How to Prevent Dandruff-Related Hair Loss

Scalp health problems associated with conditions such as dandruff and seborrheic dermatitis may lead to hair shedding.

Dandruff is a common inflammatory condition that causes white to yellowish flaky scales on the scalp. On average, 50% of the population will get dandruff. The incidence of dandruff decreases with age.

The scalp contains many species of microbes, including a naturally occurring yeast called Malassezia. An imbalance of Malassezia can lead to conditions such as seborrheic dermatitis and dandruff (which is considered a milder form of seborrheic dermatitis).

This article will discuss the link between dandruff and hair loss, how to stop hair loss related to dandruff, how to regrow hair where dandruff was, and how to tell if dandruff and hair loss are not improving.

Dandruff, Dry Scalp, and Hair Loss: An Indirect Relationship

Dandruff is a milder form of seborrheic dermatitis.

Seborrheic dermatitis, also called seborrheic eczema, is a chronic, inflammatory skin condition primarily affecting the scalp. It causes excessive production of sebum (an oily substance produced by the sebaceous glands to help hydrate and protect the skin).

An inflammatory reaction to an overgrowth of Malassezia yeast may trigger seborrheic dermatitis. An overreaction of the immune system to the excess Malassezia leads to a fungal infection that causes skin changes.

Symptoms of seborrheic dermatitis include:

• Itchy scalp
• Redness and/or inflammation on the skin
• Scaling (white or yellow scales on top of oily skin)
• Flaking/dandruff
• Scalp rash (looks dark on brown and black skin, and lighter on white skin)
  

Hair thinning and hair loss can occur with seborrheic dermatitis. This can happen when irritation and inflammation from the increased sebum production cause itchiness, prompting scratching that can damage hair follicles. The damage to the follicles can obstruct natural hair growth and lead to hair loss.

Overproduction of Malassezia is also associated with hair loss. A 2014 study suggested that Malassezia may weaken the hair root and lead to hair shedding.

A 2018 study found that oxidative stress (when the body is unable to counteract sources of oxidative damage) may play a role in premature hair loss and that Malassezia is a source of oxidative damage. The study also states that dandruff and seborrheic dermatitis show clear signs of oxidative stress.

A 2015 study found that irritation due to pollution can cause excess sebum production, oily scalp, scaling, and inflammation, which could lead to hair loss.

Stopping Hair Loss Related to Dandruff

Stopping hair loss related to dandruff and seborrheic dermatitis starts with treating the underlying condition.

Dandruff and seborrheic dermatitis are commonly treated with scalp care products such as medicated shampoos, particularly ones that control Malassezia levels.

Dandruff can typically be controlled with over-the-counter (OTC) shampoos that contains active ingredients such as:

• Zinc pyrithione (Head & Shoulders, Zincon, DHS zinc)
• Selenium sulfide 1% (Selsun Blue)
• Ketoconazole (Nizoral 1%)
• Tar-based (T-Gel, DHS tar, Pentrax)
• Salicylic acid (Neutrogena’s T/Sal Therapeutic Shampoo)

Use these shampoos as directed, and check the label for potential side effects. If you don't notice an improvement after four to six weeks, try a shampoo with a different active ingredient or see a healthcare provider.

Take the following precautions regarding tar-based shampoos:

• Don't use them on dyed or treated hair.
• Wear a hat outside (can make the scalp more sensitive to sun).
• Long-term use can cause staining on skin, hair, and nails.
  

Seborrheic dermatitis can often be treated with OTC medicated anti-dandruff shampoos. It may also be treated with topical corticosteroids (usually creams and ointments).

How to Regrow Hair Where Dandruff Had Been 

Once the dandruff or seborrheic dermatitis is effectively treated, hair typically grows back on its own. It's important to avoid damaging your scalp by scratching, which can lead to hair loss.

If your symptoms from dandruff or seborrheic dermatitis subside but your hair doesn't start to regrow, talk to a healthcare provider before trying other hair growth measures.

Signs of Dandruff and Hair Loss Not Improving 

See a healthcare provider if:

• Your symptoms persist after using dandruff shampoo for a month.
  
• Your scalp is red or swollen.
• Your symptoms are severe.
• Your scalp is very itchy.
• You have flaky, itchy patches on areas other than your scalp.
• Your symptoms get worse.
• You have any concerns.

Summary

Dandruff is a milder form of seborrheic dermatitis. Dandruff and seborrheic dermatitis are scalp conditions that cause symptoms such as flaking and itching. They are often related to an overgrowth of a yeast called Malassezia.

Hair loss may occur with seborrheic dermatitis, possibly because of the fungal infection caused by the Malassezia overgrowth or from damage stemming from scratching an itchy, inflamed scalp.

Dandruff and seborrheic dermatitis are typically treated with OTC medicated shampoos containing active ingredients such as zinc pyrithione, selenium sulfide, ketoconazole, tar-based, or salicylic acid. Topical corticosteroids may also be used for seborrheic dermatitis.

Hair loss from dandruff or seborrheic dermatitis usually grows back on its own after the underlying symptoms are treated. Call your healthcare provider if symptoms are severe, persistent, or worsening.