Scalp conditions that cause hair loss: symptoms, causes and treatment

These conditions cause irritation and swelling (inflammation) in the layers of the skin of your scalp. This inflammation can then damage the roots in your scalp that produce hair (hair follicles), which can lead to hair loss. It can also make your scalp very itchy, and scratching your skin can damage your hair follicles, too.

The good news is that these skin conditions can be managed. In some cases your hair will grow back, but regardless, there are many treatment options to help improve your scalp condition. So read on to learn about the symptoms, causes and treatment of common scalp conditions that might be causing you to lose your hair.

Common skin conditions that can cause hair loss

Seborrhoeic dermatitis

Also called seborrhoeic eczema, seborrhoeic dermatitis is a long-lasting (chronic) type of

that tends to affect areas of your skin that have more oil (sebaceous) glands – so it’s common to get it on your scalp. It’s often seen in children and can be also called ‘cradle cap’. This excess oil can cause your scalp to become inflamed and irritated, making it itchy. Scratching can damage hair follicles leading to hair loss. Once the inflammation settles down the hair loss should improve and regrow.

Symptoms of seborrhoeic dermatitis on your scalp include:

• scaly patches of skin that often also look greasy
• redness
• flaking skin (
  dandruff
  )
• swelling
• itching
• burning
• hair loss

It isn’t fully understood what causes seborrhoeic dermatitis, and several factors may play a part. But the latest research suggests it involves your body overreacting to a type of yeast (fungus) that lives on your skin’s surface.

Things that can trigger or increase your risk of seborrhoeic dermatitis include:

• having oily skin
• stress
• hormonal changes
• cold, dry weather
• family history (your genes)
• some medications
• other skin conditions, such as
  psoriasis
  ,
  acne
  or
  rosacea
• certain medical conditions, including
  HIV
  ,
  Parkinson’s disease
  ,
  epilepsy
  ,
  Down’s syndrome
  ,
  alcoholism
  ,
  depression
  and
  eating disorders

Treatments for seborrhoeic dermatitis on your scalp

Seborrhoeic dermatitis is a chronic condition, which means it can go away after treatment then ‘flare up’ again at a later date. But treatment can keep symptoms under control, improve skin condition and help you feel more comfortable. Check with your pharmacist before trying a product.

• medicated shampoos
• antifungal medication
  that you apply to the scalp (topical) or take as a tablet (oral)
• topical corticosteroids
  or anti-inflammatories
• coal tar cream – applied to affected areas and washed off several hours later

Psoriasis

is a chronic inflammatory skin condition that can affect any area of skin, but it’s common on your scalp. In the UK, it affects about 1 in 50 people, and about half of these people will have it on their scalp.

Psoriasis happens when your skin cells are replaced more quickly than they should be, leading to cells building up on your skin’s surface – usually in red, flaky patches covered in silvery flakes, known as plaques. Most people with scalp psoriasis don’t lose hair, even with thick plaques, but it can sometimes happen. Scratching, combing or pulling off plaques can also pull clumps of hair out. It doesn’t usually cause scarring so once treated, your hair should regrow normally. Some treatments used for psoriasis can also have side effects of hair loss such as oral retinoids or biologics.

Symptoms of psoriasis on your scalp include:

• a thick build-up of silvery, scaly skin
• red patches (on white skin) or purple or grey patches (on darker skin)
• dandruff-like flaking
• dryness, itching and tightness
• burning or soreness
• hair loss

It’s not known exactly what causes psoriasis, but research suggests it involves a problem with your immune system – known as an ‘autoimmune’ disease – where it attacks healthy skin cells by mistake. Genetics may play a role, too: you’re more likely to get psoriasis if a close relative has it.

Things that can trigger a flare-up of psoriasis include:

• an injury to your skin
• drinking a lot of
  alcohol
• smoking
• stress
• hormonal changes
• certain medicines, including lithium, some
  antimalarials
  , anti-inflammatories and high blood pressure medication
• immune disorders, such as HIV

Although there’s no cure for psoriasis, there are now more effective treatments than ever before, which can reduce your symptoms and improve how your skin looks and feels. Treatment can also reduce itchiness, making you less likely to scratch and cause hair loss.

Self-care measures and treatments for scalp psoriasis

Which treatment is right for you will depend on how severe your psoriasis is, and you may need to try a combination of treatments to find what works for you. Read more about

. If you think you have psoriasis, it’s best to discuss it with your doctor. You might need to be referred on to a skin specialist (dermatologist) for specialist treatment.

• topical treatments – including over the counter creams and ointments, shampoos, steroids, tars and other treatments available on prescription
• phototherapy – using UV light to slow down the growth of skin cells
• systemic medicines – prescribed oral medication, injections or medicines that target the immune system (biologics)
• reducing risk factors and triggers such as smoking, stress and drinking alcohol can also help to reduce your symptoms

Discoid lupus erythematosus (DLE)

Discoid lupus erythematosus (DLE) is a type of

that affects the skin. It’s a chronic inflammatory skin condition that usually appears on the face, ears or scalp.

Round patches of thickened skin called plaques can appear on the scalp causing hair loss. Hair loss in DLE can be permanent so the sooner it’s treated the better.

Symptoms of DLE on your scalp include:

• red or pink scaly patches of skin
• scarring
• changes in skin colour (pigmentation)
• discomfort and itching
• hair loss

The exact cause of DLE isn’t known, but like psoriasis, it's thought to be an autoimmune disease, which involves your immune system attacking normal skin by mistake. It’s more common in females, and also in people with darker skin.

Things that may worsen or increase your risk of DLE include:

• family history (genetics)
• exposure to sunlight
• smoking
• stress
• infection
• an injury
• oestrogen is thought to play a role – symptoms may worsen before your period, for example

As with other autoimmune conditions, there’s no cure for DLE, but self-care measures and treatments can usually successfully prevent and control your symptoms.

Self-care measures and treatments for DLE on your scalp include:

• year-round sun protection – including covering up with clothing and always wearing a high factor sunscreen (you may need
  vitamin D
  supplements if you avoid the sun)
• stopping smoking
• topical corticosteroids
• systemic medicines prescribed by a doctor
• stress management

Folliculitis keloidalis

Folliculitis keloidalis involves inflammation and scarring of your hair follicles. It’s another chronic skin condition, sometimes also known as acne keloidalis nuchae or acne keloidalis.

Symptoms of folliculitis keloidalis on your scalp include:

• red spots or pus-filled bumps (pustules) on your scalp and the back of your neck
• small scars where pustules have been scratched
• scars that lump together to form bigger lumps
• multiple hairs coming out of 1 hair follicle (tufted hair)
• hair loss

The cause of folliculitis keloidalis is unclear, but it;s thought that it can be triggered by an injury, such as from a razor or close haircut. Other factors that may be involved include

, bacterial infections and .

Folliculitis keloidalis is difficult to treat, and unfortunately it may carry on or come back. But there are treatments to try. Getting it diagnosed early will help ensure it can be managed successfully and minimise scarring that may cause permanent hair loss.

Self-care measures and treatment for folliculitis keloidalis include:

• oral or topical
  antibiotics
  to treat any infection
• steroid injections
  or creams
• surgery to remove big lumps
• radiotherapy
• medication like isotretinoin
• laser treatments
• making sure clothing doesn’t rub the back of your neck
• avoiding a very short or razor hair cut
• washing the affected area with antimicrobial cleanser

Central centrifugal cicatricial alopecia (CCCA)

Also called follicular degeneration syndrome (FDS) and hot-comb alopecia, this is a type of permanent hair loss caused by inflammation that damages and destroys your hair follicles. The follicles get replaced by scarring and so hair in these areas can’t grow causing permanent hair loss. It often starts on the top of your scalp and spreads outwards in a circular pattern.

Anyone can be affected by CCCA, but it’s one of the most common causes of permanent hair loss in black females, and usually begins when you’re 30 to 40 years old. Apart from hair loss, it often has no symptoms.

Other symptoms of CCCA can include:

• scalp tenderness or soreness
• itching
• burning
• hair breakage – this can sometimes be an early sign of CCCA

The exact cause of the hair damage in CCCA isn’t known, but it’s thought that several factors are involved.

Possible things involved in causing CCCA include:

• family history (genetics)
• autoimmune disease – when your immune system attacks your hair follicles
• fungal or bacterial infections
• hairstyling practices, such as use of hot combs, chemical relaxers, weaves, extensions or braids – although not all studies have suggested a link

Unfortunately, your hair won’t grow back if your hair follicles have been permanently damaged, so it’s important to get CCCA diagnosed and treated as soon as possible. Treatment can help reduce inflammation, control symptoms and prevent further hair loss.

Self-care measures and treatments for CCCA include:

• stopping or reducing the use hairstyling practices that may irritate or damage the scalp
• topical steroids or other anti-inflammatories – these can be creams, mousses, lotions or ointments
• steroid injections
• oral antibiotics
• topical Minoxidil solution or foam – may sometimes alongside other treatments to help stimulate hair growth

Skin infections

Some fungal, bacterial and viral skin infections can lead to itching, discomfort and inflammation – and in some cases, hair loss.

Ringworm of the scalp

Also known as Tinea capitis,

of the scalp is a common fungal infection. Symptoms include scaly skin that may be sore, redness and itching. It can sometimes cause bald patches to appear as infected hairs are brittle and break easily. In severe cases there can be pus-filled spots or a painful boggy swelling called a kerion. If you have this you may also have signs of infection like a fever or swollen glands in your neck.

It usually needs to be treated with antifungal tablets and a medicated shampoo. If your skin is irritated or broken, you may get a bacterial infection, which will need treatment with antibiotics. It’s also important to try to stop it spreading by washing your sheets regularly, keeping your skin clear and washing your hands after touching animals. It’s important not to scratch the area or share towels.

Bacterial folliculitis

Bacterial folliculitis is inflammation of your hair follicles due to bacterial infection. Symptoms include painful, pus-filled bumps, redness and irritation. Infected hairs easily fall out causing areas of hair loss, but this is not usually extensive or permanent.

Using antibacterial soap and ointments can help clear it up, but you may also need topical or oral antibiotics. It’s best to speak to your doctor about the best treatment option for you.

Less common scalp conditions that can cause hair loss

• lichen planopilaris – this is when a skin disease called
  lichen planus
  affects hairy areas like the scalp. It destroys hair follicles and replaces them with scarring, causing patchy permanent hair loss. It’s found to be the cause in only 1% to 8% of people with hair loss
• folliculitis decalvans – a condition causing inflammation of the hair follicles on the scalp and other body areas including the beard and pubic hair. The inflammation causes scarring and hair loss. It’s more common in males, but it’s very rare and only accounts for 3% of hair loss diagnoses
• dissecting cellulitis of the scalp – another rare condition where pus-filled spots appear and destroy hair follicles. It more often affects darker-skinned adult males of African-Caribbean origin
• pemphigus – pemphigus vulgaris and pemphigus foliaceus are very rare autoimmune conditions that can cause skin blisters on the scalp and other areas of the body, destroying skin and hair follicles leading to hair loss
• pityriasis amiantacea – a rare condition that presents as thick, silver-yellow scales on the scalp. It’s not a condition in itself but can be a symptom of other scalp conditions, including psoriasis and seborrhoeic dermatitis. It usually causes temporary hair loss and rarely permanent

When to see a doctor and how to get a diagnosis

It’s completely normal to shed some hair every day. But you should speak to a doctor or dermatologist if you notice that you’re losing more hair than usual or you have any symptoms of the scalp conditions discussed here, or you’re worried about your hair loss.

As well as skin conditions, there are many other possible causes of hair loss, including

, , and some . So it’s important to find out what’s causing yours and, if necessary, get prompt treatment.

To make a diagnosis, your doctor or dermatologist will need to gather information. To do this they may:

• ask you questions about your symptoms and any other health conditions
• look closely at your scalp
• take a swab or biopsy from your scalp
• test the health of your hair
• order blood tests

Losing your hair can be very difficult emotionally, too, and this may also be something you want to discuss with a doctor. Read our

.

Find useful information on other areas of female hair loss with our

.

Your health questions answered

Will my hair grow back?

Scalp conditions can be managed and treated, and in some cases your hair will grow back. For common conditions like psoriasis, bacterial folliculitis and seborrhoeic dermatitis the hair will usually grow back after the skin condition is treated. However, some conditions can cause permanent hair loss, for example DLE and CCCA. Usually permanent hair loss is when there is damage to the hair follicle, the skin may scar so hair can’t grow back.

How much your hair grows back and how long it takes will depend on the type and severity of your scalp condition, and what treatments are available and suitable for you. Your doctor or dermatologist will be able to advise you about hair regrowth. The aim is to treat the condition early to reduce the scarring or permanent skin damage.

Can head lice cause hair loss?

don’t usually cause any hair loss. But if they’re left untreated, severe cases can cause lots of itching, scratching and hair pulling – which can lead to hair loss. It shouldn’t be permanent and the inflammation should improve once the lice have been treated. Read about .