Can Seborrheic Dermatitis Cause Hair Loss?

• Causes of Seborrheic Dermatitis
• Conventional Treatments for Seborrheic Dermatitis
• Natural Treatment Options for Scaly Scalp Conditions

Seborrheic dermatitis is a common chronic inflammatory scaling eczema rash of the scalp. Although it is an inflammatory skin rash, seborrheic dermatitis overlaps with non-inflammatory dandruff. The appearance can range from greyish white scales throughout the scalp as seen in dandruff to yellow to reddish thick crusty patches. In severe cases it can directly cause hair loss on the scalp. In cases where the rash is itchy, scratching can cause hair loss or make it worse.^{(21, 22, 74, 76)}

Symptoms and microscopic indicators of seborrheic dermatitis are also very similar to other skin conditions, including:^(22, 76)

• Contact dermatitis
• Pityriasis amiantacea
• Psoriasis
• Tinea capitis

Initial diagnosis can be difficult between all these conditions—although psoriasis is typically more inflammatory and likely to extend beyond the scalp hairline. However, evidence suggests that seborrheic dermatitis may be a pre-psoriatic condition in some people.^(22, 76)

Causes of Seborrheic Dermatitis

In both dandruff and seborrheic dermatitis, the presence of Malassezia furfur yeasts are present on the scalp, but the relationship to the yeasts is not clear since people without the disorders also have these yeasts present. Nevertheless, when either one is treated with antifungal agents the yeast is reduced and symptoms subside, and when the yeast recolonizes the symptoms recur.^(22, 76)

Other conditions that seborrheic dermatitis is either a symptom of or triggered by include:^(22, 76)

• Facial paralysis
• HIV and AIDS
• Niacin deficiency
• Parkinson's disease
• Seasonal flare-ups similar to seasonal allergies
• Stress
• UV-radiation aggravated dermatitis with evidence of micro-inflammation
• Zinc deficiency

These suggest that a poor diet and suppressed immune system status either cause or contribute to the development of seborrheic dermatitis. Many are also associated with telogen effluvium and even scarring alopecia.^(59, 76)

In addition, topical minoxidil (used as a hair loss treatment) can make seborrheic dermatitis worse. Elderly people can also be at greater risk for developing the rash due to infrequent shampooing. However, although external factors can aggravate seborrheic dermatitis, it is considered to be an endogenous eczema caused by internal factors, including genetics.^(13, 21)

Conventional Treatments for Seborrheic Dermatitis

Traditional medical therapies to manage symptoms include:

• Itraconazole 100—systemic compound for less-severe cases⁽⁷⁶⁾
• Ketoconazole—a synthetic antifungal used in topical creams or shampoos; available in over-the-counter strengths and 2% concentration by prescription⁽⁷⁶⁾
• Pimecrolimus (1%) cream⁽⁷⁶⁾
• Salicylic acid ointment⁽²²⁾
• Selenium sulfide, pyrithione zinc, and tar shampoos⁽⁷⁶⁾
• Sodium sulfacetamide topical ointment—inhibits bacterial growth⁽⁷⁶⁾
• Steroidal creams (such as 1-2.5% hydrocortisone) for more severe cases⁽⁷⁶⁾
• Sulfur precipitate (3%) combined with 2% salicylic acid (prescription; topically applied)⁽⁷⁶⁾
• Systemic 13- cis retinoic acid (1-mg/kg dosages) in severe cases⁽⁷⁶⁾

• Tacrolimus (0.03%) ointment⁽⁷⁶⁾
• Tar ointment⁽²²⁾

Tar and salicylic acid ointments are left on for a few hours. After washing, scales can be gently scraped out with a metal comb. Most treatments will need to be repeated because of flare-ups.⁽²²⁾

Natural Treatment Options for Scaly Scalp Conditions

Topical and oral supplements of certain vitamins may help treat seborrheic dermatitis. Herbal remedies for seborrheic dermatitis include essential oils proven effective (in varying degrees) as both antifungal and antibacterial topical agents.

Typically, hair regrows once the scaly rash is treated, although occasionally scarring. However, permanent hair loss has been reported (usually associated with pityriasis amiantacea).⁽²²⁾