Can seborrheic dermatitis cause hair loss?

Can Seborrheic Dermatitis Cause Hair Loss?

Yes, seborrheic dermatitis can cause hair loss, particularly when it's severe or poorly controlled, though this hair loss is typically temporary and reversible with proper treatment of the underlying condition. 1

Understanding Seborrheic Dermatitis and Its Relationship to Hair Loss

Seborrheic dermatitis is a common inflammatory skin condition that affects sebaceous gland-rich areas, including the scalp, face, ears, and other sebum-rich regions. The condition is characterized by:

• Greasy yellowish scaling
• Erythema (redness)
• Inflammation
• Itching

Mechanism of Hair Loss in Seborrheic Dermatitis

Hair loss associated with seborrheic dermatitis occurs through several mechanisms:

1. Inflammation: The inflammatory process can disrupt the normal hair growth cycle
2. Excessive scratching: Intense pruritus (itching) leads to mechanical damage
3. Scale buildup: Heavy scaling can physically block hair follicles
4. Altered sebum production: Changes in sebaceous gland function may affect hair follicle health

Clinical Presentation

Seborrheic dermatitis on the scalp typically presents with:

• Greasy, yellowish scales that may adhere to the scalp and hair shafts
• Erythema of varying intensity
• Pruritus (itching) that may be severe
• In darker-skinned individuals, hypopigmented patches may be more prominent than erythema 2

When hair loss occurs, it is usually:

• Diffuse rather than patchy
• Temporary and reversible with proper treatment
• Not associated with scarring (non-cicatricial)

Differential Diagnosis

It's important to distinguish seborrheic dermatitis from other scalp conditions that can cause hair loss:

• Psoriasis: Features sharply demarcated plaques with silvery scales, often extending beyond the hairline 3
• Tinea capitis: Fungal infection with broken hairs and possible kerion formation
• Alopecia areata: Presents with well-defined patches of complete hair loss without scaling
• Discoid lupus erythematosus: Causes scarring alopecia with erythema, scaling, and atrophy
• Trichotillomania: Characterized by broken hairs of different lengths due to pulling

Treatment Approach for Hair Loss Associated with Seborrheic Dermatitis

First-Line Treatment: Control Underlying Seborrheic Dermatitis

1. Antifungal therapy to reduce Malassezia yeast:

   • Ketoconazole shampoo (2%) used 2-3 times weekly 4
   • Ciclopirox shampoo as an alternative
   • Selenium sulfide shampoos

2. Anti-inflammatory agents (for short-term use only):

   • Low-potency topical corticosteroids (e.g., hydrocortisone 1%)
   • Caution: Avoid prolonged use of potent corticosteroids as they may potentially worsen hair loss over time 1

3. Calcineurin inhibitors for steroid-sparing treatment:

   • Tacrolimus 0.1% ointment
   • Pimecrolimus 1% cream

For Persistent Hair Loss Despite Controlled Seborrheic Dermatitis

For patients with significant hair loss despite good control of seborrheic dermatitis:

• Intralesional corticosteroid injections with triamcinolone acetonide (5-10 mg/mL) can be considered for limited patches of hair loss 1

  • Inject 0.05-0.1 mL per site
  • Produces regrowth in approximately 0.5 cm diameter areas

• Topical minoxidil may be considered for more extensive hair loss, though evidence in the specific context of seborrheic dermatitis is limited 1

Maintenance Therapy

To prevent recurrence and ongoing hair loss:

• Regular use of antifungal shampoos (1-2 times weekly)
• Gentle cleansing with pH-neutral formulations
• Avoid irritating hair products
• Consider lifestyle modifications to reduce stress and other triggers

Special Considerations

• HIV infection: Seborrheic dermatitis can be more severe and resistant to treatment in HIV-positive individuals 5
• Parkinson's disease: Patients may have more extensive disease requiring aggressive management 5
• Skin of color: Presentation may differ with hypopigmented patches rather than obvious erythema; treatment approach should consider hair texture and washing frequency 2

When to Refer to a Specialist

Consider dermatology referral if:

• Hair loss persists despite adequate treatment of seborrheic dermatitis
• The diagnosis is uncertain
• There is scarring or permanent hair loss
• The condition is severe or unresponsive to first-line treatments

Remember that while seborrheic dermatitis can cause hair loss, proper treatment typically leads to complete hair regrowth once the inflammatory condition is controlled.