Is seborrhoeic dermatitis associated with a diffuse, low‐grade folliculitis and progressive cicatricial alopecia?

Abstract

An association between adult scalp seborrhoeic dermatitis and cicatricial hair loss has not previously been convincingly established. This study seeks to demonstrate a unique relationship between a clinically identifiable chronic scalp dermatitis-folliculitis with the characteristic histological features of low-grade inflammatory fibrosing alopecia, resulting in a distinctive progressive cicatricial alopecia which we believe is prevalent and hitherto unrecognised, and befits the description of seborrhoeic folliculitis. The clinical, epidemiological and histopathological features of seborrhoeic folliculitis are demonstrated to establish its unique status among the disorders of adult diffuse cicatricial alopecia.

A comment on the science of hair aging

“…The protective benefits of the hair to the scalp, such as UVR screening, moisture retention, and mechanical shielding, are apparent, while the role of the scalp as an incubatory environment for the pre-emergent hair fiber is often disregarded. [41] However, there is a wealth of observational data on specific dermatological conditions of the scalp, such as dandruff and seborrheic dermatitis,[42434445464748] atopic dermatitis,[4449] and psoriasis,[50515253545556575859] providing the evidence for the role of the scalp condition in supporting the production of healthy hair. Again, oxidative stress is prevalent in all of these skin conditions,[60616263646566676869707172] just as in normal skin aging and related to the specific microbiome of the scalp and to the environmental exposures.…”

Incubatory environment of the scalp impacts pre‐emergent hair to affect post‐emergent hair cuticle integrity

“…Scalp psoriasis has been shown to result in hair with altered surface physical and chemical properties and premature hair loss . Similar observations have been made regarding the impact of dandruff and seborrheic dermatitis (D/SD) on hair physical and chemical characteristics and hair loss . This can be summarized in a model identifying some of the factors that impact both pre‐ and post‐emergent hair and contribute to the cumulative stress experienced by hair (Figure ).…”

“…[26][27][28] Similar observations have been made regarding the impact of dandruff and seborrheic dermatitis (D/SD) on hair physical and chemical characteristics [29][30][31][32] and hair loss. [33][34][35] This can be summarized in a model identifying some of the factors that impact both pre-and post-emergent hair and contribute to the cumulative stress experienced by hair ( Epidemiological studies only provide indirect support for a direct causal relationship between scalp condition and hair attributes. A treatment study allows a more definitive conclusion by following in parallel the changes in scalp and resultant changes in hair.…”

Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance

“…There has been a focus in recent literature on an association between alopecia areata and AD (7), although AD and other inflammatory skin conditions can lead to a diffuse-pattern alopecia. Alopecia associated with chronic inflammatory scalp dermatoses is important to recognize, because early stage disease is reversible, although in late stages it can be scarring (2)(3)(4)(5). ACD can involve the scalp primarily or be an aggravator of another inflammatory dermatitis such as AD.…”

“…It is characterized by inflamed, pruritic, erythematous, often scaly plaques in areas of exposure to the culprit allergen. An association between other inflammatory skin conditions (seborrheic dermatitis, psoriasis, atopic dermatitis [AD]) and alopecia has been reported in the literature (2)(3)(4)(5). We describe three cases demonstrating resolution of chronic inflammatory dermatitis-associated alopecia through avoidance of balsam derivatives in children allergic to balsam of Peru.…”