Can Scalp Conditions be Caused by High Levels of DHT?'

Name: Frank

Question: My dermatologist recommended finasteride as a way to reduce the inflammation from androgens such as DHT (which he believed were causing my scalp dermatitis) as well as reducing my hair loss. However, he did not diagnose me with male hair loss specifically. I have been on finasteride 1 mg for 6 weeks, but have not noticed any change. When can I expect results, and what do I do if finasteride doesn't work for me? How can I be sure if I am not a responder to finasteride? Could seborrheic dermatitis and sebum be caused by high levels of androgens and DHT?

Answer: Hi, Frank. We would recommend speaking to your dermatologist and asking them to clarify all this for you, as you are their patient and they will have more information, such as your medical profile and their findings from a scalp assessment, to draw their conclusions from.

As you are not a Belgravia client, we can only provide you with general advice, though - as we note you are based in the USA - you are welcome to have an online consultation, which involves uploading photos, if you would like a second opinion with personalised advice.

Finasteride 1mg is clinically-proven for the treatment of Male Pattern Baldness (androgenetic alopecia); it is used to increase hair growth and prevent further hair loss by inhibiting dihydrotestosterone (DHT). This is the hormone responsible for follicular miniaturisation along the top of the scalp, and which can display outwardly as thinning hair and/or a receding hairline.

If your dermatologist prescribed finasteride 1mg in relation to treating a receding hairline, this means they have diagnosed you with Male Pattern Hair Loss.

As before, if you feel your doctor’s treatment plan or diagnosis is unclear, or if you are concerned it is not right for you - as you mention being concerned it may not work - you should contact them for a consultation so they can examine your scalp and answer your questions.

As you say you have only been taking finasteride 1mg once a day for 7 weeks, we would caution that it is simply too early to see any results as it usually takes 3 to 6 months for initial results from hair loss treatment to become apparent.

In relation to your concerns regarding seborrhoeic dermatitis (sebderm), this is a type of eczema that can affect any part on your body rich in sebaceous glands. Typically the scalp is affected but it can also flare up at the sides of your nose, around your eyebrows, sideburns, chest and in any body flexures. It may cause an inflamed and flaky scalp, constant itching, and a build-up of crust on your scalp.

It is a common, chronic skin condition that may present at random intervals over the years, though the severity varies between patients.

Although it flares up on sebaceous skin zones, it does not necessarily mean that you are producing too much sebum. Many patients with sebderm have normal sebum production.

It is thought that sebderm is triggered by an overgrowth of a harmless yeast called Malassaezia furfur that lives on the skin, or an overreaction by the skin’s immune system to this yeast.

There is not enough research to tell us precisely what triggers a flare up and I am unaware of any reliable scientific research linking high levels of DHT to sebderm.

Many patients have reported trigger factors such as stress, illness, a suppressed immune system, tiredness, and cold weather. Some patients even link it to consumption of alcohol and certain foods, but this is very subjective and unproven.

Treatments for sebderm, which usually manage the signs and symptoms, may include:

• Ketoconazole shampoo may be used to reduce the growth level of the yeast mentioned above;
• Keratolytic creams containing salicylic acid may be used to remove the scaling and keep the scalp healthy;
• Anti-dandruff shampoos may be used for the same purpose these usually contain zinc pyrithione, selenium sulphide or coal tar;
• Mild steroid creams or ointments may be used to reduce inflammation.

There is no permanent cure for sebderm but it can generally be well managed with the help of your dermatologist.

With regards sebum production, sebum is produced by the sebaceous glands. Overproduction can cause a particularly oily scalp which may also become itchy and inflamed. This may sometimes be associated with acne.

Sebum production is influenced by androgens such as testosterone (of which DHT is a by-product). It is normal for men to produce slightly more sebum than women, which may be the influenced by hormonal changes in the body.

If you believe excessive sebum production is causing you skin problems, on the scalp or elsewhere, you should also discuss this with your dermatologist as these can generally be treated depending on the signs and symptoms.