By Jc of The Nat­ur­al Haven

Quite often peo­ple mix up dan­druff and scalp eczema. The truth is both of these con­di­tions are very sim­i­lar and they both actu­al­ly share the same cause but know­ing the dif­fer­ence between the two can great­ly help to get the cor­rect treat­ment and man­age­ment.

What is dandruff?

Dan­druff is char­ac­terised by loose skin flakes which are nor­mal­ly white in colour. There is also usu­al­ly some itch­ing but this is usu­al­ly not very severe.

What is eczema?

Eczema is also known med­ical­ly as seb­or­rhe­ic der­mati­tis and like dan­druff it is also char­ac­terised by  flak­ing and itch­ing. The big dif­fer­ence is that scalp eczema often results in greasy, yel­low­ish flakes and the itch­ing can be quite severe and accom­pa­nied with inflam­ma­tion. Addi­tion­al­ly if you have eczema else­where (under the nose, on the hands/legs etc) the like­li­hood is that what you may per­ceive as dan­druff on your head may actu­al­ly be eczema.

What causes dandruff and seborrheic dermatitis/eczema?

Dan­druff and eczema have a sim­i­lar cause and three main things cre­ate the right envi­ron­ment for the flak­ing and itch­ing to hap­pen:

1. Fun­gus: Our skin and infact our bod­ies are cov­ered in bac­te­ria and fun­gi both inside and out. This is per­fect­ly nor­mal and should not be any cause for alarm. The rea­son why the scalp begins to flake is that a nor­mal fun­gus that is found on the skin is pro­duced in high­er amounts than nor­mal. This fun­gus is known as Malassezia and it affects the scalp because its food source is a spe­cif­ic fat found in sebum.

2. Sebum: The fun­gus Malassezia unique­ly prefers one spe­cif­ic fat in sebum known as ole­ic acid.  By specif­i­cal­ly choos­ing to con­sume this fat above all oth­ers in sebum, the com­po­si­tion of sebum is altered . This alter­ation is then thought to lead to the cells on the scalp los­ing their adhe­sive­ness and flak­ing off.

3. Indi­vid­ual sus­cep­ti­bil­i­ty. The fact is that some peo­ple have dan­druff and some do not. Some peo­ple have eczema and oth­ers do not. For some peo­ple high lev­els of the fun­gus -Malassezia or indeed of its food source — ole­ic acid, does not result in dan­druff. How­ev­er, for oth­ers, even slight changes in the bal­ance leads to prob­lems.

Myths

Dan­druff and scalp eczema are not linked to wash­ing hair fre­quent­ly or infre­quent­ly. Hav­ing dan­druff or scalp eczema does not mean that your per­son­al hygiene is low.

Ladies, have you con­fused dan­druff with scalp eczema? Do you strug­gle with either?

Ref­er­ences
1. J Inves­tig Der­ma­tol Symp Proc pp 15–19, (2007).
2. J Inves­tig Der­ma­tol Symp Proc 10:194–7 (2005)
3.  Sci­ence 304:304–7 (2004)

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56 Comments on "Dandruff and Scalp Eczema; Understanding the Difference"

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janice

To pre­vent or reduce eczema flare-ups, avoid expo­sure to extreme tem­per­a­tures, dry air, harsh soaps, per­fumed prod­ucts, and bub­ble baths. Use blan­kets and cloth­ing made of cot­ton instead of more irri­tat­ing fab­rics, such as wool, or stiff syn­thet­ics, such as poly­ester. After show­er­ing or bathing, pat dry (rather than rub) so you leave a lit­tle mois­ture on your skin. Then apply a mois­tur­iz­ing cream or lotion to trap mois­ture in the skin. Use a humid­i­fi­er to add mois­ture to indoor air. Here are some more tips :
http://www.skincarefeel.com/scalp-eczema-how-to-deal-with-it-effectively/

James Hilton

Very Nice Arti­cle — For More Info About Flaky Scalp Vis­it Flaky Skin Care Cen­ter

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Aldenir

Go YOU! I love flaxseed. In a pinch you can mix it in a low fat flrovaed yogurt too. ;) Anoth­er good thing about it is it will keep you “regular”.PS…I despise FISH. Despise.

Amanda
The terms seb­or­rhe­ic der­mati­tis (SD), and eczema should not be used inter­change­ably. It leads to con­fu­sion and inac­cu­ra­cies in infor­ma­tion as the con­di­tions are not one and the same. Eczema is atopic der­mati­tis which is a skin con­di­tion caused by the body’s immune response to con­tact with any­thing real­ly; from soap to grass to latex to wool to sweat. It’s some­times pos­tu­lat­ed to be an aller­gic response. Seb­or­rhe­ic der­mati­tis is caused specif­i­cal­ly by the skin’s reac­tion to pro­lif­er­a­tion of the fungus/yeast malassezia as a result of over­pro­duc­tion of sebum (seb­or­rhea) How­ev­er, the exact caus­es of seb­or­rhea remain unknown. But, it… Read more »
Berchy

Atopic der­mati­tis = Eczema
Seb­or­rhe­ic der­mati­tis = Dan­druff

Get your facts straight! I went to the doc­tor and was diag­nosed with Dan­druff (Seb­or­rhe­ic der­mati­tis) so I know this for a fact! What I don’t under­stand is how come no one did a quick google search to check your facts.

After I saw that error I stopped read­ing because it only left me to won­der what oth­er errors are in there!

Tel8
I don’t know for sure that I have eczema on my scalp- my der­ma­tol­o­gist nev­er did say what it specif­i­cal­ly was, but I found that as soon as I did an ACV rinse, the sev­er itch­ing on my scalp, neck and the tops of my ears imme­di­ate­ly- and I do mean imme­di­ate­ly- stopped. Pri­or to that it felt like my scalp was on fire and I felt every sin­gle strand of hair where it touched it. Since then, I’ve done two more ACV rins­es (each time with slight­ly less vine­gar, as I used it in a very high ratio the… Read more »
Jane

If you have eczema, are think you could be prone, find an SLS free shampoo.As many of us wash our hair in show­ers there is an increased risk of expo­sure to aggres­sive irri­tants from over the counter sham­poos, most reg­u­lar brands.
This is one of the most com­mon con­trib­u­tors to eczema flare­ups!,
Jane

embracingnatural

great post! I have been diag­nosed with SD by my der­ma­tol­o­gist, and after using lots of pre­scrip­tion sham­poos and lotions, I have found that ben­tonite clay/ACV works won­ders for my flare ups. I know it is a strug­gle, and I hope that every­one suf­fer­ing with this con­di­tion finds what works for them. I also treat it as an aller­gy, which is only to say that I lim­it harsh chem­i­cals that are like­ly to cause it to flare. Thanks for bring­ing this top­ic to light.

lee
I’ve known I had eczema since I was very young. It start­ed on my back and neck, and it was a del­i­cate bal­ance to keep my skin hap­py with out meds. The Dr told my moth­er to keep me away from cer­tain food and keep me my skin hydrat­ed. It also kin­da help I lived in a high humid­i­ty cli­mate. As a teen I rarely suf­fered an episode. As an adult I noticed splotch­es on my face, went to the der­ma­tol­o­gist. Guess what eczema and was told if you have it its all over the body scalp too. My flares… Read more »
Felicia

my derm Rx Nizo­ral sham­poo to cut down on the yeast which feed on sebum. ACv and the like are not going to do that, so if this is tru­ly your prob­lem, you need a anti-yeast solu­tion. i do not know if cut­ting them in your diet will accom­plish this.

Lu

JC- Thanks as always for your well-researched and ref­er­enced arti­cles. I always like facts with my sci­ence.

I won­der if you could expand a lit­tle more on eczema and hair loss? I have had eczema all my life but recent­ly noticed a spot on my scalp where the hair has fall­en out, although I had noticed extreme itch­ing in that spot before. Thank­ful­ly, my hair is very dense and my der­ma­tol­o­gist pre­scribed meds (eczema meds) for it but any addi­tion­al resources would be help­ful. Thanks!

The Natural Haven

Thanks for the com­pli­ment Lu. I am glad that you are see­ing a der­ma­tol­o­gist because this is the best way to mon­i­tor and treat eczema.

The hair loss/thinning with scalp eczema is relat­ed to severe itch­ing. This itch­ing can lead to man­u­al pulling of hair which leads to unin­ten­tion­al loss of hair. Eczema is well stud­ied in chil­dren who often unlike adults can severe­ly pull out alot of hair. How­ev­er, most case reports from doc­tors show that once treat­ment is giv­en to treat eczema, the hair regrows as nor­mal.

Valerie

Although my hair has grown back in those spots the hair is also thin­ner and more sparse. I have to be extra gen­tle with the hair in those areas. The length is fine but I am almost sure that the hair fol­li­cles have shrunk­en because of the severe itch­ing and use of steroid creams on my scalp.

Night Jade
ACV with tea tree oil worked a lot for me if your hair can han­dled being washed with sham­poo. I poured it over my scalp and let it sit for about an hour then rinsed it off. It didn’t remove the build up so I had to sham­poo it as well as to get out the smell. It real­ly made a dif­fer­ence though. Nor­mal­ly I have to wash my hair once a week but I was able to make it to two weeks. The only prob­lem is my hair is very weak. Shampoo…even gen­tle shampoo…dries it out. So the acv… Read more »
hyspin
Ques­tion: Have you deter­mined that the flakes that you have are dan­druff flakes noth­ing else, like build or prod­ucts that don mix well? As for the ACV it helped for me but I heard that the best way to get the best use out of it is to use it at least 3 days in a row. Appar­ent­ly you apply it to your scalp leave it for 10 min­utes and then wash it out and do that for 3 days straight. I don’t know for cer­tain if that real­ly cause a great dif­fer­ence but I find that once I avoid min­er­al… Read more »
Moni

JC,

Can you explain how the same cause pro­duces two dif­fer­ent con­di­tions? Is it due to the bod­ies response to these caus­es? Is there a rea­son why some peo­ple get dan­druff and oth­ers get scalp eczema?

The Natural Haven

Eczema is thought to have a hered­i­tary com­po­nent. If there is a famil­ial his­to­ry of eczema (and also asth­ma and hayfever) then it is pos­si­ble that future gen­er­a­tions will have it. 

Although dan­druff and eczema share the same eti­ol­o­gy (i.e caus­ing fac­tors), they are dif­fer­ent because as indi­vid­u­als we have dif­fer­ent genes and dif­fer­ent pro­duc­tion lev­els of sebum as well as reac­tions to changes to sebum and fun­gal activ­i­ty. Some peo­ple nev­er have dan­druff, some have it once in a while, oth­ers have chron­ic dan­druff. Some peo­ple have eczema but oth­ers do not.

W. Lotus

I have dan­druff; my scalp begins itch­ing a flak­ing just a day or two after wash­ing. I’ve stopped oil­ing my scalp in the hopes that will cut down on the flake build-up, but so far I don’t see a dif­fer­ence.

jjleb85

Is it true that tea tree oil helps with dandruff/itchy scalp?

The Natural Haven

Thanks for the ques­tion, I just learned some­thing new because I looked this up. 

Yes one study showed that tea tree oil helps with itch­i­ness in about 40% of the cas­es. It is not shown to improve flak­ing. (Jour­nal of the Amer­i­can Acad­e­my of Der­ma­tol­ogy, Vol­ume 47, Issue 6 , Pages 852–855, Decem­ber 2002)

Oth­er stud­ies seem to indi­cate tea tree oil has anti­fun­gal prop­er­ties.

Connie

The first one looks worth the effort you have tak­en to capu­tre it. My favourite this time is of course the sec­ond one which at the first glance seemed to me like a bou­quet or some­thing. Nature is full of such mag­ic!

hyspin

Also note as a micro­bial, sci­ence jour­nal (since I have been burned for not using my sci­ence jour­nals first)
http://jac.oxfordjournals.org/content/45/5/639.full

Oth­er info con­firm­ing the usage for dan­druff and oth­er uses(Hosted by Nation­al Insti­tutes of Health):
http://nccam.nih.gov/health/tea/treeoil.htm

Zoopath

I have had seb­or­rhe­ic der­mati­tis for many years. In gen­er­al what works for me is wash­ing once a week (too much wash­ing and too lit­tle wash­ing caus­es flare ups), nev­er oil­ing my scalp, nev­er let­ting my scalp stay wet for long peri­ods of time and a pre­scrip­tion foam steroid called Lux­iq (it’s pret­ty pricey but keeps things under con­trol). I use a coal tar sham­poo about once a month but I’m care­ful to only get it on my scalp, not my hair. My hair growth isn’t affect­ed by it at all.

Terry Lewis

What is the best way to con­trol scalp eczema?

Ebone R

I see a der­ma­tol­o­gist and was pre­scribed a beth­metha­sone valer­ate foam which is a cor­ti­cos­teroid. It’s made for the scalp but I was also instruct­ed to put it on any flare up. I do not have to use it every day and usu­al­ly clears my flare ups in two to three days using only at night. In addi­tion, at the spots where I know I usu­al­ly have flare ups I mois­tur­ize with Aquaphor. I drink plen­ty of water just to help with over­all hydra­tion; the more hydrat­ed I am the less itchy I feel.

Ahmed
Unique and Pow­er­ful Nat­ur­al Heal­ing Cream That Works Great for Fis­sure, Eczema, Acne, Aging, and More (Health and Beau­ty) My eight year old daugh­ter has had eczmea since she was three. We began using Dr. Wheat­grass Antiox­i­dant Skin Recov­ery Spray and the Dr. Wheat­grass Skin Recov­ery Cream just two weeks ago and the results have been amaz­ing. Her eczmea was severe, and we have tried many oth­er prod­ucts to help her con­di­tion. The Skin Recov­ery Spray and Skin Recov­ery Cream are the only prod­ucts that have worked. Her skin began to improve the day after the first appli­ca­tion, and with… Read more »
The Natural Haven

There is a post com­ing up on this but as hyspin said, the best thing to do with eczema is to see a der­ma­tol­o­gist.

hyspin

You best bet to ask your der­ma­tol­o­gist. Each per­son caus­es varies. They need to deter­mine the cause eczema and treat accord­ing. But be care­ful often the pri­ma­ry pre­scribed med­i­cine is known to be steroid creme, which most pop­u­lar side affect is thin­ning skin. You also have to keep a prop­er dry­ness to mois­ture bal­ance which is depen­dant on the type of eczema and it sever­i­ty.

Coily Africana
You are so right about the steroids, and the fact is that do not work. What i mean by this is that, they will work when you are using them but once you stop it comes back(they just sup­press), so you can end up being depen­dent on them. I used it on and off over a 4yr peri­od before I refused to use them any longer, which was 3yrs ago. Till date I can’t use any type of deodor­ant for my armpits, it will burn and my scalp cant even take any heat it becomes inflamed. IMO, ask your doc­tor… Read more »
hallease

This was very help­ful, I have actu­al­ly won­dered why my “dan­druff” had got­ten so bad. Now though, I won­der if there is any treat­ment advice you could add to the arti­cle? I think a lot of mine devel­oped from when I used to have treat­ed hair. (I now have locs) I also now use nat­ur­al prod­ucts and focus more on mois­ture. Any advice though?

Cyn

Does eczema affect hair growth in any way?

ST

I can speak from expe­ri­ence hav­ing expe­ri­enced eczema (S.D) for years. When­ev­er it “acts up” I have real­ized that my hair growth is vir­tu­al­ly impos­si­ble. Instead my hair is trashy and tears out eas­i­ly and I am unable to use oil based hair prod­ucts. Addi­tion­al­ly, wher­ev­er I may have those greasy yel­low­ish flakes the hair basi­cal­ly tears out, leav­ing a patch. Are there any prod­ucts you could rec­om­mend that would not cause the out­break to wors­en? Trust me, I need sug­ges­tions, my patience is wear­ing thin after near­ly 20 years of this con­di­tion.

Amanda
I post­ed this on a dif­fer­ent arti­cle last month but I’ll repost here with hopes that it’ll help oth­ers out. I alter­nate between keto­cona­zole and ciclopirox (both pre­scrip­tion anti fun­gals) sham­poos about every 2 weeks. I wash my scalp every 3–6 days (usu­al­ly 4) depend­ing on how much I sweat dur­ing my 6 day a week work­outs and whether I’ve been swim­ming. Dur­ing real­ly bad flare ups I use ciclopirox olamine cream on affect­ed areas. Be wary of the “oil your dry scalp” or “mas­sage ‘insert name here’ oil/butter into your scalp” sug­ges­tions. Aside from cer­tain esters and essen­tial oils… Read more »
Coily Africana
This describes exact­ly what hap­pens when I have a flare-up and it is not con­tained ear­ly. These are the steps I would sug­gest 1) De-flake- Apply an emol­lient (Epa­derm is one) to soft­en the scales/flakes and help remove them, try to make sure it is actu­al­ly on your scalp and not hair (I used to have a nurse apply it for me), mas­sage it light­ly and leave overnight 2)Shampoo- Rinse off emollient(no need for sham­poo, as it is soapy)and put sham­poo on your scalp for some minutes(my Derm makes a mix for me which I think is black soap mixed… Read more »
Valerie
you could try over the counter hydro­cor­ti­sone. (I have eczema as well) now, it may be too weak but it may also pro­vide some type of relief. when i go to my derm, they give me a steroid gel to apply to my scalp but its also dry­ing. just make sure you have a clean scalp and then apply the oint­ment spar­ing­ly in those spots. i’ve run out of my gel and its what im doing now to stop itch. i def­i­nite­ly feel your pain because i suf­fered from itch and patch­es of bald spots for years before i got it… Read more »
Coily Africana

Though I have scalp psoriasis(or Seb­or­rhoe­ic dermatitis/eczema/psoriasis depend­ing on doctor)it can present and affect sim­i­lar to eczema. It does not affect growth, how­ev­er it can cause mild to severe thin­ning. I had to shave off all my hair 3 dif­fer­ent times with­in a 4yr peri­od due to severe flare-ups.

The Natural Haven

Great ques­tion! In gen­er­al no it does not affect hair growth. How­ev­er, some peo­ple can expe­ri­ence severe inflam­ma­tion and itch­ing which can then lead to hair loss (usu­al­ly in a small patch where the eczema is present).

b.

How does lack of water & excess sug­ar intake affect dan­druff and/or eczema? I’ve been won­der­ing about that late­ly.

STW

I just want­ed to reply based on expe­ri­ence. I have had eczema all my life and I have found when my diet is not up to par it is worse for me espe­cial­ly when I took in a lot of sug­ar. I think ulti­mate­ly when your feed­ing your body the right nutri­ents your way bet­ter off and that sug­ar in excess can make your eczema worse.

kan

I must agree — when I intake too many sug­ar and white carbs it flares up pret­ty bad­ly. But when I stay away from them, all is com­plete­ly well! This is kin­da cool in a way since we shouldn’t be eat­ing too many carbs and sug­ar any­how. All that processed food is just ter­ri­ble for the body in so many ways.

hyspin

That so very true. I actu­al­ly have to work on that sug­ar is my dietary down fall. But luck­i­ly my Doc­tor has found that my blood sug­ar lev­el is nor­mal, YES, thank good­ness for drink­ing a lot of water with my sug­ary snacks.

The Natural Haven
I have not seen stud­ies link­ing dan­druff or eczema to not tak­ing in water or tak­ing excess sug­ar. In fact I actu­al­ly found a recent Ger­man study that showed that sug­ar intake did not aggra­vate eczema (Acta Derm Venere­ol 2001; 81: 282–284) I have seen how­ev­er stud­ies which link flare ups of dan­druff and eczema to psy­cho­log­i­cal stress and aller­gies (e.g milk and eggs). A der­ma­tol­o­gist should be able to give you a full aller­gy test if you think that your eczema or dan­druff is relat­ed to a food aller­gy. While dan­druff and eczema are char­ac­terised by flak­ing dry skin,… Read more »
hyspin
I always take it back to what you use on your skin out of per­son­al and through friends expe­ri­ences. I find often the things that you allow to be rub into the skin, stress and some­times food aller­gies can cause the onset of a flare up. Not nec­es­sar­i­ly fun­gus. My der­ma­tol­o­gist and Doc­tor both not­ed that peo­ple with child Asth­ma have a high­er chance of the onset of eczema. She men­tion also the house holds with Cats ( I think it is their sali­va I am guess­ing) can make eczema suf­fers sit­u­a­tion worst.  In my case my eczema was brought on… Read more »
Siri
If I may, the body is able to reg­u­late fun­gus on the body which pre­vents over­loads caus­ing eczema and oth­er fun­gus ail­ments such as yeast infec­tions and thrush. Some­times the body is unable to reg­u­late fun­gus when the immune sys­tem is low­ered (i.e. can­cer and oth­er immune-sup­pre­sant dis­eases, being sick, cer­tain med­ica­tions, stress, aller­gies, etc.) and that is when eczema can flare and become notice­able when it oth­er­wise was not. So it is caused by fun­gus. My child has Crohn’s Dis­ease and when she had a flare up, she was “blessed” with both thrush and a yeast infec­tion. That’s when… Read more »
hyspin
Study link: Sec­ond last para­graph: http://www.dermatitisfacts.com/atopic-dermatitis-eczema/atopic-dermatitis-microorganisms-role.php “Malassezia is also active in pro­mot­ing a vari­ety of inflam­ma­to­ry respons­es, such as, by stim­u­lat­ing ker­atinocytes. How­ev­er, anti­fun­gal stud­ies have not been able to find the clin­i­cal sig­nif­i­cance of malassezia induced aller­gy in eczema.” next link http://www.eczema.com.au/articles/67-is-eczema-a-fungus/ “Eczema is not a fun­gal infec­tion Eczema is an inflam­ma­to­ry skin con­di­tion. It is in no way relat­ed to fun­gi, how­ev­er a fun­gal infec­tion may devel­op on top of the weak­ened eczema skin. As the con­di­tions are unre­lat­ed they require dif­fer­ent treat­ments. Fun­gal con­di­tions respond quick­ly to good hygiene, dry con­di­tions and anti­fun­gal creams” All the oth­er… Read more »
hyspin

Also a lot of fun­gal infec­tions look like eczema and der­mati­tis but are not nec­es­sar­i­ly the same thing nor will be treat­ed or cured the same way. Think of it of a female heart attack often the symp­toms of a wom­ans heart attack could be eas­i­ly mis­tak­en for indi­ges­tion, tired­ness, and stress, in some cas­es because the pain is always the noto­rius Crush­ing chest pain which most peo­ple asso­ciate with a heart attack.

hyspin

sor­ry cor­rec­tion:
” in some cas­es because the pain is always the noto­rius Crush­ing chest pain which most peo­ple asso­ciate with a heart attack.”
change to
“in some cas­es, because the pain is NOT always the noto­rius Crush­ing chest pain which most peo­ple asso­ciate with a heart attack”.

The Natural Haven
Hyspin — I know that com­ments can eas­i­ly be mis­in­ter­pret­ed so please know that I am not being con­de­scend­ing to you. I do have to put you on the spot because the web­sites you have giv­en are real­ly poor in terms of sci­ence. 1. Have you noticed that the web­sites that you give have no sin­gle actu­al ref­er­ence to a sci­en­tif­ic jour­nal? 2. How do you know the infor­ma­tion you are read­ing is fac­tu­al and researched? Where are the stud­ies that are quot­ed? I ref­er­enced this paper in the arti­cle above http://www.nature.com/jidsp/journal/v12/n2/full/5650049a.html I will quote the first line of this paper  ‘Dan­druff… Read more »
hyspin
Yes and that is not­ed but all I am say­ing that just their is fun­gus doesn’t mean that that was the direct cause of the infec­tion. It like have a wound infect­ed just because a lot of untreat­ed wounds can be infect doesn’t mean that is what cause the wound. All the sci­ence jour­nal prove so far is cor­re­la­tion. But as sci­en­tist or researcher do note that “cor­re­la­tion doesn’t equate to cau­sa­tion”. okay if I need to quote a med­ical jour­nal so be it. http://www.ncbi.nlm.nih.gov/pubmed/11979041 “. to AEDS and in what pro­por­tion they share aller­gens remains to be clar­i­fied.” And from… Read more »
hyspin

Do note I am not say­ing fun­gus can­not cause it (it can) but I know a whole lot of oth­er more com­mon caus­es of sud­den flare up eczema. Luck­i­ly I haven’t got­ten eczema on the scalp.

hyspin
Well lack of water could con­tribute to eczema but allow to skin to get dry is more the cul­prit. Also cer­tain irri­tants also can result in eczema. But here a kick­er appar­ent­ly eczema can so bad to cause weep­ing eczema. Which results in a whole dif­fer­ent approach to to eczema and can spread to health skin if the weep­ing (water secre­tions) starts to spread. But eczema is not only flack­ing it can be pumps or a rash so it not so easy to nar­row out based off of flak­ing skin. But flak­ing is an good indi­ca­tor that it had or… Read more »
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