Eczema, formally known as atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, red, and intensely itchy patches. While it commonly affects the limbs and body, when eczema flares on the scalp, a noticeable side effect is hair thinning or loss. This experience often leads people to wonder if the lost hair will ever return. This article will explore how inflammation affects the hair cycle and whether hair loss from eczema is temporary or permanent.
How Eczema Causes Hair Loss
Hair loss associated with eczema results from two distinct processes that disrupt the normal growth environment of the hair follicle. The first involves the biological impact of chronic inflammation on the hair growth cycle. The immune response that causes redness and scaling on the scalp also affects the surrounding hair structures.
Persistent inflammation weakens the hair roots and prematurely forces hairs from the active growth phase (anagen) into the resting phase (telogen). This widespread, simultaneous shedding is a form of temporary hair loss known as telogen effluvium. The hostile environment created by the flare-up means that follicles cannot sustain healthy growth, leading to increased shedding and diffuse thinning.
The second cause of hair loss is the mechanical trauma resulting from intense itching, or pruritus. Eczema triggers an itch-scratch cycle that physically damages both the hair shaft and the skin surface. Constant scratching breaks hair strands off or pulls out hair by the root, causing localized patches of hair loss. This manipulation can also lead to minor wounds, leaving the area vulnerable to secondary bacterial infections that damage the follicle.
The Prognosis for Regrowth
Hair loss resulting from an eczema flare is generally not permanent. Since the underlying cause is a disruption of the hair cycle due to inflammation and physical stress, the hair follicles usually remain intact. Once the eczema is effectively treated and the inflammation subsides, the hair cycle can normalize.
The hair will re-enter the anagen (growth) phase after the scalp has healed. While some individuals may notice reduced shedding within a few weeks of successful treatment, visible thickening and substantial regrowth take time. Because hair grows at a rate of approximately half an inch per month, it can take three to six months to see noticeable improvement in density.
In rare and severe instances, eczema-related hair loss can become permanent. This outcome occurs if chronic, deep-seated inflammation leads to a condition called scarring alopecia (cicatricial alopecia). Scarring alopecia involves the destruction of the hair follicle and its replacement with scar tissue, preventing future hair growth in that area. Managing severe or persistent scalp inflammation is important, especially if secondary infections are present.
Management Strategies to Encourage Recovery
The most effective strategy for promoting hair regrowth is gaining control over the underlying eczema and its inflammatory process. Dermatologists often prescribe topical corticosteroids or topical calcineurin inhibitors to quiet the immune response on the scalp. These anti-inflammatory medications reduce the swelling and redness that disrupt the hair follicle’s function.
Targeting the inflammatory cascade stops the progression of hair loss and signals the follicles to exit the resting phase. Medicated shampoos containing active ingredients like ketoconazole, salicylic acid, or coal tar can manage flaking and inflammation, particularly in cases of seborrheic dermatitis. These products help lift scales and reduce yeast overgrowth contributing to the flare.
Preventing mechanical trauma from scratching is a fundamental step toward recovery. Using oral antihistamines, if recommended by a physician, can help reduce the intensity of the itch sensation. Applying cool compresses or wet wraps provides temporary relief, helping to break the damaging itch-scratch cycle that causes hair breakage.
A gentle hair care routine further supports the healing scalp environment. Avoid shampoos and conditioners containing harsh sulfates, fragrances, or dyes, as these can be irritants that trigger a new flare-up. When styling, minimizing the use of excessive heat, such as from blow dryers on a high setting, and opting for loose hairstyles reduces stress on sensitive hair shafts and follicles.