How to Treat Scalp Eczema for Black and Brown Women - Healthline

Seborrheic dermatitis (SD) is a chronic form of eczema that affects the scalp, face and other areas of the body that have high sebum or oil production. SD affects around 6.5 percent of African Americans and is among the top five medical diagnoses that Black patients receive.

For Black and Brown women, hair is often a source of pride and self-expression. But for those with seborrheic dermatitis, a form of eczema that affects the scalp, it can be a source of stress.

The condition can cause:

• scaly or petal-shaped flaky skin patches in and around the hairline
• pale or pinkish rash with yellowish scale
• irritation across the scalp

These symptoms can also occur:

• between or on the eyebrows
• around the nose
• on the cheeks
• on the beard area
• on the upper chest
• on the back
• in the armpits
• in the groin

SD presents differently according to skin type. On darker skin, it may be marked by:

• raised skin
• thick or leathery skin
• pale or pink skin with scaling
• changes in the pigment of the skin

A chronic form of eczema affecting the scalp and face, seborrheic dermatitis (SD) affects around 6.5 percent of African Americans. It's among the top five medical diagnoses Black people receive.

The condition is thought to be caused by an overgrowth of Malassezia yeast and excess production of sebum. Research suggests a number of other possible triggers, including:

• environmental irritations (extreme temperatures)
• stress
• harsh detergents, shampoos, chemicals, and soaps
• some medications, including psoralen, interferon and lithium
• hormonal imbalances
• preexisting conditions

The shape and quality of human hair fibers differ across racial groups, and physicians should take into account the different hairstyles and processes used by people of different races when treating SD.

For example, some research has suggested that personal and cultural habits can contribute to SD, such as:

• frequent use of pomades and other hair products
• chemical relaxers
• infrequent shampooing
• excessive brushing

At the same time, harsh treatments for SD could be too drying or risk damaging the hair shaft. Some chemicals and ingredients in hair products can also lead to an allergic reaction. This can worsen SD, and the immune response can cause an itchy, scaly rash.

Asian skin may also be more susceptible to irritants in topical treatments.

For this reason, it's important to treat SD on a case-by-case basis, taking into account skin and hair type as well as cultural factors. However, not all physicians understand different types of hair.

A 2014 survey of 200 African American women found that of those who had discussed their hair with a physician, 68 percent felt their physician didn't have a good understanding of African American hair.

If you have Black or Brown skin, these tips can help you manage the condition.

If your hair is chemically treated and dyed, you may want to seek out gentler products for your scalp than you would with a natural afro. This is to avoid damage to the shaft and minimize hair loss.

Additionally, the application and washing methods will differ. If your hairstyle consists of braids or locs, they should be loosened up to treat the buildup of sebum.

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Over-the-counter dandruff shampoos are very drying. This can lead to breakage if the hair is inherently brittle. Photo credit: Getty Images

There are a range of over-the-counter and prescription shampoos and conditioners that can help with SD.

Look for store-bought shampoos containing:

Prescription antifungal shampoos include:

• ciclopirox 1% (Loprox)
• ketoconazole 2% (Nizoral)

You may also be prescripted a steroid shampoo like clobetasol 0.05% shampoo (Clobex), which you alternate using week on week with ketoconazole 2% antifungal shampoo.

Be aware that the formulation of the shampoo can make a difference. Some shampoos can dry out the hair shaft more.

For example, over-the-counter dandruff shampoos are very drying and this can lead to breakage for people who have inherently brittle hair. Black hair responds best to oil preparations or ointment.

Use of medicated shampoos at least once a week can prevent flares of SD. Antifungal shampoos used once a week or less may not be effective.

Here is how to use antifungal shampoos:

1. Work into your hair starting at the scalp.
2. If you have natural or chemically treated hair, lightly comb through your hair starting at the scalp and working your way down to detangle. These shampoos work best if left on the hair for 5 minutes.
3. For braids and locs, you'll want to massage these products onto your hair and scalp by sectioning.
4. Rinse.

Avoid shampoos with added fragrance, since this can irritate skin.

SD is also treated with:

• topical antifungal medications
• topical steroids
• topical calcineurin inhibitors

Since SD stems from the scalp, some therapies are aimed at healing the skin and removing scales.

Oil-based sprays and moisturizers can help soothe the skin. These can be left in overnight by covering the hair with a towel or shower cap. Always make sure this scalp spray is compatible with your hair type.

Some products are intended to be sprayed onto affected areas before shampooing and conditioning your hair. If you have braids or locs, make sure to rub underneath them to reach the scalp and let this sit for 5 to 15 minutes.

DIY hair treatments are popular in Black and Brown communities, with anecdotal success for a range of skin conditions.

A Palestinian study of herbal treatments for scalp disorders found that items such as olive oil and honey were commonly used.

Research has shown that Black people with eczema preferred oil preparations over alternatives because they were less likely to dry out their skin.

Crushed aspirin has been used successfully to treat other painful skin conditions and is sometimes included in hair mask recipes for relief.

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Olive oil and honey are common ingredients in DIY hair masks. Oil-based preparations are less drying for people with eczema. Photo credit: CalypsoArt/Shutterstock

To try one such mixture, combine small amounts of:

• honey
• plain yogurt
• crushed aspirin
• mint oil

Apply this paste to your hair and let it sit for 30 minutes. For best results, sit under a dryer. Rinse out this mixture.

To seal, mix together small amounts of:

• extra virgin olive oil
• coconut oil
• tea tree oil
• camphor oil

Leave in this emollient mix.

Aloe vera gel is an effective treatment for SD that can restore a damaged scalp. You can purchase a bottle of aloe vera gel or cut open a leaf from an aloe plant.

To use a leaf, scape out the gel and apply it onto your scalp and hair. Leave it in for 10 minutes, then rinse.

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Extreme weather can be damaging to hair, especially in people with brittle hair. Photo credit: Getty Images

Identifying and minimizing triggers may help you to manage SD. Actions that may help with SD include:

• trying to reduce your stress level through relaxation or by removing sources of stress
• limiting sugar consumption, which can lead to yeast buildup
• staying hydrated
• aiming to eat nutritious foods so your body feels nourished
• avoiding harsh hair products
• preparing for extreme weather by protecting your hair in harsh climates with hairstyles such as braids, twists, buns, cornrows, and Bantu knots
• aiming to shampoo and condition your hair at least once a week

Finding the right care for your condition and skin type

Seborrheic dermatitis is best treated by a healthcare professional who specializes in treating skin conditions, such as a dermatologist. However, not all dermatologists have experience treating seborrheic dermatitis in Brown and Black skin.

Here are two resources for finding healthcare professionals who specialize in treating People of Color:

• Skin of Color Society's "Find a Doctor" tool. The Skin of Color Society's database is aimed at connecting patients with skincare specialists skilled in treating People of Color.
• American Academy of Dermatology Association's "Find a Dermatologist" tool. This search tool contains a database of dermatologists according to their specialized services.

Seborrheic dermatitis can affect your quality of life and self-esteem. Effective treatments for SD on the scalp can be tailored to the hairstyles and textures of Black and Brown women.

Over-the-counter and prescription shampoos and a roughly once-a-week washing schedule can help reduce the symptoms of SD.