Itchy Scalp and Hair Loss: What Causes Both Symptoms?

From verywellhealth.com

Alopecia (hair loss) is caused by a disruption in the body's hair production cycle. It can have several causes, some of which also cause an itchy scalp.

Skin conditions, infections, parasites like lice, and other factors can cause scalp pruritus (itchiness). Some conditions can cause an itchy scalp and hair loss, such as tinea capitis (scalp ringworm). Too much scratching of an itchy scalp can also cause damage leading to hair loss.

This article will discuss the causes, confirmation, and treatment of itchy scalp, hair loss, and ways to minimize itching and shedding.

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What Causes Hair Loss and Itchy Scalp?

Hair loss and itchy scalp both have a variety of causes, some of which can overlap.

Hair Loss Causes

Hair grows in a cycle with three phases:

Anagen: Actively growing hair (years)

Catagen: Hair stops growing and separates from the follicle (about 10 days)

Telogen: Follicle rests, and then the hair falls out (two to three months)

An interruption to this cycle or damage to the hair follicle can cause hair to fall out faster than it regenerates, leading to bare patches or thinning.

Some causes of hair loss include:

Androgenetic alopecia: Male-pattern hair loss or female-pattern hair loss

Telogen effluvium: When many follicles enter the resting phase but new growth doesn't begin, so lost hair isn't replaced; typically triggered by factors such as a medical event, physical or emotional stress, or pregnancy/childbirth; usually temporary, but can become chronic

Anagen effluvium: Rapid hair loss from medical treatment, such as chemotherapy; usually grows back

Alopecia areata: Autoimmune condition in which the immune system attacks the hair follicles, causing hair to fall out and preventing new hair from growing

Tinea capitis: Fungal infection that may cause itching, oozing sores or blisters, and /or patches of hair loss

Cicatricial alopecia (scarring alcopecia): Inflammation that destroys the hair follicle and causes scar tissue to form, preventing hair from regrowing in those areas; can cause itching, swelling, and red or white lesions that can resemble a rash; types include lichen planopilari, discoid lupuserythematosu, folliculitis decalvan, dissecting cellulitis of the scalp, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia

Hair shaft abnormalities: Causes hair strands to thin, weaken, and break

Loose anagen syndrome: Hair that's not firmly rooted to the follicle and is easily pulled out

Trichotillomania: Mental health disorder in which a person intentionally pulls out their hair and finds it difficult to stop

Traction alopecia: Results from hair strands that are damaged by tight hairstyles that pull hair away from the scalp with high force

Damage to shafts or follicles: Damage resulting from products such as dyes or perms, hot appliances like hair dryers or curling irons, or injuries such as burns

Nutritional imbalances: Such as iron, zinc, linoleic acid, alpha-linolenic acid, and protein deficiencies, or over-supplementation of vitamin A

Itchy Scalp Causes

Many things can cause the scalp to itch, including:

Seborrheic dermatitis: Skin condition that causes symptoms such as scalp itch and flaking and may cause sensations of tightness, prickling, burning, and/or pain

Scalp psoriasis: Autoimmune condition causing reddish patches, flaking, silvery-white scaling, dry scalp, and often itching. May cause increased hair shedding

Dandruff: Dry, itchy scalp with flaking

Contact dermatitis: A reaction to shampoo, conditioner, hair dye, hair care products, brushes, or other things that touch the scalp. It causes itching, dryness, flaking, and sometimes a rash

Hives: Red, raised, itchy bumps that tend to come and go within a few hours or go away and come back

Infestations: Tiny bugs such as scabies or lice

Scalp ringworm: Fungal infection on the scalp that can lead to hair loss

Atopic dermatitis (eczema): Inflammation, irritation, and redness on the scalp, often with itchiness

Neuropathy: Intense itching, without symptoms such as a rash or skin reaction, caused by a nerve problem; may be due to damage, medical condition (such as shingles or diabetes), scarring (such as from hair loss), or other abnormalities

Skin cancer: Itchiness may result from cancer that on the scalp

Red-scalp syndrome: A variant of the skin condition rosacea, marked by itching, stinging, and burning of the scalp, with redness, papules (small bumps), pustules (pus-filled bump), and telangiectasias (spider veins, small, widened blood vessels on the skin)

Sensitive scalp: Common condition causing redness and/or symptoms such as itching, prickling, burning, or pain; triggered by chemical, emotional, hormonal, and physical factors, such as shampoos, water, stress, menstrual cycle, weather, and temperature

Pollution: Can cause environmental damage to hair, and has been linked to hair and scalp problems such as itching, redness, irritation, dandruff, sensitive scalp syndrome, and hair loss

The Link Between Hair Loss and Itchy Scalp

Hair loss and scalp itch overlap in a number of ways.

Some conditions, such as tinea capitis/scalp ringworm, cicatricial/scarring alopecia, and scalp psoriasis, can have both itching and hair loss as symptoms.

Conditions that cause scalp itch can indirectly lead to hair loss if there is excessive rubbing or scratching of the scalp, leading to damage or hair breakage.

Conversely, some people with non-scarring alopecias, such as alopecia areata and androgenetic alopecia, experience itching or burning preceding the development of new patches of hair loss.

Comorbidity (co-occurrence of another condition) can also be a factor. For example, people who have androgenetic alopecia often also have seborrheic dermatitis.

Unmodifiable Risk Factors For Hair Loss

Hair loss can't always be prevented. Some causes of hair loss that are difficult (or not possible) to prevent, control, or change include:

Genetics: Male and female pattern baldness can be related to heredity

Aging: Hair loss or hair thinning is common in all sexes by about age 70 years

Hormones: Hair loss can be influenced by hormones, including changes in testosterone with age, or hormonal with pregnancy

Autoimmune conditions: Conditions such as alopecia areata, psoriasis, some thyroid conditions, lupus, and other autoimmune conditions can be associated with hair loss

Confirming Itchy Scalp and Hair Loss Symptoms

If you are experiencing itchy scalp, hair loss, or both, talk to your healthcare provider or see a board-certified dermatologist. They can help you find an accurate diagnosis and work with you to determine a treatment plan that works for you.

Your provider will likely:

• Ask about your symptoms in detail
• Discuss your hair care routines and habits
• Get your medical history, and ask about recent illnesses or medical events
• Ask about a family history of your symptoms, such as family members with hair loss
• Talk to you about your emotional well-being and stress levels
• Ask about the foods you eat and any recent changes you have made to your diet
• Perform a physical examination of your hair and scalp

If a cause for your symptoms isn't apparent after this exam, tests may be ordered, including:

• Blood tests to check for certain conditions
• Examination of a hair sample under a microscope
• Examination of a skin sample, from a skin scraping or biopsy

When to See a Healthcare Provider

If your symptoms are bothering you, your primary healthcare provider, a board-certified dermatologist, or in some cases, a pharmacist may be able to help.

See a provider if you experience any of the following:

• Hair loss in an unusual pattern
• Rapid hair loss
• Hair loss at an early age (such as before you are in your 30s)
• Red, scaly, or abnormal skin on the scalp
• Itching or pain with hair loss
• Abnormal facial hair, acne, or an abnormal menstrual cycle
• Male-pattern baldness if you are female
• Weight gain, muscle weakness, intolerance to cold temperatures, and/or fatigue
• Bald patches in your eyebrows or beard
• Infected areas on your scalp
• A lesion or lesions that could be skin cancer

How to Treat Hair Loss and Scalp Itching 

Treatment for hair loss and/or scalp itching depends on what is causing the symptoms.

If you are reacting to a product or your symptoms are triggered by identifiable factors, avoiding those triggers as much as possible is the first place to start.

Medicated shampoo may be recommended for conditions such as dandruff or psoriasis.

Infections like scalp ringworm and scabies should be treated by a medical professional who can prescribe topical and/or oral medications.

Moisturizing creams or ointments may be used to help with dryness or itchiness. Your healthcare provider may recommend medicated ointments, such as corticosteroid lotions, for conditions such as seborrheic dermatitis.

Your healthcare provider may suggest taking specific supplements if a nutritional deficiency causes your symptoms. Hormonal therapy may be suggested if there is a hormonal cause for the symptoms.

Prescription medications that may be used to help decrease hair loss and/or stimulate new hair growth include:

Rogaine (minoxidil)

Propecia/Proscar (finasteride)

A hair transplant procedure, in which a surgeon moves healthy hair from one area of the scalp to a thinning area, is another option.

Treatment options for patchy hair loss due to alopecia areata include:

• Topical corticosteroids
• Topical anthralin (a medication used for psoriasis)
• Minoxidil
• Injected corticosteroids (directly into the areas with hair loss)

Low-level light therapy (LLLT) has also been approved by the U.S. Food and Drug Administration (FDA) as a treatment option and is effective in treating androgenic hair loss.

How to Minimize or Stop Scalp Itching and Shedding

As with treatment, strategies to minimize or stop itching and shedding depend on the cause. Some general tips for caring for a scalp that is itching and/or shedding include:

• Avoid sharing items such as brushes, hats, and combs.
• If advised, wash hair regularly with medicated shampoo (like those for dandruff), as directed.
• Handle, brush, and comb hair gently.
• For hair loss, use a gentle shampoo and condition well.
• Use leave-in conditioner or detangler after you wash and condition your hair.
• Use a microfiber towel to wrap your hair after washing to reduce the time spent blow-drying.
• Skip hot oil treatments, and at-home chemical treatments such as colouring, perming, chemical straightening, and relaxing.
• Use hot appliances sparingly, and set them to the lowest heat you can manage.
• When possible, let your hair air-dry.
  
• Avoid tight hairstyles and try not to twist your hair or pull on it.
  
• Adopt healthy lifestyle habits, like eating nutrient-rich foods and avoiding smoking.

Summary

Itchy scalp and hair loss can both be caused by a number of different factors, including medical conditions, environmental factors, and genetics.

There is some overlap between itchy scalp and hair loss. Both symptoms can occur with the same condition, such as scalp ringworm. Scratching an itchy scalp can cause damage that leads to hair loss. Hair loss in conditions such as alopecia areata may cause scalp itch to occur before the hair falls out.

It's important to see a healthcare provider to get an accurate diagnosis and appropriate treatment plan.

Treatment depends on the cause but may include topical medications and shampoos, oral or injected medications, and lifestyle practices.

https://www.verywellhealth.com/itchy-scalp-and-hair-loss-8351171