Does Seborrheic Dermatitis Cause Hair Loss?

What is Seborrheic Dermatitis?

Seborrheic dermatitis is a condition that affects the skin and is a chronic form of eczema (also known as dandruff, seborrheic eczema, or seborrheic psoriasis). It is exasperated in areas of the body that have sebaceous (oil-producing) glands. These areas include the scalp, face, ears, eyelids, eyebrows, nose, chest, upper back, armpits, and under the breasts and groin area. 

The disease affects a variety of ages and ethnicities, but tends to peak in three age groups: within the first three months of being born, during puberty, and in adulthood (40 to 60 years of age). During infancy, research shows that children have a 42% chance of contracting the condition, and adults have a 1–3% risk.1 People assigned male at birth (AMAB) are more likely to be affected than people assigned female at birth (AFAB) (3.0% vs. 2.6%, respectively).1

Symptoms

In infants, seborrheic dermatitis presents itself as a form called cradle cap. It develops on the face or scalp with flaky, scaly, greasy patches. They can appear as white or yellow scales (on fairer skin tones) or pink with white or grey scales (on darker skin tones).2 It also affects the nappy area and is often mistaken for a nappy rash. This is often a harmless, non-contagious skin condition that clears by itself within 6 to 12 months.2 

Parents should visit a GP when treatments do not improve the condition, such as when:

  • The scales spread all over the body.
  • They bleed or leak fluid and are swollen. 
  • In teens and adults, the symptoms persist as flaky, scaly and greasy patches (yellow or white) or red, crusty and itchy skin. They appear as stubborn dandruff in areas that have hair.

Causes

The exact cause of seborrheic dermatitis has yet to be understood. However, there are risk factors that make you more susceptible to it. These risk factors include:

Fungal Colonisation 

Malassezia is a type of yeast that is found in regions of the body that have oil-producing glands. Studies have shown that there is a direct link between the excessive growth of Malassezia and the severity of seborrheic dermatitis.3 The fungus has the ability to break down the oils produced by glands to release acid and fats. The excessive accumulation of acids and fats can irritate the skin, cause abnormal growth of skin cells and deposit fat inside the cells.4 These events further trigger an inflammatory reaction that causes the skin to break down and eventually die. It is additionally suggested that environmental factors influence this excessive growth of Malassezia, and the fungus would not cause any damage if it grew at a controlled rate on the skin.5

Sebaceous Gland Activity

The skin’s oil production plays a vital role in the prognosis of seborrheic dermatitis. Oil production peaks at birth due to the mother’s pre- and post-birth hormonal influence on the baby.6 At puberty, circulating sex hormones (androgens) have a similar effect.7 Oil production progressively stabilises between twenty to thirty years of age. However, for people AMAB, the rate of production is higher between 30 to 60 years of age; whereas, in people AFAB, production drops after menopause. The pattern of hormonal activity and its effect on oil production can contribute to the disease. Moreover, the composition of these oils (particularly oils that are high in cholesterol) can be favourable to fungal growth.8

Individual Susceptibility

Genetic and environmental factors can affect a person’s susceptibility to seborrheic dermatitis. These factors include the integrity of the skin barrier, immunity, neurogenic factors, emotional stress, and other factors.

The integrity of Skin Barrier

The skin is an intricate organ made up of cells that are mosaiced between fat and protein structures. It plays an important role in preventing water loss and protecting against harmful bacteria that enter the body. Any predisposed genetic condition of the skin (e.g. psoriasis, acne, rosacea) or environmental irritants (such as harsh alcohol-based creams, soaps, chemicals, solvents, or detergents) that deteriorate the integrity of the skin’s barrier can be a contributing risk factor for seborrheic dermatitis.9

Immunity

A weakened immune system (for example, from organ transplant recipients, adult Hodgkin's lymphoma, adult non-Hodgkin's lymphoma, HIV/AIDS, alcoholic pancreatitis, and some cancers) can also increase an individual’s susceptibility to seborrheic dermatitis. Studies have suggested that the body’s inability to have an appropriate immune reaction to control fungal growth on the skin can be a causal factor for seborrheic dermatitis.10  

Neurogenic Factors and Emotional Stress

There is a high incidence of seborrheic dermatitis in patients who have neurological diseases (e.g. Parkinson’s, tardive dyskinesia, epilepsy), depressive disorders, and emotional stress. It is suggested that oil production on the skin is regulated by the brain in conjunction with hormones.11 Therefore, a loss of brain function or stress contributes to the disease. Similar implications are observed with individuals who have neurological damage (e.g. traumatic brain or spinal cord injury, facial nerve palsy).12 Neurological disorders further inhibit the ability to maintain good hygiene and can also be a contributing factor.

Other Factors

Other factors that cause seborrheic dermatitis include harsh weather, recovery from stressful medical conditions (down syndrome, heart attack), some medications (antipsychotics and other drugs), poor nutrition, sex hormone (androgen) imbalance, and zinc and vitamin B6 deficiencies.13

Diagnosis

The diagnosis of seborrheic dermatitis can be easily distinguished from other skin conditions due to their prominence in areas that are high in oil-producing glands. Doctors will diagnose it by visual examination and taking samples of scraped skin to rule out similar conditions such as:

  • Psoriasis: This disorder has a similar presentation, with dandruff and red skin covered with flakes and scales. However, these scales are silvery-white and distributed all over the body.
  • Atopic Dermatitis (Eczema): The skin is itchy and inflamed, often recurring. It is mostly present in the folds of the elbows, the back of the knees, and on the front of the neck.
  • Tinea Capitis: On the scalp, the disease causes hair loss patches. The rash appears on the abdomen but is usually not red.
  • Rosacea: This condition appears mainly on the face. It has very little scaliness and a lot of redness.1 

Treatment

The majority of the treatments for seborrheic dermatitis are often topical. These include:

Creams, Shampoos or Ointments that Control Inflammation 

Corticosteroids are drugs that are anti-inflammatory and anti-irritant. They should be used sparingly on the scalp or skin, as they can cause thinning and skin discolouration. Some of the prescribed hydrocortisone include fluocinolone (Capex, Synalar), clobetasol (Clobex, Cormax), and desonide (Desowen, Desonate). Some drugs such as tacrolimus (Protopic) and pimecrolimus (Elidel) can modulate the immune system to stop inflammation. These drugs are more effective than corticosteroids; however, they are not the first choice of treatment due to concerns that they can cause cancer.14

Antifungal Gels, Creams or Shampoos

These topical agents directly disrupt the growth of fungi responsible for seborrheic dermatitis. The main side effects of these drugs are redness, dryness, and itchiness of the scalp or skin. They include: ketoconazole, bifonazole, miconazole, ciclopirox olamine, selenium sulphide, and zinc pyrithione. Antifungals such as itraconazole and terbinafine can be taken orally. These are not the first choice of treatment because they can cause severe side effects.14 

Other Miscellaneous Treatments

These would include: coal tar (a shampoo that has antifungal properties), lithium gluconate/succinate and metronidazole (anti-inflammatory gels), and phototherapy (the use of light to modulate the immune system and stop the abnormal growth of skin cells).1

Can seborrheic dermatitis cause hair loss? 

Seborrheic dermatitis does not directly cause hair loss. If hair loss does occur, it is often because of itching of the scalp when it is flaky and scaly. Inflammation of the scalp can also affect the hair follicles by stopping them from physically pushing new hair through.15 This causes thinning, patchy hair loss, (alopecia areata) or temporary hair loss (telogen effluvium). 

How soon can I lose my hair if I have seborrheic dermatitis?

Hair loss with seborrheic dermatitis is not sudden. It happens gradually over time as the disease progresses (weeks to months). In infants, the disease can clear up within 6 to 12 months. In adolescence, the condition can last for the duration of puberty. In adults, the disease often recurs, so it is highly likely that there will be points in time, for up to many years, where it can flare up again.13

Will hair loss from seborrheic dermatitis grow back?

Hair loss from seborrheic dermatitis is not permanent. Typically, the hair will grow back once the individual has received treatments to manage the inflammation and stop the itching of the scalp.15 

How can I prevent losing my hair if I have seborrheic dermatitis?

The main way to prevent losing hair from seborrheic dermatitis is to use medication that stops dandruff and itching. These medications are usually antifungal or anti-inflammatory.

In infants, the key steps to treating the disease on the scalp are by using gentle baby shampoo daily, brushing away the scaly skin as it becomes softer, and applying topical seborrheic dermatitis medication to moisturise the scalp (usually available over the counter).15

In adults, seborrheic dermatitis can be managed with some of these key ingredients of shampoos: salicylic acid, ketoconazole, pyrithione zinc, sulphur, coal tar, and selenium sulphide.15 There are some natural treatments that can alleviate dandruff and the mild symptoms of seborrheic dermatitis; however, it is important to consult your doctor first. These include aloe vera gel, quassia Amara, solanum chrysotrichum, avocado oil, and tea tree oil.16 In some cases, hair transplants can be used as a treatment for extreme hair loss.

Should I wash my hair every day if I have seborrheic dermatitis?

You should wash your hair daily with your prescribed medicated shampoos (mentioned in treatments) until symptoms subside. Once symptoms have subsided, you can shampoo your hair once to three times a week as needed. Shampoos may seem to lose their effectiveness over time, so it is recommended to try to alternate between 2 or more types.14 It is further recommended that shampoos should be left on for the full treatment time as it allows the active ingredients to take effect. These shampoos may be rubbed gently on the face, ears, and chest and rinsed off completely.

Frequently Asked Questions (FAQs)

What happens if seborrheic dermatitis is left untreated?

If seborrheic dermatitis is left untreated, the scales can become thick, yellow, and greasy. This, in turn, can lead to itching that leaves the skin damaged or open and more prone to secondary bacterial/fungal infection.17 

How long does it take to get rid of seborrheic dermatitis on the scalp?

With the use of antifungal shampoos or creams, it can take up to 4 weeks for the symptoms to clear upon using these treatments daily.18

Is scalp seborrheic dermatitis curable?

No, seborrheic dermatitis is not curable. It can go away temporarily but can flare up again in the future due to its recurrent nature.13

What vitamin deficiency causes seborrheic dermatitis?

Seborrheic dermatitis can occur due to a lack of vitamin B6, biotin, and zinc. Vitamin B6 is a nutrient needed for healthy skin as it synthesises collagen, a protein that is the basal foundation.19 Vitamins such as biotin directly disrupt the pathogenic pathways by aiding in the breakdown of sebum, thereby curbing the disease. Biotin can also help in treating alopecia.20 Zinc plays an important role in regulating hormones and immunity. It also reduces inflammation (all of which contribute to seborrheic dermatitis).21 Studies have shown that dietary patterns play a role in the recurrence of seborrheic dermatitis, and thus it is advised to adopt a fruit-rich diet as opposed to a fat-rich diet.22 

Who is prone to getting seborrheic dermatitis?

Newborns and adults aged between 30 to 60 are more likely to get seborrheic dermatitis. However, certain risk factors increase the likelihood of contracting the disease. These include:

  • Pre-existing skin disorders
  • Immunological disorders
  • Neurological disorders
  • Emotional stress
  • Eating disorders
  • Stressful medical conditions

References

  1. Seborrheic dermatitis and dandruff: a comprehensive review. J ClinInvestig Dermatol [Internet]. 2015 [cited 2022 Jul 27];3(2). Available from: http://www.avensonline.org/fulltextarticles/JCID-2373-1044-03-0019.html
  2. Cradle cap [Internet]. nhs.uk. 2017 [cited 2022 Jul 27]. Available from: https://www.nhs.uk/conditions/cradle-cap/
  3. Gaitanis G, Magiatis P, Hantschke M, Bassukas ID, Velegraki A. The malassezia genus in skin and systemic diseases. Clin Microbiol Rev [Internet]. 2012 Jan [cited 2022 Jul 27];25(1):106–41. Available from: https://journals.asm.org/doi/10.1128/CMR.00021-11
  4. Plotkin LI, Squiquera L, Mathov I, Galimberti R, Leoni J. Characterization of the lipase activity of Malassezia furfur. Med Mycol [Internet]. 1996 Jan [cited 2022 Jul 27];34(1):43–8. Available from: https://academic.oup.com/mmy/article-lookup/doi/10.1080/02681219680000071
  5. Bukvić Mokos Z, Kralj M, Basta-Juzbašić A, Lakoš Jukić I. Seborrheic dermatitis: an update. Acta Dermatovenerol Croat. 2012;20(2):98–104.
  6. Zouboulis CC, Akamatsu H, Stephanek K, Orfanos CE. Androgens affect the activity of human sebocytes in culture in a manner dependent on the localization of the sebaceous glands and their effect is antagonized by spironolactone. Skin Pharmacol Physiol [Internet]. 1994 [cited 2022 Jul 27];7(1–2):33–40. Available from: https://www.karger.com/Article/FullText/211271
  7. Niemann C, Horsley V. Development and homeostasis of the sebaceous gland. Seminars in Cell & Developmental Biology [Internet]. 2012 Oct [cited 2022 Jul 27];23(8):928–36. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1084952112001516
  8. Ro BI, Dawson TL. The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff. Journal of Investigative Dermatology Symposium Proceedings [Internet]. 2005 Dec [cited 2022 Jul 27];10(3):194–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15525864
  9. Turner GA, Hoptroff M, Harding CR. Stratum corneum dysfunction in dandruff. International Journal of Cosmetic Science [Internet]. 2012 Aug [cited 2022 Jul 27];34(4):298–306. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-2494.2012.00723.
  10. Adalsteinsson JA, Kaushik S, Muzumdar S, Guttman‐Yassky E, Ungar J. An update on the microbiology, immunology and genetics of seborrheic dermatitis. Exp Dermatol [Internet]. 2020 May [cited 2022 Jul 27];29(5):481–9. Available from: https://onlinelibrary.wiley.com/doi/10.1111/exd.14091
  11. Burton JL, Shuster S. Effect of l-dopa on seborrhœa of parkinsonism. The Lancet [Internet]. 1970 Jul [cited 2022 Jul 27];296(7662):19–20. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673670924761
  12. Wilson CL, Walshe M. (12) Incidence of seborrhoeic dermatitis in spinal injury patients. Br J Dermatol [Internet]. 1988 Jul [cited 2022 Jul 27];119(s33):48–48. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.1988.tb05386.
  13. Seborrheic dermatitis: what is it, diagnosis & treatment [Internet]. Cleveland Clinic. [cited 2022 Jul 27]. Available from: https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis
  14. Seborrheic dermatitis - diagnosis and treatment - mayo clinic [Internet]. [cited 2022 Jul 27]. Available from: https://www.mayoclinic.org/diseases-conditions/seborrheic-dermatitis/diagnosis-treatment/drc-20352714
  15. Seborrheic dermatitis hair loss: Causes and treatment [Internet]. 2019 [cited 2022 Jul 27]. Available from: https://www.medicalnewstoday.com/articles/327257
  16. Seborrheic dermatitis - whole health library [Internet]. [cited 2022 Jul 27]. Available from: https://www.va.gov/WHOLEHEALTHLIBRARY/tools/seborrheic-dermatitis.asp#ref-3
  17. Scaly skin patches may be seborrheic dermatitis [Internet]. Verywell Health. [cited 2022 Jul 27]. Available from: https://www.verywellhealth.com/seborrheic-dermatitis-symptoms-4769659
  18. Seborrheic dermatitis: symptoms and treatments | bupa uk [Internet]. [cited 2022 Jul 27]. Available from: https://www.bupa.co.uk/health-information/healthy-skin/seborrhoeic-dermatitis
  19. [cited 2022 Jul 27]. Available from: https://academic.oup.com/HTTPHandlers/Sigma/LoginHandler.ashx?error=login_required&state=a78aad40-7df9-4fde-b124-9d9474f664c6redirecturl%3Dhttpszazjzjacademiczwoupzwcomzjnutritionreviewszjarticlezylookupzjdoizj10zw1111zjjzw1753zy4887zw1952zwtb01034zwx
  20. Saleem F, Soos MP. Biotin deficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 27]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK547751/
  21. AKTAŞ KARABAY E, AKSU ÇERMAN A. Serum zinc levels in seborrheic dermatitis: a case-control study. Turk J Med Sci [Internet]. 2019 Oct 24 [cited 2022 Jul 27];49(5):1503–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018314/
  22. Sanders MGH, Pardo LM, Ginger RS, Kiefte-de Jong JC, Nijsten T. Association between diet and seborrheic dermatitis: a cross-sectional study. Journal of Investigative Dermatology [Internet]. 2019 Jan [cited 2022 Jul 27];139(1):108–14. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X18324801
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Jade Roberts

Master of Research - (MRes), Biomedical Sciences, Imperial College London
Jade is currently a PhD student at the University of Reading. Her research focuses on how cells can mechanically and electrically interact in response to mechanical movements. Her specialties are cardiovascular biology, electrophysiology, and biomedical engineering.

Leave a Reply

Your email address will not be published. Required fields are marked *

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818