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Scalp Eczema Treatment: Antifungal Creams & Ointments

How treat eczema on the scalp
Treatment for eczema on the scalp may include these antifungal creams, ointments or sprays.

Eczema on the scalp can be a stubborn condition that persists for years, though it can come and go without warning. While the condition cannot be completely cured, symptoms of it can be managed through various treatments that aim to:

  • Remove scales
  • Reduce itching
  • Calm the inflammation that is causing redness and swelling

The primary target of treatment should be the scalp and not the hair. Always part the hair and apply medications directly to the scalp. Avoid hot oil massages and heat drying because it may exacerbate your eczema.

Treatment of scalp eczema may include:

  • Moisturizing the scalp with creams and spray-on oils.
  • Applying coconut oil (available in most pharmacies) to the scalp.
  • Treating the flares with massage treatments (use coconut oil but never olive oil).
  • Washing the hair with medicated shampoos as prescribed by the dermatologist.

Additionally, treatment can also be applied during flares of eczema on the scalp, including:

  • Topical antifungal cream or medicated shampoo for mild cases of eczema.
  • Topical steroids can be beneficial on the scalp.
    • Alcohol-based topical steroids may cause a stinging sensation
    • A lotion, mousse or gel preparation may be a comfortable option.
    • Use topical steroids for two weeks only.
  • Topical steroids of different strengths may be used if the scalp eczema extends to the hairline and face.
  • Topical steroids combined with salicylic acid can be beneficial if the scalp is scaly and inflamed.
  • Oral antibiotics may be prescribed if scalp eczema is infected.
Table. The treatment for eczema on the scalp in adults and adolescents (American Family Physicians, 2015) Product Dosing frequency Side effects Cost for generic (brand)*

Over-the-counter preparations

Coal tar shampoo
Two times per week
Inflammation of hair follicles (folliculitis), skin rash (contact dermatitis), sensitivity to light (photosensitivity)
$5 for 130 mL

Selenium sulfide shampoo
Two times per week
Alopecia, hair discoloration, irritation
$7 for 325 mL

Tea tree oil shampoo
Irritation, contact dermatitis
$14 for 473 mL

Zinc pyrithione shampoo
Two times per week
$5 for 420 mL

Topical antifungals

Loprox (ciclopirox one percent shampoo)
Daily initially, then two times per week
Burning, skin rash, itching
$59 ($527) for 120 mL

Nizoral (ketoconazole two percent shampoo)
Daily initially, then two times per week
Irritation, itching and high sensitivity to sunlight
$16 ($63) for 120 mL

Topical corticosteroids

Luxiq (betamethasone valerate 0.12 percent foam)
Two times daily
Stinging, itching, patches on the skin (hypopigmentation), thinning of the skin (skin atrophy)
$88 ($274) for 50 grams

Clobex (clobetasol 0.05 percent shampoo), alternating with ketoconazole two percent shampoo
Each two times weekly, alternating medications, for up to two weeks
Burning, redness, folliculitis, hypopigmentation, itching, skin atrophy
$144 ($644) for 118 mL

Capex (fluocinolone 0.01 percent shampoo)
Burning, dryness, hypopigmentation, skin atrophy
NA ($364 for 120 mL)

Synalar (fluocinolone 0.01 percent solution)
One or two times daily
Burning, cough, fever, hypopigmentation, pruritus, runny nose, skin atrophy
$32 ($289) for 60 mL

For infants, treatment for eczema on the scalp may include:

  • Emollients to help loosen scales, such as mineral or olive oil, petroleum jelly
  • Removing scales by rubbing with a cloth or infant hairbrush
  • Ketoconazole one to two percent two times daily for two weeks

What are the different types of eczema that affect the scalp?

The scalp is an area of the body that can be affected by different types of eczema. The characteristics of the scalp during the chronic and acute phases of eczema are:

  • Chronic phase: Dry, itchy and scaly.
  • Acute (eczema flare) phase: Inflamed, weepy and painful.

The different types of eczema that affect the scalp include:

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