Dandruff, Seborrhoeic Dermatitis And Hair Loss
Seborrhoeic dermatitis does not usually cause permanent hair loss, but it does cause shedding. Inflammation around the follicle and the scratching that goes with an itchy scalp both push hairs out early, so flaking and increased shedding commonly arrive together. Treating the scalp condition usually settles the shedding. The important thing is knowing which scalp symptoms mean something more serious.
Key points
Seborrhoeic dermatitis is an inflammatory scalp condition driven by an overgrowth of Malassezia yeast, which lives normally on skin, combined with oil production and an individual inflammatory response.
It causes shedding through inflammation and scratching rather than destroying follicles, so hair generally regrows once the scalp is treated.
Antifungal treatment, usually ketoconazole shampoo, is the mainstay, and it needs contact time on the scalp rather than on the hair.
Redness, scaling, tenderness, burning or a smooth shiny band at the hairline can indicate a scarring alopecia, where follicles are destroyed permanently, and that needs assessing promptly.
Flaky, itchy scalp with shedding? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
What seborrhoeic dermatitis is
The mechanism
Malassezia is a yeast that lives on almost everyone's skin without causing problems. In seborrhoeic dermatitis it overgrows in oil-rich areas and breaks down sebum into compounds that irritate the skin in people whose immune system reacts to them. The result is redness, greasy yellowish scale, itching and flaking.
On the scalp it is what most people call dandruff when mild. It also commonly affects the eyebrows, the sides of the nose, behind the ears and the chest, which is a useful clue that the scalp problem is part of a pattern rather than an isolated event.
Why it flares
It fluctuates, typically worsening with stress, cold dry weather, illness and hormonal change, and improving in summer. It is more common and often more stubborn in people with Parkinson's disease, in those who are immunosuppressed, and after a period of significant stress or illness.
How it causes shedding
Two mechanisms, neither of which destroys the follicle.
Inflammation around the follicle disrupts the hair cycle and can push hairs into the resting phase earlier than they would otherwise go, so more hairs release over the following weeks.
Scratching does the rest. An itchy scalp gets scratched, and mechanical trauma pulls hairs out and damages the shaft. Many people underestimate how much of their shedding is coming from their own fingernails.
The reassuring implication is that this shedding is usually reversible. Settle the inflammation, stop the scratching, and the hair cycle normalises. What seborrhoeic dermatitis does not do in ordinary circumstances is scar follicles or cause permanent baldness.
Not sure whether your shedding is the scalp or something else? Ask our doctors on WhatsApp.
How to treat it properly
Free and more effective than most people manage, because the usual failure is technique rather than product.
Use an antifungal shampoo. Ketoconazole is the best established, with zinc pyrithione, selenium sulfide and ciclopirox as alternatives. Rotating between two different agents often works better than using one indefinitely.
Give it contact time. This is the single most common mistake. The shampoo needs to sit on the scalp for several minutes, not be rinsed out in 20 seconds, and it needs to reach the scalp rather than lather over the hair. Part the hair and apply it directly.
Use it regularly during a flare, typically two or three times a week, then reduce to a maintenance frequency rather than stopping entirely, because it recurs.
Stop scratching, which is easier said than done but matters. Treating the itch is part of treating the hair loss.
Expect to manage rather than cure it. Seborrhoeic dermatitis is a chronic relapsing condition, and the aim is long periods of control.
Where it does not settle, prescription treatment including topical steroids or calcineurin inhibitors, and in resistant cases oral antifungal treatment, can be considered by a doctor.
The scalp signs that mean something else
This is the part worth reading carefully, because the cost of missing it is permanent.
Scalp psoriasis produces thicker, silvery, well-defined plaques rather than greasy yellow scale, often extending past the hairline, and may come with nail changes or plaques elsewhere. It is treated differently.
Scarring alopecias are the serious ones. Redness and scaling around individual follicles, tenderness or burning rather than simple itch, loss of the visible follicle openings, a smooth shiny patch, or a pale scarred band at the front hairline. Conditions such as frontal fibrosing alopecia and central centrifugal cicatricial alopecia destroy follicles permanently, and once a follicle has scarred no treatment brings it back. They are also commonly mistaken for stubborn dandruff for months before anyone looks properly.
Fungal infection of the hair shaft, tinea capitis, causes patchy loss with broken hairs and scaling, is more common in children, and needs oral antifungal treatment rather than shampoo.
If your scalp is tender, burning, or you can see smooth areas where the follicle openings have disappeared, get it examined rather than buying another shampoo.
Does treating the scalp help pattern hair loss
Partly, and it is worth being precise about it.
A healthy scalp is a better environment for growth, and inflammation is unhelpful to follicles that are already miniaturising, so controlling seborrhoeic dermatitis is a sensible part of any hair plan. Ketoconazole shampoo has also been studied for a possible direct benefit in pattern hair loss, and the evidence there is suggestive rather than strong.
What it will not do is treat androgenetic alopecia. If your parting is widening or your crown thinning, that is a separate process driven by DHT sensitivity, and no shampoo reverses it. The two frequently coexist, which is why people treat their dandruff, see the shedding settle, and remain puzzled that their density has not returned.
When to be assessed
If shedding continues after the scalp has settled. If the scalp is tender or burning rather than itchy. If you can see smooth areas without follicle openings. If there is a pale band at the hairline or loss concentrated at the crown. If it is not responding to a properly used antifungal shampoo after several weeks.
A scalp examined with dermoscopy answers most of these quickly, because the follicle openings, the pattern of scale and the presence or absence of scarring are visible under magnification in a way they are not to the eye.
Book a scalp assessment. Message us on WhatsApp.
What assessment and treatment cost
Antifungal shampoos are inexpensive and available without prescription, and for most people they are the whole answer. We would rather you tried one properly for a month than paid us anything.
Where assessment is needed, flagship Harley Street and Mayfair clinics commonly charge £600 to £850 or more per PRP session for hair, and London practices generally charge 50 to 70 percent more than clinics outside the capital. Our care is doctor-led and priced below those rates, with blood testing run from the same clinic and any plan confirmed after your free suitability review.
The suitability review
Every enquiry begins with a free doctor-led suitability review rather than a booking. A GMC-registered doctor examines the scalp with dermoscopy, distinguishes inflammatory scalp disease from pattern loss and from scarring alopecia, arranges a biopsy where a scarring condition is suspected, and reviews or arranges your bloods.
You then get one of two answers. Approved for treatment, where there is pattern thinning worth treating alongside the scalp condition. Or not approved, which here is often the answer, because treating the scalp properly resolves the shedding and nothing further is needed.
We decline a meaningful share of enquiries, and sending someone away with a shampoo technique rather than a treatment plan is a routine outcome.
Why people choose The London PRP Clinic by The Wellness
The London PRP Clinic by The Wellness is a doctor-led, blood-test-first clinic treating from 10 Portman Square in Marylebone and the Light Centre in Belgravia. Every treatment is performed by GMC-registered doctors, and no clinician treats a patient here until they have completed 100 supervised treatments.
Because we diagnose before we treat, the scarring alopecias that get mistaken for stubborn dandruff are the conditions we are most concerned to catch early. Across our work we report more than 187 five-star reviews.
Book your free suitability review. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about dandruff and hair loss
Does dandruff cause hair loss?
Seborrhoeic dermatitis causes shedding through inflammation around the follicle and through scratching, but it does not normally destroy follicles, so hair generally regrows once the scalp is treated.
Will my hair grow back after treating my scalp?
Usually yes, because the follicles are intact. Shedding settles over the following weeks and months once inflammation and scratching stop.
What is the best shampoo for seborrhoeic dermatitis?
Antifungal shampoos, with ketoconazole the best established, and zinc pyrithione, selenium sulfide and ciclopirox as alternatives. Rotating two agents often works better than one alone.
Why is my dandruff shampoo not working?
Most often technique. It needs to reach the scalp rather than the hair and to sit there for several minutes, used two or three times a week during a flare, then continued at a lower frequency.
When is a flaky scalp something more serious?
If it is tender or burning rather than itchy, if follicle openings disappear leaving smooth areas, if there is a pale band at the front hairline, or if it does not respond to proper antifungal treatment. These can indicate a scarring alopecia.
Does treating dandruff help pattern hair loss?
It improves the environment for growth and reduces shedding, but it does not treat androgenetic alopecia, which is a separate process. The two often coexist.
This article is for information and does not replace personal medical advice. Scarring alopecias require prompt specialist assessment. Individual results vary. All treatments at The London PRP Clinic by The Wellness are performed by GMC-registered doctors. Written and reviewed by the clinical team at The Wellness. Last updated September 2026.