Is my scalp hair loss and scaling from eczema or psoriasis?

Question

Hello doctor,

I am a 40-year-old female with long-standing eczema. Recently, the scalp patches have been very itchy, with thick crusts and mild hair fall. I am confused whether this is eczema or psoriasis. There is dandruff-like scaling and redness behind the ears.

How can we confirm the exact diagnosis?
Are medicated shampoos enough, or do I need oral medication?
Can frequent hair washing worsen the condition permanently?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

If your scalp is itchy, with thick scaling or crusting, and you notice redness behind your ears, you might wonder if it is eczema or psoriasis, because both conditions can look quite similar. It often takes a careful look to tell them apart.

Scalp eczema (which includes atopic or seborrheic dermatitis) often brings on intense itching, greasy or flaky dandruff-like scales, and redness behind the ears or along the hairline. During flare-ups, you might see some oozing or crusting, and sometimes hair can fall out temporarily from inflammation or scratching.

Scalp psoriasis, on the other hand, usually means thick, dry, silvery-white scales and distinct patches (plaques) that can even extend past the hairline. The crusts tend to be thicker, with less oozing, and you might notice psoriasis in other places, too, like your elbows, knees, or nails.

A dermatologist can usually figure out what is going on just by looking at your scalp. If things are not clear, they might use a special tool called a dermatoscope, but a skin biopsy is rarely needed. If there is a lot of crusting, your doctor might also check for a scalp fungus (like ringworm).

For mild cases, medicated shampoos are often all you need. If there is a seborrheic (greasy) component, shampoos with Ketoconazole or Ciclopirox can help. For thick scales, coal tar or salicylic acid shampoos are good choices. If you are still dealing with itching, crusting, or hair loss, your doctor might recommend topical anti-inflammatory treatments like steroid lotions or foams, or non-steroid options. Pills are only needed in severe or stubborn cases.

Washing your hair often will not make things permanently worse, but harsh shampoos or hot water can dry out and irritate your scalp. Stick to gentle shampoos, use lukewarm water, and do not scrub too hard to help reduce inflammation and scaling.

Here are a few general scalp care tips for you:

Follow the directions on your medicated shampoo.
Try not to scratch or pick at crusts.
Keep your nails short.
Steer clear of hair products with fragrance or alcohol.
And remember that stress can sometimes trigger flare-ups.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.