Women With This Scalp Condition May Be More Prone To Hair Loss. Here's How To Find Relief
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Like many Black women, Cheriene Floyd, began to use chemicals to alter the texture of her naturally coarse, thick hair at a young age—8, to be exact. Around that time, she began to notice irritated, flaky patches of skin popping up around her eyebrows, hairline, nose, and the inside of her ears. “I have early memories of stylists pointing out the ‘dryness’ on my scalp, telling me to grease it with oils,” she recalls.
It didn't help.
Adults in Floyd’s life were perplexed too—what could be causing these symptoms? Some assumed it was a reaction to the hair relaxers. A nurse at school suggested it was a cleanliness issue, which only made Floyd more self-consciousness. “At that age, I didn’t have the knowledge or confidence to question those assumptions,” she admits. "So, I really internalized the belief that something was wrong with me.”
A true diagnosis didn’t come until a few years later, when at 12, a dermatologist told Floyd that her longtime skin struggles were not a product of uncleanliness or a temporary reaction to hair treatments, but rather flare-ups of seborrheic dermatitis. She was one of more than 10 million people in the United States living with the inflammatory skin condition, known to cause chronic dryness, flaking, and scaling of the skin.
Finally, an answer
A form of eczema categorized by a chronic dryness, flaking, and scaling of the skin, seborrheic dermatitis is often associated with one of its hallmark physical manifestations: dandruff. "It's quite common, affecting between one and five percent of the population," says Kenneth Mark, MD, a board-certified dermatologist in New York City. And while it can appear in patients of all ages and skin types, research show it's one of the top five medical diagnosis received by Black patients, affecting 6.5% of this population.
In adults, seborrheic dermatitis is a lifelong condition that cannot be cured, only managed. Although the skin disease most typically occurs on the scalp and face, flare-ups are also known to happen in other areas with plentiful sebaceous glands, including the chest, upper back, and inside and around the ears.
The root of the issue
Like similar skin conditions, the cause of seborrheic dermatitis isn’t always easy to pin down. “It’s believed to be connected to a disruption of the skin’s microbiome by an overgrowth of a yeast-like fungus called Malassezia,” explains Geeta Yadav, MD, a board-certified dermatologist in Toronto. Malassezia grows in the presence of skin's natural oil, called sebum, so overactive sebaceous glands or infrequent hair or face washing can exacerbate the condition. This important detail came too late for Floyd, who spent years following the advice of her hairstylist—to treat scaly patches with emollients and oils, a solution commonly explored by patients of color, research shows. “It wasn't until I was in my thirties that a dermatologist informed me that oil on the scalp can actually exacerbate seborrheic dermatitis," says Floyd, now 45. "Who knows how much more damage I was doing with my haircare regimen.”
Other risk factors for developing the condition include “genetics, stress, hormonal fluctuations, dry air, and a weakened immune system due to diseases such as HIV or Parkinson’s Disease,” Dr. Yadav adds.
Unexpected toll
The irritation and flakiness can cause a secondary set of symptoms—such as post-inflammatory hyperpigmentation and skin lightening, which are both common problems in patients with deeper skin tones. In rare cases, sebhorreic dermatitis can result in hair loss, possibly due to scratching or oxidative stress caused the overgrowth of Malessezia, some research suggests.
But the physical side effects pale in comparison to the emotional toll. “Like eczema and psoriasis, seborrheic dermatitis is immediately visible and draw unwanted attention, causing patients to change the clothing they wear to minimize the appearance of flakes,” Dr. Yadav says. “Many struggle with self-esteem issues due to the condition.” For Floyd, it spawned years of shame, something she's only been able to fully come to terms with as an adult. “Seborrheic dermatitis caused me to shrink, to avoid drawing too much attention to myself,” she recalls. “Even on days when I started off without a flare-up, I was constantly aware that one could develop, and this awareness affected everything from how close I allowed people to get to me to my clothing choices to my willingness to be photographed.”
Difficult road to diagnosis
Many cases of seborrheic dermatitis take time to be properly diagnosed—especially in those with darker skin, who may present differently from those with lighter complexions. And though most patients will try an over-the-counter remedy as their first line of defense, Dr. Yadav suggests seeing a dermatologist at the first sign of symptoms. “This condition can take a toll on one’s mental health, so I recommend seeking medical attention as soon as possible,” she says. “Managing your seborrheic dermatitis can go a long way toward improving your everyday life.”
In most cases, a conversation and physical examination is enough to diagnose the skin disease, but dermatologists will likely ask about family and medical history as well, just to rule out the possibility of other forms of eczema or psoriasis.
Relief within reach
Luckily, there’s a wide range of options for those dealing with seborrheic dermatitis, from readily available over-the-counter solutions that aim to reduce the impact of Malassezia or slough away dead skin cells and oil to prescription-strength topical steroids and anti-yeast medications, Dr. Mark says. But while effective, many of these treatments are impractical for Black women in particular, research shows, because they require near-daily use and don't take into account the fact that different ethnicities may wash less frequently.
It's a conundrum Floyd experienced first-hand: She tried her luck with over-the-counter products containing zinc, salicylic acid, and coal tar and even experimented with sulfur products, which ultimately singed her strands. “Most of the shampoos completely dried out my hair, and the creams caused hyperpigmentation,” she recalls. “If you were to look at pictures of me in middle school, you’d notice discoloration around my hairline–the result of harsh topical steroids.”
As a result, Floyd turned to home remedies. “I tried everything from apple cider vinegar to coconut oil to aloe vera to tea tree oil,” she says, admitting that during flare-ups, she'd apply these ingredients to affected areas on her face and scalp. But she quickly learned that “just because something is natural, doesn’t mean it will be gentle or effective.” Of all these natural remedies, aloe vera is the only one that remains in her treatment plan today, alongside a prescription steroid shampoo and Zoryve (roflumilast) 0.3%, a topical foam she discovered earlier this year and swears by.
And while seborrheic dermatitis cannot be cured or reversed, flare-ups can be avoided. The best form of prevention is frequent washing of the body, face, and scalp with antifungal ingredients, an especially crucial step after exercise or on humid or sweaty days. Extra precautions like sticking to lukewarm showers, limiting stress where possible, wearing loose clothing that won’t irritate skin, and adding humidity to the air with a humidier can also help, says Dr. Mark notes. “The key is to treat it and get better—it's a fixable problem,” he says.
A path forward
But perhaps the most transformational step for Floyd was confronting her vulnerability and discussing her condition openly. It was then that she started to realize how much seborrheic dermatitis had held her back over the years—and how she needed to break free from that mindset. “I went from living with embarrassment and feeling unattractive to finding power in sharing my story,” she says. “It’s now become an important part of my journey to honor the fullness of who I am.”
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