TE vs Seborrheic Dermatitis

What Is Seborrheic Dermatitis?

Seborrheic dermatitis is a common, chronic inflammatory skin condition that primarily affects areas rich in oil glands, especially the scalp. It is characterized by redness, greasy scales, and persistent itching. This condition results from a combination of factors, including the overgrowth of certain yeast on the skin, increased sebum (oil) production, and the body’s immune response.

On the scalp, seborrheic dermatitis often presents as patches of inflamed, flaky skin that may be yellowish or greasy in appearance. The inflammation can range from mild to severe, and symptoms may fluctuate over time, often worsening during periods of stress or seasonal changes.

How it relates to dandruff

Dandruff is considered a mild form of seborrheic dermatitis. While dandruff mainly causes dry, white flakes without significant redness or irritation, seborrheic dermatitis involves more pronounced inflammation, itching, and greasy or yellowish flakes. Both conditions are linked to the same underlying mechanisms, such as yeast overgrowth and increased oil production.

The presence of dandruff does not always mean a person has full-blown seborrheic dermatitis, but persistent or severe flakes, especially with scalp redness or itching, may indicate the more inflammatory form.

Common areas affected (scalp, eyebrows, beard area, around nose)

Seborrheic dermatitis most frequently affects the scalp, but it can also involve other areas with high oil gland density. Commonly affected sites include the eyebrows, the skin between the eyebrows, the beard area, and the sides of the nose. In some cases, it may also appear behind the ears, on the chest, or in body folds.

The distribution of seborrheic dermatitis helps distinguish it from other scalp and skin conditions. When flakes, redness, or itching extend beyond the scalp to these facial or body areas, seborrheic dermatitis should be considered as a possible cause.

Telogen Effluvium vs Seborrheic Dermatitis

Hair shedding patterns

Telogen effluvium is defined by diffuse hair shedding from the entire scalp. The hair loss is typically sudden in onset and can be traced to a trigger event that occurred one to six months earlier. Shedding is usually most noticeable during washing or brushing, and complete bald patches do not occur. The density of hair may appear reduced, but the scalp itself remains healthy without scarring or significant inflammation.

In contrast, seborrheic dermatitis does not directly cause diffuse hair shedding. Any hair loss associated with seb derm is usually due to breakage from scratching or inflammation at the scalp surface. The pattern is not truly diffuse and is often localized to areas with the most inflammation or scaling. Hair may appear brittle or thin in affected patches, but widespread shedding is not a hallmark feature.

Itching and inflammation (more typical with seb derm)

Itching and inflammation are prominent symptoms of seborrheic dermatitis. The scalp often feels itchy, sore, or even burning, especially during flare-ups. Redness and irritation are visible, and scratching can worsen both the discomfort and the appearance of the scalp.

Telogen effluvium, on the other hand, is not usually associated with significant itching or inflammation. Some individuals may report scalp tenderness or trichodynia (a sensation of discomfort or pain in the scalp), but these symptoms are not specific to TE and can occur in other types of hair loss as well. The scalp in TE typically looks normal aside from the increased shedding.

Presence of dandruff and flakes (greasy/yellow vs dry/white)

Seborrheic dermatitis is strongly associated with visible flakes and scaling. The flakes are often greasy or yellowish and may stick to the scalp or hair shafts. In severe cases, thick crusts can form. The presence of oily, adherent flakes is a key feature that helps distinguish seb derm from other scalp conditions.

In telogen effluvium, dandruff and flakes are not primary symptoms. The scalp usually appears clean, without significant scaling or flaking. If flakes are present in someone with TE, it may indicate a coexisting scalp condition such as seborrheic dermatitis or psoriasis.

Causes and Triggers

Common causes of telogen effluvium (stress, illness, postpartum, meds, deficiencies)

Telogen effluvium is most often triggered by a significant physiological or psychological stressor. Common causes include acute illness with fever, major surgery, childbirth (postpartum), rapid weight loss, or starting or stopping certain medications. These events disrupt the normal hair growth cycle, pushing more hairs into the shedding (telogen) phase.

Nutritional deficiencies, such as low iron, vitamin D, or zinc, can also contribute to TE. In some cases, the trigger is easy to identify, while in others, especially with chronic TE, the cause may remain unclear.

Common causes of seborrheic dermatitis (yeast overgrowth, oil production, immune response)

Seborrheic dermatitis is believed to result from an interaction between Malassezia yeast (a normal skin inhabitant), excess oil production, and an individual’s immune response. When the yeast population increases or the immune system reacts abnormally, inflammation and flaking occur.

Other contributing factors include genetic predisposition, hormonal changes, and environmental influences. Seborrheic dermatitis is not caused by poor hygiene and is not contagious. Flare-ups may be more frequent during times of stress or cold, dry weather.

Shared triggers (stress, weather changes, sleep disruption)

Both telogen effluvium and seborrheic dermatitis can be triggered or worsened by stress. Psychological stress impacts the hair growth cycle and the skin’s immune response, making both conditions more likely to flare during difficult periods.

Seasonal changes, particularly cold or dry weather, can worsen seborrheic dermatitis and may also contribute to TE by affecting overall health and well-being. Disrupted sleep and fatigue are additional shared triggers that can impact scalp health and hair growth.

Symptoms: How to Tell Them Apart

How each condition feels (itch, burn, soreness, tenderness)

Seborrheic dermatitis typically causes noticeable discomfort on the scalp, including itching, burning, and soreness. The urge to scratch can be intense, and the affected areas may feel tender or inflamed, especially during active flare-ups.

Telogen effluvium, in contrast, is usually not associated with significant scalp sensations. Some individuals may experience mild tenderness or trichodynia, but most only notice increased hair shedding without discomfort. If severe itching or burning is present, another scalp condition may be involved.

How each condition looks (flakes, redness, scaling, diffuse thinning)

Seborrheic dermatitis is visually marked by greasy, yellowish flakes, redness, and sometimes thick scaling on the scalp. The affected skin may appear inflamed, and flakes can extend to the eyebrows, beard, or sides of the nose.

Telogen effluvium presents as diffuse thinning of the hair across the entire scalp. There are no bald patches, scarring, or significant redness. The scalp itself appears normal, with no scaling or flaking unless another condition is present.

Quick self-check guide (what points to TE vs what points to seb derm)

A quick way to distinguish between telogen effluvium and seborrheic dermatitis is to focus on the main symptoms:

• Points to TE: Sudden or gradual increased hair shedding from all over the scalp, no bald patches, normal-looking scalp, minimal or no itching.
• Points to Seb Derm: Persistent scalp itching, visible greasy or yellow flakes, redness or scaling, discomfort, and involvement of other oily skin areas (eyebrows, beard, sides of nose).

If both increased shedding and significant scalp discomfort or flakes are present, both conditions may be occurring together.

Diagnosis: How Are They Identified?

What doctors ask (timeline, triggers, product changes, medical history)

When evaluating hair loss or scalp symptoms, doctors begin by taking a detailed history. They ask about the timeline of hair shedding or scalp discomfort, recent illnesses, major life events, new medications, and any changes in hair or skin products. Questions about family history, nutritional status, and underlying medical conditions are also common.

For telogen effluvium, the focus is on identifying a trigger that occurred one to six months before the onset of shedding. For seborrheic dermatitis, doctors inquire about the pattern of itching, flaking, and whether symptoms affect areas beyond the scalp.

What doctors look for on exam (scalp scaling/redness vs miniaturization vs diffuse shed)

During the physical exam, doctors inspect the scalp for signs of inflammation, scaling, and redness. Seborrheic dermatitis is identified by greasy flakes, redness, and sometimes thick crusts. The distribution of flakes and involvement of other facial areas are also noted.

In telogen effluvium, the scalp usually appears normal, but there may be visible diffuse thinning or a higher number of short, regrowing hairs. There are no bald patches, scarring, or significant redness. The hair pull test may reveal increased shedding in active TE.

Common tests when needed (pull test, dermoscopy/trichoscopy, basic labs)

If the diagnosis is unclear, doctors may perform a gentle hair pull test. In active telogen effluvium, this test typically yields at least two hairs per pull. Dermoscopy or trichoscopy can help visualize hair shafts, scalp scaling, and new hair growth, aiding in the distinction between TE and other causes of hair loss.

Basic laboratory tests may be ordered to check for nutritional deficiencies, thyroid dysfunction, or other systemic causes of hair loss. In most cases, a careful history and physical exam are sufficient for diagnosis.

Treatment Options

Treating telogen effluvium (address trigger, correct deficiencies, time)

The main approach to treating telogen effluvium is to identify and address the underlying trigger. This may involve recovering from illness, correcting nutritional deficiencies, or adjusting medications under medical supervision. Most cases of acute TE resolve within six months once the trigger is removed.

Supportive care includes gentle scalp care and avoiding unnecessary stress to the hair. Patience is important, as regrowth can take several months. Telogen Effluvium Treatment.

Managing seborrheic dermatitis (medicated shampoos, topical anti-inflammatories when needed)

Seborrheic dermatitis is managed with medicated shampoos containing antifungal agents such as ketoconazole, which reduce yeast overgrowth and inflammation. Other options include shampoos with zinc pyrithione, selenium sulfide, or coal tar. These products should be used as directed, with adequate contact time on the scalp.

In more severe cases, topical corticosteroids or other anti-inflammatory treatments may be prescribed for short-term use. Consistent scalp care and avoidance of known triggers can help keep symptoms under control. Ketoconazole and Hair Loss.

What to do if you have both (prioritize calming the scalp while TE recovers)

It is possible to experience both telogen effluvium and seborrheic dermatitis at the same time. In these cases, the priority is to calm scalp inflammation and control flaking with appropriate medicated shampoos and gentle care. Avoiding harsh products and minimizing scratching can help prevent further irritation and hair breakage.

Once scalp inflammation is managed, focus on supporting hair regrowth by addressing any underlying triggers for TE. Recovery may take time, but most people see improvement with consistent care and medical guidance.

Scalp Care Tips

Wash routine (how often, contact time for medicated shampoos)

A regular wash routine is important for managing both seborrheic dermatitis and telogen effluvium. For seb derm, washing the scalp two to three times per week with a medicated shampoo is often recommended. Allow the shampoo to remain on the scalp for several minutes before rinsing to maximize its effectiveness.

For those with TE, gentle cleansing is key. Avoid overwashing, but do not let oil and flakes build up. Adjust frequency based on scalp needs and product instructions.

Gentle product strategy (avoid fragrance-heavy irritants, stop harsh actives temporarily)

Choose hair and scalp products that are free from harsh fragrances, alcohol, and strong detergents. These ingredients can irritate sensitive scalps and worsen inflammation or shedding. Temporarily stop using strong actives like exfoliating acids or retinoids on the scalp during flare-ups.

Opt for mild, pH-balanced shampoos and conditioners. If using medicated shampoos, follow the instructions carefully and avoid combining multiple treatments unless directed by a healthcare provider.

Habits to avoid (scratching, heavy oils, hot water, tight styles)

Scratching the scalp can worsen inflammation, increase flaking, and lead to hair breakage. Try to avoid this habit, especially during flare-ups. Heavy oils and greasy styling products can clog pores and aggravate seborrheic dermatitis.

Use lukewarm water for washing, as hot water can dry out the scalp and increase irritation. Avoid tight hairstyles that pull on the hair and scalp, as these can contribute to hair shedding and discomfort.

Frequently Asked Questions

Can telogen effluvium cause itching?

Itching is not a primary symptom of telogen effluvium. Most people with TE notice increased hair shedding without significant scalp discomfort. However, some may experience mild tenderness or trichodynia, but persistent itching suggests another scalp condition may be present.

Is dandruff always a sign of seborrheic dermatitis?

Dandruff is a mild form of seborrheic dermatitis, but not all flakes are due to seb derm. Other scalp conditions, such as psoriasis or dry skin, can also cause flaking. Persistent or severe flakes, especially with redness or itching, are more likely to indicate seborrheic dermatitis.

How long does hair shedding last in TE?

In acute telogen effluvium, hair shedding typically lasts less than six months. Chronic TE is defined by shedding that continues for more than six months. The duration depends on the underlying trigger and individual factors.

Do TE and seborrheic dermatitis ever occur together?

Yes, it is possible to have both telogen effluvium and seborrheic dermatitis at the same time. Scalp inflammation from seb derm can contribute to hair breakage, while TE causes diffuse shedding. Managing both conditions involves calming scalp inflammation and addressing TE triggers.

Will my hair grow back after telogen effluvium?

Most people with telogen effluvium experience full regrowth once the underlying trigger is resolved. Regrowth may take several months, and new hairs can often be seen as short, fine strands during recovery.

Can stress cause both conditions?

Yes, stress is a known trigger for both telogen effluvium and seborrheic dermatitis. Psychological or physical stress can disrupt the hair growth cycle and the skin’s immune response, leading to flare-ups of both conditions.

What shampoo is best for scalp flakes?

Medicated shampoos containing antifungal agents like ketoconazole, zinc pyrithione, or selenium sulfide are effective for managing scalp flakes caused by seborrheic dermatitis. Choose a product suited to your scalp type and follow usage instructions for best results.

Are these conditions contagious?

Neither telogen effluvium nor seborrheic dermatitis is contagious. They result from internal factors such as stress, hormonal changes, immune response, or yeast overgrowth, not from person-to-person transmission.