Confusion Over Seborrhoeic Dermatitis and Seborrhoeic Alopecia

Scalp conditions and hair loss are two separate areas which can sometimes overlap.

One particular issue Belgravia specialists are often asked about is 'seborrhoeic alopecia'; this is not a recognised hair loss condition and is often a misunderstanding that occurs when the scalp problem seborrhoeic dermatitis (sebderm) is present simultaneously alongside Male Pattern Baldness, or another cause of shedding.

A new report by HealthCMi, an online resource for acupuncture practitioners, has further compounded this confusion by publishing an article on how it believes acupuncture and 'herbs' can treat seborrhoeic alopecia.

In order to clear up this on-going source of confusion, we spoke to Belgravia hair loss specialist, Rali Bozhinova, to get the facts on the matter.

Sebhorrhoeic alopecia is a misleading term

According to the HealthCMi article, acupuncture and 'herbs' (non-specific) were trialled against finasteride 1mg - the only clinically-proven, MHRA-licensed and FDA-approved oral Male Pattern Hair Loss treatment, for 'sebborrhoeic alopecia'.

"Heilongjiang University of Traditional Chinese Medicine Second Affiliated Hospital researchers compared results in a clinical trial. Drug therapy produced an 82.5% total effective rate. Acupuncture and Chinese herbal medicine produced an 87.5% total effective rate. The researchers conclude that the application of acupuncture and herbs “is an effective method in treating seborrheic alopecia,” they write.

Adding, "This type of hair loss is due to a skin condition (seborrheic dermatitis) wherein there is an excess production of sebum on the scalp, typically accompanied by itching, pain, and flaking dandruff. The protocolized investigation by Kong et al. compared patients receiving finasteride with patients receiving acupuncture and herbal medicine."

Rali responds, "This article says that seborrheic alopecia is hair loss due to seborrheic dermatitis, but I wouldn’t call it seborrheic alopecia as this is misleading.

It also talks about using acupuncture and Chinese herbs for hair loss associated with seb. derm compared to the use of finasteride - which we know is used in male pattern hair loss aka androgenetic alopecia, not because someone has seb. derm. so, such comparison will never be accurate. They do mention androgenic alopecia later in the article, which adds to the confusion."

What is seborrhoeic dermatitis and does it cause hair loss?

"Seborrhoeic dermatitis is a chronic inflammatory condition; it can affect the scalp as well as face and flexures on the body," explains Rali. "It usually presents with inflammation and flaky skin; the patient often feels that their scalp is itchy.

The official description of what causes seborrhoeic dermatitis, according to the British Association of Dermatologists, is that it is “triggered by an overgrowth of a harmless yeast called Malassezia that lives on the skin, or an overreaction by the skin’s immune system to this yeast”.

It does not necessarily cause hair loss but in severe cases, where a thick crust has formed or the patient has been scratching excessively, it may result in hair breakage or temporary hair loss. In such instances the hair loss would occur where the seb. derm. is located."

Often people incorrectly associate sebderm with an oily scalp, something Rali feels is a common misconception as the scalp does not have to be oily in cases of sebderm and it is not caused by excess sebum production.

"There is another scalp condition called seborrhea oleosa where more sebum is produced making the scalp very oily," she notes. "This can happen with hormone imbalances and higher androgen levels - because androgens can influence the activity of the sebaceous glands - and can be seen with PCOS sometimes and, therefore, with Female Pattern Hair Loss, for example."

With regards the causes of sebderm, Rali says it, "doesn’t have to be associated with androgens; it can flare up for a number of varied reasons, including cold, dry weather, low immunity, stress, tiredness, and some neurodegenerative conditions such as Parkinson’s disease. Many patients mention that certain foods trigger it too, but this information is largely anecdotal.

On the other hand, Male and Female Pattern Hair Loss are genetic conditions, with recognised symptomatic patterns of shedding, and are definitely associated with androgen levels, especially dihydrotestosterone, often referred to by its abbreviation, DHT."

DHT is the androgen hormone which causes follicular miniaturisation - the weakening of hairs and gradual destruction of hair follicles - in the affected areas, from the crown to hairline and temples, in men and women with genetic hair loss. This displays outwardly as increasingly thinning hair and shedding that may eventually lead to baldness, though usually only for men.

Treating hair loss and scalp conditions

Anyone concerned their hair is looking thinner, they are experiencing more hair fall than usual or are starting to notice signs such as a receding hairline, would do well to take professional advice as soon as they can.

Taking a proactive approach to finding out what the problem is by having a consultation at a dedicated hair loss clinic - or online - can provide an expert diagnosis, as well as personalised treatment recommendations in a timely manner. At Belgravia these are based on the specialists' findings, diagnosis and each individual patient's medical profile and any lifestyle requirements.

If there are any scalp issues present, they can also diagnose and advise on at-home or in-clinic therapies to help you treat or manage these, heading off both flaky scalps and further hair loss in one fell swoop.