Author: Dr. William Rassman

Dr.Rassman, you’ve written much about dermatitis and hair loss. It seems that in your opinion even the worst case of sebhorrheic dermatitis (excessive plaque, high levels of sebum, chronic flaking, bleeding etc.) doesn’t contribute directly to hair loss – especially of the patterned kind. However many people out there believe the two to be linked, including many physicians. I just came across an article from a non-profit organization called the American Hair Loss Association detailing various hair fungi and scalp conditions.

In their discussion of dermatitis they claim that, and I quote, “Although all this inflammation is not specifically directed at the hair follicle, if hair follicles are in the vicinity of the inflammatory cells then they can still be adversely affected. Hair follicles find inflamed skin an unhealthy environment in which to grow. Thus seborrheic dermatitis may non-specifically cause diffuse hair loss.” Is this a reputable source and how would you respond to this claim?

*The full article can be found here: AHLA – Infectious Agents

Flaking of the skin from seborrheic dermatitis itself does not cause hair loss, but if the scalp is picked and the flakes are pulled off, then hair loss can be a result of that process (meaning the hair will come off with the plaque). If a person picks on it regularly, that person can develop traction alopecia or even a condition called dermatillomania, a form of OCD.

I usually point out to our readers that the most common cause of hair loss (in men) is related to genetics. The differentiating factor for male pattern (genetic) hair loss from other types of hair loss is the “pattern” of the loss… but there are other causes of hair loss aside from genetics. Hair loss can be from fungus, psoriasis, anemia, immunologic, infections, stress, etc and many of these conditions may appear like a form of dermatitis. These types of hair loss can be diffuse or patchy, but there is not necessarily a cause and effect between the skin condition and the hair loss.

The American Hair Loss Association is a good, well meaning organization. I just do not agree with the opinion that they expressed connecting seborrhea to hair loss directly. I’m not sure where they got their information about that.

Dr. Rassman,

I have been noticing a lot lately that most balding men also tend to lose hair on the back of the neck. The “receding neckline,” as I call it, is something that I never hear talked about on hair-loss forums, and it doesn’t appear to be represented on the Norwood scale.

Have you had any experience with patients who were concerned about this?

Yes, we occasionally see patients with neckline hair loss. It is not that common, but it does occur. In fact, a few years back a patient came to see me specifically requesting to have hair transplanted into his receding neck hairline.

The loss of neck hair is why harvesting donor hair from the correct (non-neck) area is very important for future hair loss planning. I have seen patients from other clinics who had their donor hair harvested from the neck area and I often worry that they may lose those hairs in the future if their neck hair was genetically determined to fall out, which would compromise the hair transplant.

I have been experiencing hair loss and notice during daily shedding, there are visibly different diameter hairs. Do the thin hairs represent minaturized hairs destined for baldness or can this be seen with the normal telogen phase? Thanks for your reply.

A non-balding person can lose 100 to 200 hairs a day. These hairs can be thick or thin, miniaturized or non-miniaturized. The good news is there are likely 100 to 200 new hairs growing at other areas of the scalp.

You cannot say miniaturized hairs represent hairs that are destined for baldness. It may just be a normal part of the hair cycle. In every hair follicular unit there are one or two vellus hairs which are short and thin. They go through the hair cycle like their big brothers in that follicular unit.