17. Ooh sorry for the multi-post questions but what about palm oil? I've read that it has tocotrienol which may be good for hair growth! I'm hoping it doesn't have the same effect like castor oil and the others?

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  18. What should i do for a 3yr old who has eczema and scratched so hard that she has scabs on her scalp? she scratches so much that it hurts her head when we wash her hair.her scabs have no time to heal because shes constantly scratching anf picking at her scabs we cut her nails n she also takes medicine for her eczema,eveno shampoo is wat she uses..will leaving her hair down help her scabs heal faster?

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    1. I feel for your daughter. First you should tell your child's primary care provider (PCP) and maybe he/she may have a suggestion. Since your child is scratching so often thus stimulating the inflammatory response (triggering histamine) you may want to try giving her children's Benadryl temporarily until the healing of the scalp begins. What shampoo does she use? If the shampoo is for eczema you may want to leave it on her scalp for 20-30 minutes or longer.
      I hope this helps.

      -CEPJ80

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    2. JC,

      I'm so glad that you discussed this topic. I have Seborrheic dermatitis (SD) which has made growing my hair difficult particularly in the winter months. It is a common condition but little is known about it within the general population. I may post some of the things I've done to alleviate symptoms without using steroids.
      If anyone is suffering from this condition, you may want to read this there are several journals out there on the treatment of SD):

      Adult Seborrheic Dermatitis
      A Status Report on Practical Topical Management
      James Q. Del Rosso, DOcorresponding author
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100109/

      Thank you for discussing the topics that affect the scalp.

      -CEPJ80

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  19. I noticed a few flakes on my scalp when winter started and thought my scalp was dry so I massaged Virgin Coconut oil on my scalp and went to sleep. I awoke with my scalp on fire and finally had to see a dermatologist as the itching and burning would not stop for weeks and Head and Shoulders wasn't curing me. The dermatologist said it was SD and prescribed me Ketoconazole 2% and a steroid solution. I have yet to try the Keto. as I read about it causing hair loss. Is coconut oil a haven for yeast overgrowth and anyone have great results from using the Ketoconazole?

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  20. I am dealing with itchy scalp and lose of hair right now. Just saw my GP and was given a prescription for Betamethasone Valerate Foam 0.12% too be applied 2 times a day.

    Seems that I have been itchy for a month and the scratching it stopped the hair growth. Stop scratching seems to be a big key. I cut my nails as instructed and use a little Benadryl Cream if needed.

    I'll stop back here if the foam works and if the hair starts to return.

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  21. Unfortunately, Malassezia can feed on any triglycerides with fatty acids of 13 carbons and above. This includes virtually every naturally derived bulk oil we know of. The natural antifungal properties of oils like neem, sesame, and coconut, are not strong enough to make a difference in this case. It can also feed on wax esters, like those from jojoba or lanolin, and phospholipids, like those from lecithin.

    Malassezia cannot metabolize pure hydrocarbons, like white mineral oil or petroleum jelly.

    Fractionated coconut oil, on the other hand, may be of use. The product usually termed "fractionated coconut oil" is a liquid coconut oil derivative in which almost all the fatty acids above C12 have been removed. This yields an oil that is almost all medium chain triglycerides, so it stays liquid even at refrigerator temperatures, and quickly absorbs into skin without a greasy feeling. More importantly for us, medium chain triglycerides cannot be metabolized my Malassezia, as shown by a 1999 paper in Critical Care Medicine. Even better, once Malassezia releases the free fatty acids from the glycerol backbone, they're actually toxic to it, preventing further growth.

    Fractionated coconut oil is now being sold on grocery store shelves as "liquid coconut oil", albeit at gouging prices. Even better is capric/caprylic triglycerides, and even further purified form of coconut oil with no triglycerides above C10 - but this can only be found online.

    Just thought I'd share what I'd learned from several years of battling with this menace.

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    1. Thanks for the info! I will look for this liquid coconut oil! What is the capric/caprylic triglyceride ourified coconut oil marketed as so that I may search for it online? Thanks!

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  22. Since coconut oil is one of the few that can penetrate the hair shaft, does this "liquid coconut oil" penetrate as well?

    NOW I know why my scalp is so itchy...I have had eczema for YEARS, and I use coconut and olive oils. I am semi-tempted to just take an "L". My hair gets dry and matted, and eliminating oils is a recipe for disaster. I'm going to have to choose one. :(

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  23. I am so grateful for your information. As a sufferer of SD, I have been pushed to my limits by this reptilian like shedding. Dermatologist and stylist focused on symptons not causes. I just wanted to say thank you...I have to go throw away some products -Right now!

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  24. Thank you (all of you!) so much for all the great information here! I'm really struggling with my Ethiopian daughter's scalp. She's been seeing a dermatologist for 6 months for a variety of issues. We've been treating for fungus, just in case, and have had no improvement. Think we've determined it's SD. Time to add some of these suggestions to our regimen. Thanks again!

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  25. My daughter is 11 and she has ezcema and she scratchs so hard everyday in her scalp that it leave red sores. We have tried so many oils, and shampoos and nothing works. What shampoo and oil or essential oil can we use that will be gentle on the hair. The oils we use soak up and drys my childs hair out which has resulted in hair breakage. Really need your help

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  26. If we're not supposed to use oils on our hair with these conditions then what are we supposed to moisturize/seal our hair with? And what about conditioners that contain these oils?

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    1. It is not a general 'we are not supposed to'. If you have severe dandruff then avoiding natural oils is a logical option. You can still use them but avoid scalp contact as a compromise or you can choose mineral oil/silicone based products. Some people are actually allergic to coconut oil and coconut oil is a base for many of the conditioners that are commercially available. These people will use alternate products including natural options like clay or butter for conditioning.

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  27. I have eczema, so I always have bouts of dry skin all the time. My scalp has never been an issue until this summer. The crazy itching started when I started training for an athletic event - hence the sweat causing the irritation. The scalp has now been an issue for 5 months. Severe dryness and nonstop itching. This is what I've tried with no success - apple cider vinegar, olive oil and tumeric, fenugreek seeds, eucerin, scalpicin, doctor prescribed steroid foam, and of course all the shampoos - coal tar, salicylic acid shampoo, baby shampoos, etc. This is what I've recently tried with great (and sudden) success so far - tea tree oil shampoo and conditioner along with taking flaxseed oil supplements. (If only one of the two are working, I can't isolate which one it is since I started both at the same time.) But WOW, what a relief!!! I feel like it is actually starting to heal. I rub the tea tree oil conditioner on my scalp and leave a little bit on throughout the day. Oh yes, and for immediate relief, I had applied aloe to the scalp and it has helped tremendously. (On a side note for other itch sufferers - the best thing that I've found for nonstop itchiness on my ears has been Mario Badescu control cream. I don't know much about it, but it worked for me!) Good luck!

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    1. The flaxseed oil makes sense, according to Dr. Mercola (this was taken from his website: http://articles.mercola.com/sites/articles/archive/2007/11/20/dandruff-is-caused-by-scalp-fungus.aspx:

      Dandruff, as well as other dry-skin conditions, can often be a sign that you have a fatty acid imbalance. This is a very common problem, as your standard American diet (SAD) is far higher in omega-6 than omega-3.

      Your ideal ratio of omega-6 to omega-3 fats is 1:1. But the current ratio of omega-6 to omega-3 in the average American diet varies from 20:1 to 50:1!

      Your primary sources of omega-6 are corn, soy, canola, safflower, and sunflower oil; these oils are overabundant in your typical diet, which explains your excess omega-6 levels. Omega-3, meanwhile, is typically found in flaxseed oil, walnut oil, and fish.

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  28. What tea flaxseed oil are you using and is it pill form or on your scalp? I buy grounded flax seed and put that in my salads every day, is it the same thing? I have been using raw honey on my scalp for a month now and so far its the only thing that has helped it a little. mix it w/ water and hear it up and leave it on over night.

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