Approximately 20% of patients seeking medical care for a skin condition are believed to be experiencing a form of eczema [1]. This inflammatory condition can cause rashes, dryness, itching, and discomfort on several parts of your body, including your scalp. But can scalp eczema cause hair loss?
Fortunately, research shows that it is unlikely for your scalp eczema to lead to hair thinning [2]. While it can rarely happen, it is usually the result of severe skin inflammation and forceful scratching which leads to hair breakage at the affected site. If this happens to you, you can expect new hair growth once your eczema improves. Keep reading to learn more about the relationship between this condition and your scalp and hair health, such as:
Eczema is a chronic skin condition that manifests with inflammation, redness, dryness, itching, and in some cases, oozing or fluid-filled blisters on the affected site. It is normally diagnosed in childhood and frequently continues into adulthood, and its progression is often unpredictable [3]. It can range from mild, barely noticeable forms to severe manifestations that require medical treatment. This condition can occur anywhere on your body, including your head – when that happens, it is called scalp eczema.
There are several kinds of scalp eczema: some genetic, some fungal, and some triggered by contact with irritant substances. This condition is recurrent, meaning that once you have it, its symptoms can be treated, but it will often flare up again at a later point [1].
Scalp eczema does not normally cause hair loss [2][4]. However, severe forms can produce significant enough scalp inflammation to affect your hair in several ways [5][6]:
If you suspect your eczema is causing your hair loss, it is best to see a dermatologist or a trichologist. They can check if you have a type of alopecia alongside your dermatitis.
It’s quite unlikely that eczema is causing your hair loss. But if this is the case, your hair should start to regrow once the condition has been successfully treated or resolved spontaneously. However, your scalp eczema may flare up again at a later date. It can usually be triggered by factors such as [1][8]:
If you have a more severe type of scalp eczema, where the skin cracks and bleeds, seek medical treatment and keep the area clean. When the skin barrier is damaged and you have open wounds, it is easy for bacteria to get inside, causing an infection. Left untreated, infections can advance, causing health problems and even scarring alopecia. If this happens, a hair transplant into scar tissue may be your only chance of restoring hair growth in the affected area.
A complex combination of factors can cause the different types of eczema. The three common forms of this condition that can affect the scalp are as follows:
This yeast infection of the scalp affects approximately 3-5% of the worldwide population. It can involve several parts of the body, but it affects the scalp in 70% of cases [8]. It often appears in babies, with 42% of newborns affected. This is known as cradle cap [9].
Prevalence increases again at puberty, as hormonal changes lead to increased sebum production on the scalp. The final peak is between ages 40-60, when further hormonal fluctuations normally occur. Seborrheic dermatitis can flare up frequently and its symptoms can be treated, but it cannot be permanently cured [10].
Causes: Seborrheic dermatitis is caused by a fungal infection known as Malassezia furfur [11]. This fungus normally lives on the skin and scalp, but sometimes overgrows, leading to skin conditions. It feeds on the natural oil (sebum) secreted by your scalp, making it dry and causing inflammation.
Symptoms: Yellow greasy scales or plaques, inflammation, redness, itchiness and tenderness of the scalp. In some cases, you may have scalp lesions or a weeping rash [11]. Seborrheic dermatitis doesn’t normally cause hair loss, however, it may do so if you have a severe form with intense inflammation and you scratch your scalp vigorously, causing hair breakage.
This form of eczema affects 15-30% of children and 10% of adults worldwide. It often starts in childhood and may continue into maturity, or its symptoms may gradually improve.
There is a strong genetic component to atopic eczema. It is linked with the development of two other health problems: approximately 30% of children who experience atopic dermatitis develop asthma and 35% develop allergic rhinitis (hayfever) [12]. That doesn’t mean it is causing these conditions, but you may be more likely to develop eczema if you have asthma and/or hayfever and vice versa.
Causes: Atopic dermatitis is mostly genetically inherited, but certain environmental factors, such as exposure to irritants and allergens, can also contribute [12]. Flare-ups can be triggered by various factors, such as cold weather, hormonal changes, exposure to irritants or a temporary weakening of the immune system.
Symptoms: Thickened, inflamed, red, dry and itchy skin patches that can flake, crack and bleed. In some cases, small, fluid-filled blisters can form or a weeping rash may develop.
Contact dermatitis occurs when your skin is exposed to a substance you are allergic to. It occurs in almost 20% of the European population [13]. On the scalp, contact dermatitis is often a reaction to an ingredient of a hair product, the metal part of a hair accessory (e.g. nickel), or the fabric of a hat or scarf.
While most allergic reactions are mild, severe ones can cause anaphylaxis which is life-threatening. Be sure to contact emergency services immediately if you are feeling very ill or having trouble breathing alongside other symptoms of contact dermatitis.
Causes: There is a genetic component to allergic dermatitis, but it is also influenced by environmental factors, such as repeated exposure to certain irritants. People who experience atopic dermatitis are also more likely to develop allergic eczema, as it’s easier for allergens to penetrate the damaged skin barrier [13].
Symptoms: Scalp inflammation, redness and swelling, accompanied by itching, burning and tenderness. In some cases, a rash or blistering, oozing sores may also develop [13]. Severe forms can cause breathing difficulties and chest tightness (these symptoms require emergency medical attention).
Hair loss caused by scalp eczema usually resolves on its own once this condition has been treated and the flare-up has ended. Mild cases will often resolve on their own over time. However, more severe or persistent flare-ups that cause hair loss may require medication. Here are the most common treatments for the main kinds of scalp eczema.
The first thing you can try is to treat seborrheic dermatitis at home using a medicated shampoo containing ketoconazole (e.g. Nizoral shampoo for hair loss), selenium sulphide, salicylic acid, coal tar, tea tree oil for hair or zinc pyrithione [11] [14]. If that does not work, your dermatologist may prescribe anti-inflammatory medication, such as steroid creams or calcineurin inhibitors [11]. They may also recommend oral antifungal medication.
The first line of treatment for mild atopic eczema includes emollients (lotions that soften the skin) and topical steroids to reduce scalp inflammation. More severe forms may require medication to reduce immune system reactivity, such as calcineurin inhibitors.
Your healthcare provider may also recommend oral antihistamines to reduce scalp itchiness and/or oral antibiotics to prevent secondary infections in the affected areas [12][14]. If you have atopic dermatitis, it is important to determine whether you have any allergies and protect yourself from potential triggers. These may include known allergens and irritants, respiratory infections, stressful periods, cold weather, and shampoo with harsh chemicals.
The best way to prevent allergic dermatitis of the scalp is to be aware of your sensitivities and check the ingredient list of the hair products you use. However, once eczema has developed, you need to clean the exposed area of the scalp well using warm water and a gentle shampoo.
Taking an oral antihistamine can reduce scalp itchiness, while an emollient cream can help prevent dryness. If the allergic reaction persists, you may need to use steroid creams to help it subside [13][14].
While very rare, severe allergies can be life-threatening. So if you notice severe scalp and face swelling, chest tightness or difficulty breathing, contact emergency services immediately, as you may need to receive injectable adrenaline, oxygen and/or other hospital-grade medication to support breathing [15].
Several common scalp problems can be mistaken for scalp eczema, which is why it is a good idea to see a dermatologist or a trichologist when you experience persistent symptoms. Here are some of the most common conditions that have symptoms resembling those of eczema.
Dandruff can be caused by the same fungus as seborrheic dermatitis, but it can also be a result of other conditions, such as a dry scalp. Seborrheic dermatitis can also affect other parts of your body (face, trunk, armpits), while dandruff only affects the scalp. Finally, dandruff is not accompanied by scalp inflammation [16].
Symptoms: fine, dry, white or grey flakes on the scalp, mild itching.
This autoimmune condition can easily be mistaken for eczema due to a very similar presentation. However, scalp psoriasis is usually diagnosed as an adult, while many types of eczema are diagnosed in childhood. Additionally, psoriasis plaques tend to have well-defined edges, while eczema is more diffuse [17].
Symptoms: Thickened, pink/red, inflamed patches of skin covered in white or silver flakes. Itchiness and tenderness in the affected scalp area, accompanied by localised hair loss.
This fungal infection often appears in children and it is highly contagious. While it can look similar to certain forms of eczema, ringworm is usually recognised by its tell-tale round shape.
Symptoms: Well-defined red round patches of skin with slightly raised edges, accompanied by itching and patchy hair loss in the affected area [18].
A common hair follicle infection, scalp folliculitis can resemble eczema, especially in mild forms. Its characteristic red bumps or pimples can be mistaken for a contact dermatitis rash. It can be fungal, bacterial or viral in nature and is normally accompanied by inflammation [19].
Symptoms – scalp redness and inflammation, small, red bumps or pimples around the base of the hair strands, itchiness, tenderness, sometimes yellow crusts or scabs on the affected area of the scalp.
If you are experiencing excessive hair shedding and are wondering if it is caused by eczema, it is best to get a professional diagnosis. That is because you could be missing the first signs of hair thinning and balding, which could lead to more advanced hair loss.
Book a consultation today with one of your experienced trichologists and find out for sure if your hair thinning is eczema-related. They can rule out a different scalp problem or alopecia.
Once the cause of your hair thinning has been determined, our hair doctors will provide you with the best, personalised treatment for your condition so you can enjoy fuller hair and a healthier scalp. Find your closest hair loss clinic locations for a convenient consultation.
If you would like to know more about scalp eczema and its relationship with hair loss, see the answers to these frequently asked questions.
Eczema can also develop on your face, trunk, limbs and other areas covered in hair, but this doesn’t normally lead to hair loss. However, in rare and severe cases, the resulting inflammation can lead to hair shedding, especially through excessive scratching that breaks your hair stands.
For example, if you are experiencing severe facial seborrheic dermatitis, and scratching the affected areas vigorously, it could be a cause of beard loss or of eyebrow hair loss [2].
No, you can rest assured that you can’t get scalp eczema simply by touching or sharing hair accessories with someone who has it [20]. However, be sure to clean any shared headgear or styling tools properly, as you can still get contagious bacterial infections.
No, it’s just a myth that poor personal hygiene such as not washing your hair frequently enough can cause scalp eczema. However, research shows that washing your hair frequently (5-6) times a week can reduce scalp dryness, dandruff and hair shedding. Moreover, not washing your hair enough may cause hair loss by allowing dirt and sebum to build up on your scalp [21].
This largely depends on the severity of your eczema and the impact of inflammation on your hair follicles. Normally, your hair should start growing back a few weeks after the eczema symptoms have resolved, but in more severe cases, it can take a few months.
If you had eczema-induced hair loss over 3-4 months ago and are still not seeing regrowth, it is best to see a trichologist, as you may need hair growth treatment.
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