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

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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… 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… 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… 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… 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… 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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