Does Scratching Itches Cause Hair Loss?

Quick Summary: Does Scratching Itches Cause Hair Loss?

Structure of a Hair Shaft: The main parts of a hair shaft are its cortex and cuticle. They protect and maintain hair integrity.
What Causes Itching on the Scalp? Itching, known as pruritus, can be caused by various factors like dandruff, psoriasis, allergic reactions, infections, infestations, and stress. Itching alone does not cause hair loss, however, aggressive and habitual scratching of these itches can lead to hair loss.
How Itching Can Lead to Hair Loss? Scratching can cause mechanical damage, inflammation, and secondary infections – all of which can contribute to hair loss.
Diagnosing the Cause of an Itchy Scalp: Proper diagnosis involves a visual examination, reviewing hair care routines, patch testing, laboratory analysis, and blood tests to identify the underlying cause.
Treatment and Management Strategies: Managing itching and preventing hair loss involves treating the underlying cause, such as by using medicated shampoos, topical steroids, antifungal treatments, allergy management, stress reduction, physically avoiding scratching, and keeping the scalp moisturised.
Can You Have a Hair Transplant with an Itching Scalp? It’s important to explore the cause of an itchy scalp before undergoing a hair transplant. This is to ensure a successful procedure and to avoid complications.
Conclusion: While itching itself doesn’t cause hair loss, underlying conditions that trigger itching must be managed to protect hair health and prevent hair shedding. Seeking professional advice is key to minimising the impact of itching on hair health.

Hair loss can be distressing, and when accompanied by itching, it raises concerns for many individuals. Does the itching itself lead to hair loss, or is it merely a symptom of an underlying condition? In this article, we’ll explore the connection between itches and hair loss, investigate potential causes, and provide insights into how you can manage both symptoms effectively.

Structure of a Hair Shaft

Before diving deeper, it’s important to revisit the basics of hair anatomy as these structures are affected by itching.

Hair is a complex structure with each part playing a specific role. These complex structures are significantly influenced by how we care for them. The strength of our hair largely depends on its two main shaft components: the cortex and the cuticle¹. These parts work together to protect and maintain the integrity of your hair through everything life throws at it, from brushing to styling to itching.

The Cuticle: The hair’s first line of defence. The cuticle’s layers of tiny, overlapping scales (similar to roof slates) not only protect the inner parts of the hair against damage from external factors, but also plays a significant role in how shiny and smooth your hair looks and feels because of its reflective mirror-like properties.
The Cortex: Going deeper, you’ll find the cortex. Thanks to durable keratin proteins bonded tightly together, the cortex is a source of strength and elasticity. It also contains melanin, the pigment responsible for your hair’s colour and protecting your strands from UV damage.

hair shaft diagram — Structure of a hair shaft.

What Causes Itching of the Scalp?

By definition, itching is the existence of a tingling or uncomfortable feeling that is associated with a desire to scratch. Itching of the scalp, medically known as “pruritus”, can be caused by a variety of factors. While it can be annoying, it’s important to understand that itching itself doesn’t directly cause hair loss². However, the underlying conditions that trigger itching may lead to temporary hair loss if left untreated, and the urge to scratch an itch can lead to physical trauma such as bleeding.

Common Causes of Scalp Itching:

Seborrheic Dermatitis: Dandruff is a common symptom and sign of itching characterised by the shedding of dead skin cells, which appear as white or yellowish flakes in the hair and on the shoulders. Seborrheic dermatitis causes inflammation, redness, and increased itching which in turns also leads to dandruff. Often the condition is caused by the overgrowth of a yeast-like fungus called Malassezia, which can irritate the scalp and lead to itching. While dandruff is not contagious or harmful, it can be a persistent and embarrassing condition³.
Psoriasis: Psoriasis is an autoimmune condition that leads to the rapid turnover of skin cells, resulting in thick, scaly patches on the skin. The scalp is one of the most commonly affected regions in psoriasis. These patches can be itchy and may cause discomfort, potentially leading to hair loss if the scalp is scratched excessively⁴.
Allergic Reactions: Allergic contact dermatitis occurs when the scalp reacts to certain hair care products, such as shampoos, dyes, or styling products. The resulting inflammation can cause itching and discomfort, which may lead to hair thinning if scratching becomes habitual⁵.
Infections: Fungal infections like ringworm and bacterial infections, such as folliculitis, can lead to inflammation and itching, which may result in hair shedding if not treated promptly. Chickenpox is a highly contagious viral infection that is commonly known for causing an itchy rash along with red spots and blisters. Excessive scratching can damage the scalp and hair follicles, potentially leading to temporary hair shedding in affected areas⁶.
Infestations: Head lice are tiny parasitic insects that infest the scalp and feed on human blood, causing intense itching. The itching is primarily a reaction to the lice bites and their saliva, which can lead to significant discomfort. While lice themselves do not cause hair loss, the persistent scratching often associated with a lice infestation can damage the scalp and hair follicles resulting in temporary hair thinning or loss in areas where scratching is most frequent⁷.
Stress and Anxiety: Emotional stress and anxiety can lead to physical symptoms, including scalp itching. This type of itching, often referred to as “psychogenic pruritus”, doesn’t stem from an underlying skin condition but can still lead to hair loss due to excessive scratching. Telogen effluvium is a different condition where stress, shock or trauma results in a form of temporary hair loss⁸.

How Itching Can Lead to Hair Loss

While itching itself doesn’t directly cause hair loss, the act of scratching can damage the hair and scalp, potentially leading to hair shedding. Here’s how:

Mechanical Damage: Repeated scratching can cause trauma to the hair cuticle, eventually damaging hair follicles. The mechanical force exerted by scratching can weaken hair strands, causing them to break or fall out prematurely. This is particularly true if the itching is persistent and intense.
Inflammation: Conditions like seborrheic dermatitis, psoriasis, and allergic reactions cause inflammation of the scalp. Inflammation can damage the hair follicles, disrupt the normal hair growth cycle, and lead to hair thinning or shedding⁹.
Secondary Infections: Continuous scratching can create small openings or wounds on the scalp, increasing the risk of bacterial infections. These infections can further irritate the scalp and exacerbate hair loss.

Diagnosing the Cause of an Itchy Scalp

If you experience persistent scalp itching accompanied by noticeable hair loss, it’s important to consult a dermatologist or hair loss specialist. A professional evaluation can help determine the underlying cause of your symptoms and guide you toward effective treatment options.

Diagnosing the cause of an itchy scalp involves a thorough evaluation including:

Visual Examination: A dermatologist will first examine your scalp for visible signs of conditions like dandruff, psoriasis, or fungal infections.
Hair Care Routine Review: Discuss recent changes in your hair care products or routine, as these can contribute to scalp irritation.
Patch Testing: A small amount of the suspected product may be applied to a discrete area of skin to rule out allergic contact dermatitis.
Laboratory Analysis: If an infection is suspected, a sample of scalp skin or hair may be taken for laboratory testing.
Blood Tests: In cases where a systemic condition, such as a thyroid disorder, is suspected, blood tests may be conducted to determine the underlying cause.

Treatment and Management Strategies

Addressing the underlying cause of scalp itching is essential for preventing further hair loss and complications like scarring or secondary infections. Here are some strategies to manage itching and protect your hair¹⁰:

Medicated Shampoos: If dandruff or seborrheic dermatitis is the culprit, medicated shampoos containing ingredients like ketoconazole, selenium sulfide, or zinc pyrithione can help reduce itching and inflammation. Regular use can also prevent the overgrowth of the fungus responsible for these conditions. Lice infestations can be effectively treated with medicated shampoos and carefully removing nits (lice eggs).
Topical Steroids: For conditions like psoriasis or allergic contact dermatitis, topical corticosteroids can reduce inflammation and itching. These should be used under the guidance of a healthcare provider, as long-term use can have side effects¹¹.
Antifungal Treatments: If a fungal infection is causing itching and hair loss, antifungal medications—either topical or oral—can effectively clear the infection and alleviate symptoms.
Allergy Management: Identifying and avoiding allergens in hair care products is crucial for managing allergic contact dermatitis. Hypoallergenic products may be recommended to prevent further reactions. Soothing lotions or antihistamines can be used to manage the itch. As the saying goes, “prevention is better than cure.” To avoid potential allergic reactions to new hair products, it’s a good idea to conduct a patch test first. You can do this by applying a small amount of the product to a discrete area of skin, such as behind the ear. If no irritation or allergic reaction occurs after 24 hours, it’s generally safe to proceed with regular use.
Stress Reduction: Stress management techniques, such as mindfulness, yoga, and therapy, can help reduce psychogenic itching and prevent associated hair loss. Reducing stress can also have a positive impact on overall hair health.
Avoid Scratching: While it can be difficult, minimising scratching is important to prevent further damage to the scalp and hair follicles. Keeping nails trimmed and wearing gloves at night may help reduce the urge to scratch.
Moisturising and Nourishing: Regular application of nourishing oils or creams can maintain scalp moisture, reducing dryness and quell flakiness thereby effectively reduce scalp itching and promote overall scalp health. Coconut oil helps moisturise the scalp and prevent dryness. Peppermint oil provides a cooling sensation that can alleviate itching and improve blood circulation to the scalp. To use these oils, apply a few drops to the scalp, massage gently, and leave it on for at least 30 minutes before washing it out with a gentle shampoo.

Can You Have a Hair Transplant with an Itchy Scalp?

Hair Transplant is a surgical procedure that involves transplanting healthy hair follicles from a donor area on the scalp to bald or thinning areas. This procedure provides results that are long-lasting, effectively restoring hair growth and improving appearance and self-confidence. Undergoing a hair transplant with an itchy scalp can be a concern for patients, and it’s important to explore the underlying cause of the itchiness so you can optimise your scalp before proceeding with the procedure.

An itchy scalp can cause inflammation, irritation, and even infection, which could compromise your recovery and thereby the success of the hair transplant. For instance, inflammation may interfere with the healing process post-transplant, while an active infection could increase the risk of complications. If you have been diagnosed with psoriasis, it is important to note that physical trauma to the skin, such as surgery, can lead to new psoriasis patches, a phenomenon known as the Koebner effect.

Therefore, before a hair transplant, it’s crucial to consult with your Surgeon to explore and treat the cause of the itchy scalp. Effective treatment of the underlying condition can ensure that the scalp is healthy and prepared for the procedure, maximising the chances of a successful transplant and minimising the risk of further irritation or damage to the scalp.

Conclusion

While itching doesn’t directly cause hair loss, the underlying conditions that trigger scalp itching can lead to hair shedding if not properly managed. Addressing the root cause of itching, whether it’s dandruff, psoriasis, or an allergic reaction, is essential to protect your hair and maintain a healthy scalp. By taking proactive steps and seeking professional advice when necessary, you can minimise the impact of itching on your hair health.

References

Monselise, A., Cohen, D. E., Wanser, R. and Shapiro, J. (2017) ‘What Ages Hair?’, International Journal of Women’s Dermatology, 3(1 Suppl), pp. S52–S57. Available at: https://doi.org/10.1016/j.ijwd.2017.02.010
Bin Saif, G. A., Ericson, M.E., Yosipovitch, G. (2011) ‘The itchy scalp–scratching for an explanation’, Exp Dermatol, 20(12), 959-68. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233984/
NHS. “Dandruff and Seborrhoeic Dermatitis.” Available at: https://www.nhs.uk/conditions/dandruff/
National Psoriasis Foundation. “Scalp Psoriasis.” Available from: https://www.psoriasis.org/about-psoriasis/types/scalp-psoriasis/
American College of Allergy, Asthma, and Immunology. “Allergic Contact Dermatitis.” Available from: https://acaai.org/allergies/types/skin-allergies/contact-dermatitis/
CDC. “Ringworm and Other Fungal Infections.” Available from: https://www.cdc.gov/fungal/diseases/ringworm/index.html
Vázquez-Herrera, N. E., Sharma, D., Aleid, N.M., Tosti, A. (2018) ‘Scalp Itch: A Systematic Review’, Skin Appendage Disorders, 4(3), pp. 187-199. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120392/
Harvard Health Publishing. “Understanding the stress response.” Available from: https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
NIH. “Inflammation: Causes and Impact.” Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
Rattanakaemakorn, P., & Suchonwanit, P. (2019) ‘Scalp pruritus: Review of the pathogenesis, diagnosis, and management’, BioMed Research International, 1-10. https://onlinelibrary.wiley.com/doi/10.1155/2019/1268430
Mosca, M., Hong, J., Hadeler, E., Brownstone, N., Bhutani, T., Liao, W. (2021) ‘Scalp Psoriasis: A literature review of effective therapies and updated recommendations for practical management’, Dermatol Ther (Heidelb), 11(3), pp. 769-797. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163911/