How to Tell the Difference Between Nummular Eczema and Ringworm
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Published On: Nov 30, 2022
Last Updated On: Mar 8, 2024
Scalp eczema comes with unique problems like highly visible dandruff, scaly patches of skin and even hair loss. Treating it can also be tricky, since it’s difficult to moisturize or apply ointment underneath the hair.
But people grappling with a scalp eczema flare don’t have to suffer. In our Ask the Ecz-perts series, Dr. Vivian Shi, dermatologist and associate professor at the University of Arkansas for Medical Sciences, discussed scalp eczema and shared some ways to treat it.
Scalp eczema is not always easy to diagnose. Itching or inflammation on the scalp could be related to eczema or other problems, such as psoriasis, lice or even nerve issues.
Even when eczema is to blame, it’s important to determine the specific type. Scalp eczema is an umbrella term that typically includes three different kinds of eczema. Dr. Shi explained that atopic, contact and seborrheic dermatitis can all affect the scalp.
But that’s not all. “People with eczema can have more than one scalp condition happening simultaneously,” said Dr. Shi.
If you suspect you have scalp eczema, be sure to book an appointment with a dermatologist before trying any remedies. Starting with a diagnosis can save you time, money and frustration.
Since there are several types of scalp eczema, there are no one-size-fits-all solutions. The recommended treatment will depend on the type of eczema you have.
Atopic dermatitis (AD) is characterized by rashes, sore skin and itching. Topical medications, injections and systemic medications may be recommended for AD on the scalp.
“The hair can make applying topical medication to your scalp difficult, so we try to use a medicated oil or solution dropper form of the medication,” said Dr. Shi. “A shower cap can be used after applying the medication to maximize the penetration of the medication products into your scalp’s skin.”
Dr. Shi explained that intralesional steroid injections may be used when people have isolated patches of eczema. This involves injecting a medication directly into the affected areas.
“If topical and intralesional options do not work for you, systemic medications may be the next step to treat your scalp eczema,” said Dr. Shi. Systemic medications treat the whole body rather than focusing on the area that’s flaring.
Contact dermatitis occurs when the skin comes into contact with an irritant or allergen in the environment. Symptoms include itchy, crusty, scaling skin and blisters. The first step towards treating contact dermatitis is determining the cause of the flare.
“Patch testing is a way to determine what common ingredients you may be allergic to,” said Dr. Shi. “The ingredients are applied onto your skin and monitored by a dermatologist for any reactions.”
Irritants can be easier to identify since they often sting or hurt when applied.
If you have contact dermatitis on your scalp, you may need to switch your shampoo, conditioner or other hair care products to more eczema-friendly options. A doctor may also prescribe a topical, oral or injectable steroid to calm the flare.
Seborrheic dermatitis often appears on the scalp. Symptoms include dandruff, flaky white or yellow skin scales, rash and itching. Topical, systemic and antifungal medications may be prescribed.
A doctor may also recommend an over-the-counter or prescription shampoo. However, it is important to note that some common therapies for seborrheic dermatitis on the scalp can be problematic for African American people due to dry or delicate hair.1 Over-the-counter shampoos and ketoconazole shampoo may be used but with caution — it should only be applied directly to the scalp and not the hair shaft. These shampoos may be too drying for Black hair and can cause it to break, especially if it has been chemically treated.1 Hair texture should be considered as part of the treatment discussion. One study found that Black study participants preferred antifungal ointment while Caucasian participants preferred antifungal foams, gels and sprays.1
Before trying anything new, make sure you have visited a dermatologist and understand the cause of your symptoms. If you have contact dermatitis, read labels carefully to avoid your triggers.
Many people with eczema benefit from personal care products free of fragrances and other problematic chemical ingredients. For a list of hair care options vetted by dermatologists, try the Seal of Acceptance™ Product Directory.
“Eczema is a relapsing, remitting chronic condition, so the key is to not only treat during a flare, but also proactively take preventative measures to make flares shorter in time and go longer between flares,” said Dr. Shi. “Even on your scalp, you could preventatively moisturize the affected area to protect the skin barrier and prevent flares from occurring just as you would on other parts of the body.”
Relieving eczema flares can be an ongoing process, but the more information you have about your condition and what works for you, the better you will be able to manage it.
To find out more about scalp eczema, watch Dr. Shi’s video below.
Reference
1. Elgash M, Dlova N, Ogunleye T, Taylor SC. Seborrheic dermatitis in skin of color: clinical considerations. J Drugs Dermatol. 2019;18(1):24-27.
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