Seborrheic alopecia
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Seborrheic alopecia is a form of hair loss associated with excessive activity of the scalp's sebaceous glands and accompanying scalp inflammation. This phenomenon most often occurs in people with seborrheic dermatitis and manifests as thinning of the hair on the scalp, accompanied by increased oiliness of the skin, itching, and the presence of scales. Excess sebum promotes the growth of yeasts of the genus Malassezia, which can intensify the inflammatory reaction and disrupt the normal hair growth cycle. Although seborrheic alopecia does not always lead to permanent hair loss, chronic inflammation of the hair follicles can cause their weakening and increased hair shedding.
Seborrheic alopecia – symptoms
Symptoms of seborrheic alopecia result primarily from dysfunction of the sebaceous glands and chronic inflammation of the scalp. In the course of the disease there is overproduction of sebum, which accumulates on the surface of the skin and hair, leading to the characteristic greasiness of the scalp. Excess sebum creates an environment conducive to the growth of microorganisms, especially yeasts of the genus Malassezia, which further intensifies inflammation around the hair follicles.
The most commonly observed symptoms include:
- excessive oiliness of the hair and scalp, often appearing just a few hours after washing,
- scalp itching, which can vary in intensity,
- presence of yellowish or whitish scales, resembling severe dandruff,
- erythema of the scalp, particularly in the forehead, temples and behind the ears,
- weakening of hair structure and increased hair shedding,
- hair thinning, most commonly in the frontal and vertex areas.
Chronic inflammation of the scalp can lead to disruption of the normal hair growth cycle. Under physiological conditions hairs pass through three phases: anagen (growth phase), catagen (transition phase) and telogen (resting phase). In seborrheic dermatitis there is shortening of the anagen phase and earlier transition of hairs into the telogen phase, which causes increased hair shedding. This phenomenon is referred to as inflammation-induced telogen hair shedding.
It is also important to differentiate seborrheic alopecia from androgenetic alopecia, because both conditions can coexist. In androgenetic alopecia there is gradual miniaturization of hair follicles under the influence of androgens, mainly dihydrotestosterone (DHT), leading to progressively thinner and shorter hairs. In seborrheic alopecia, however, the key roles are played by scalp inflammation and sebum overproduction. In clinical practice it is often observed that seborrhea and scalp inflammation exacerbate the process of androgenetic alopecia, accelerating hair loss.
Seborrheic alopecia – how to treat
Treatment of seborrheic alopecia primarily involves controlling excessive sebum production and reducing inflammation of the scalp. Proper dermatological diagnosis is of key importance, as the symptoms may resemble other skin conditions such as scalp psoriasis, fungal infection, or androgenetic alopecia.
The basis of therapy is topical treatment including preparations that regulate sebum secretion and limit the growth of microorganisms. The most commonly used are:
- antifungal shampoos containing ketoconazole, ciclopirox olamine, or zinc pyrithione,
- keratolytic preparations (e.g., with salicylic acid or sulfur), which help remove excessive scales,
- anti-inflammatory preparations, including short-term topical glucocorticosteroids,
- preparations regulating sebaceous gland activity, containing among others niacinamide, zinc, or sulfur.
A very important element of therapy is appropriate scalp care for those prone to seborrhea. Such skin requires regular but gentle cleansing that removes excess sebum and desquamated epidermal cells, while not disrupting the skin’s hydrolipidic barrier. It is recommended to use cleansing products with seboregulating action, avoid heavy occlusive cosmetics, and limit the use of aggressive hairdressing procedures that may further irritate the scalp.
In some cases, metabolic and hormonal factors may also be significant. Hormonal imbalances, increased androgen activity, chronic stress, or a diet high in high-glycemic-index foods can increase sebum production and exacerbate scalp inflammation. For this reason, therapeutic management also recommends attention to lifestyle, including a proper diet, limiting excessive intake of simple sugars, and ensuring adequate supply of nutrients that support hair growth, such as zinc, biotin, and B vitamins.
Complementary treatments may include trichological therapies and aesthetic medicine procedures aimed at improving scalp microcirculation and stimulating hair follicle activity. The most commonly used methods include:
- scalp mesotherapy, involving the administration of nutrients and factors that stimulate hair growth,
- platelet-rich plasma (PRP) containing growth factors that support the regeneration of hair follicles,
- low-level laser therapies (LLLT), which stimulate the metabolism of hair follicle cells and improve scalp blood supply.
Treatment effectiveness depends on early initiation of therapy and regular monitoring of the scalp condition. In most cases, appropriate management allows reduction of inflammation, decreased hair loss, and restoration of proper conditions for hair growth.
