Dandruff is a common scalp problem that affects almost half of all adults [1]. It is more frequently encountered in men than women and younger people are more exposed to it than older ones [2]. In this condition, small pieces of dry skin flake off your scalp and may land on your shoulders.
Dandruff may be the reason your scalp itches a day after washing, but can it also cause hair loss? In this article, we’ll explore:
Dandruff is considered the mildest form of seborrheic dermatitis [3], an itchy, inflammatory skin condition that affects oily body areas (e.g. face, scalp, beard area, armpits, and chest) [4]. However, dandruff only affects the scalp and causes itchy, flaky skin with no visible inflammation.
In general, dandruff itself doesn’t directly cause hair loss. However, the underlying condition causing it may also be the reason your hair is falling out. Poor scalp health associated with dandruff and seborrheic dermatitis may cause premature hair loss in some cases [5]. If you have severe scalp itchiness, you may scratch it hard enough to damage hair follicles, which could cause some hair breakage [6] but not complete baldness.
One study investigated the link between dandruff and hair loss. Over two days, unaffected scalps lost 50-100 hairs, while people with dandruff lost 100-300 [1]. This may be due to microscopic levels of inflammation found on the scalps of people with this condition [7]. However, there was no clear link between dandruff severity and the amount of hair loss [1].
Research suggests that dandruff may worsen certain hair loss conditions [1]. For example, it may exacerbate androgenetic alopecia, also known as male or female pattern baldness [1].
There are many reasons you may have dandruff on your scalp. These include:
Treating dandruff may improve scalp health and resolve symptoms like itching and skin flaking. It will not necessarily resolve your hair loss, but it may do in cases where both conditions have the same underlying cause.
There are overlaps between dandruff treatments and hair loss treatments. Here, we’ll explore some common treatments for dandruff and which of these may also help reduce hair shedding.
The most common dandruff treatment is the use of anti-dandruff shampoo, containing antifungal ingredients such as zinc pyrithione (ZPT) and octopirox [11]. Most of these shampoos effectively resolve dandruff symptoms but can often worsen your hair condition [11].
These anti-dandruff formulations can also come as creams or lotions containing similar active ingredients [12]. A well-known anti-dandruff shampoo called Nizoral can also treat hair loss. If you’re also experiencing hair shedding, you may benefit from special shampoos for hair loss, too.
One study investigated anti-dandruff shampoos containing either 1% ketoconazole, 1% piroctone olamine, or 1% zinc pyrithione. Men with pattern baldness, telogen effluvium and dandruff used these shampoos 2-3 times per week for six months. Results showed that all three types of shampoo cleared dandruff and reduced hair shedding by the end of treatment [13].
Contrary to popular belief, washing your hair every day will not make it fall out. In fact, regular hair cleansing is great for your scalp health, and less frequent shampoo washing is associated with an increased risk of dandruff [14].
Image Source: https://karger.com/view-large/figure/11355860/000512786_F03.jpg [15]
This graph shows the relationship between wash frequency and dandruff, itch, and dryness. As you can see, these symptoms are more common with infrequent washing, which shows that washing your hair daily can protect you from dandruff [15].
Specific chemical hair treatments have a high risk of side effects and can cause dandruff. One example is chemical hair relaxers, often used by people with curly type 3 hair or coily hair to achieve smooth, straight locks.
A 2013 study investigated the effects of chemical hair relaxers on 90 women in India. 95.56% of women experienced side effects after the procedure, including dandruff in 61% and hair loss in 47% [16]. This suggests that avoiding these chemicals may protect against dandruff and hair loss.
Emotional stress may aggravate the symptoms of dandruff [17]. Acute or chronic stress can also cause hair loss, specifically telogen effluvium [18] and aggravate hair loss conditions such as androgenetic alopecia or alopecia areata [18].
Fortunately, it’s possible to regain hair loss from stress. If you’re going through a challenging time, consider stress-relieving strategies to reduce hair loss and prevent dandruff.
Aggressive scratching of an itchy scalp could cause some hair loss, but it is not the most common cause. Here are some of the conditions that may be causing your hair to fall out:
Also known as female or male pattern baldness, this condition causes a distinct pattern of hair loss depending on gender. It affects up to 80% of men and 50% of women at some point in their life [19]. Androgenetic alopecia has a strong genetic component – men are 5 to 6 times more at risk if their fathers experience balding [20]. However, you will not necessarily go bald if your dad is bald.
Men often develop an M-shaped hairline and a bald spot on the crown, which can eventually progress to complete baldness. Women normally experience diffuse thinning and a gradually widening hair parting on top of their heads.
In telogen effluvium, an excessive proportion of your many hair follicles suddenly enter the telogen (resting) phase of the hair growth cycle. This can cause diffuse hair shedding across the scalp but does not usually cause complete baldness [21]. Most healthy people lose up to 100 hairs daily, but people with this condition may lose up to 300 [21].
A triggering event usually causes telogen effluvium. This includes both physical and psychological causes, such as childbirth or pregnancy, severe infections, psychological stress, major surgery, or discontinuing the use of birth control pills [21].
This is an autoimmune condition in which the immune system attacks the hair follicles, causing hair loss [22]. In alopecia areata, this usually causes partial hair loss on the scalp. More severe forms include alopecia totalis, which describes the complete loss of scalp hair, and alopecia universalis, which describes a total loss of scalp and body hair [23].
Traction alopecia is hair loss caused by excessively tight hairstyles worn for prolonged periods. At-risk hairstyles include frequently worn tight ponytails, buns, weaves, or hair extensions, and tight braids such as cornrows, dreadlocks or hair extensions can cause hair loss [24].
The risk of this condition increases with the extent and duration of pulling on the hair and the use of chemical relaxers [24]. In the later stages of traction alopecia, irreversible scarring alopecia may develop if tight hairstyling continues without intervention [24].
Many other types of alopecia result in temporary or permanent hair loss. These include chemotherapy-induced hair loss, ophiasis alopecia, yeast infections of the scalp, fungal infections such as lichen planopilaris, and trichotillomania.
If home treatment methods don’t work, book a consultation with a trichologist at a hair clinic near you. As specialists in scalp and hair health, these hair doctors will be able to diagnose the cause of your dandruff and hair loss.
They will examine your scalp for signs of the conditions that cause dandruff and evaluate the health of your locks using hair loss diagnosis tests, such as the hair pull test and blood tests for hair loss. They will then recommend the best hair loss products and treatments to resolve your symptoms.
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