I Have Severe Dandruff, Diffuse Hair Loss, and Questions

Hi Dr. Rassman,

I have been diagnosed with some pretty serious seborrheic dermatitis (scalp). I have chronic severe dandruff (easily noticeable from a distance), major flaking and yellowish scales. Also, there is intense itching and patchy inflammation.

For sometime now, I have also been losing hair. It has been what is known as diffuse hair loss, but the saving grace is there is no visible miniaturization (after diagnosis), and there is absolutely no emerging pattern (I have always been a NW2 from my early 20s and remain perfectly so).

But the diffuse hair loss is worrying me, since my hair is starting to appear a lot thinner.

My questions are:

1. Will controlling dandruff and reducing inflammation help stop the diffuse hair loss?
2. How does dandruff cause hair loss? (More specifically, how does it affect the follicle?)
3. I’ve heard about cortisones being used for seborrheic dermatitis. Are they effective and safe?
4. I have been put on a 2% ketoconazole shampoo to be used thrice a week. Is this safe to use for seborrheic dermatitis?

Thanks

1. Dandruff doesn’t cause permanent hair loss. It is a skin issue.

2. See above answer. If you’re constantly scratching your scalp or brushing out the dandruff, it’s possible you could be causing hair loss.

3. Efficacy or safety of topical cortisone is something that is a doctor/patient issue. Sometimes the use of steroids can induce hair loss. That is why you always should follow your doctor’s advice.

4. Ketoconazole shampoo 3 times a week is a seborrheic dermatitis treatment that many doctors recommend. See here for other treatments.