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Hair Loss/Lack of sleep, anxiety, inflammation and shedding


QUESTION: Dr. Panagatacos,

I notice when I don't sleep well, or have bouts of anxiety (such as worrying about a deadline til the point of losing sleep) my scalp begins to immediately itch severely especially in my mpb prone areas (forelock, temples, crown). My scalp begins to emit a "yeasty" odor during this time as well. My hair sheds badly when I experience this type of inflammation. I notice it does go away and I become inflammation free when I sleep normally and do not have as much stress. I have been using Finasteride (now dutasteride) and nizoral shampoo for many years but those two cannot stop this occurrence.

What is this. Why does it happen and how can I alleviate it?

Best regards,

ANSWER: The most likely cause is Seborrheic Dermatitis which can flare at times of stress. When stressed the body produces androgen stress hormones from the adrenal gland. These hormones then stimulate the oil glands on the face and scalp (every hair has an oil gland attached to it). On the surface of the skin and in the oil gland there are bacteria and yeast which feed on the oil. When there is more oil there is more food for these organisms which then leave behind chemicals which are irritating to the skin. This is what is causing your symptoms.
I would suggest a daily shampoo using DHS zinc Shampoo which has 2% zinc pyrithione. This is considered a dandruff shampoo. It has three beneficial effects for you. It kills yeast and bacteria and it lowers the DHT levels in the hairs by lowering the levels of the 5 alpha reductase hormone (the same one finasteride and dutasteride inhibit).
If this is not enough to control the symptoms then you should ask your dermatologist if it is possible to get a prescription for Nizoral 200mg pills to take daily for two weeks.

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QUESTION: Thank you Dr. Panagotacos,that explanation fits very well with what is occurring with me. The stress hormone you refer to is cortisol correct? Is there any way to decrease these stress hormones through drugs or other means?

Unfortunately I cannot use zinc pyrithione shampoo as It stings and irritates my scalp. I have also read zinc ions can interfere with minoxidil and make it degrade which has me hesitant regarding its use.

I did not know about the oral use of ketoconazole for seb derm? Is it ok to use this method whenever I have a severe flare up? Doesn't taking ketoconazole orally interfere with a whole array of androgens?

Under stress the adrenal gland produces several hormones which then lead to Testosterone and DHT. The best way to minimize these hormonal increases at times of stress is to find a way to modify your behavior to minimize stress. This sounds simplistic but there is not easy way to do this with medications.
From Wikipedia
The main subset of androgens, known as adrenal androgens, is composed of 19-carbon steroids synthesized in the zona reticularis, the innermost layer of the adrenal cortex. Adrenal androgens function as weak steroids (though some are precursors), and the subset includes dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione.

  Zinc salts used in a shampoo will not degrade the minoxidil lotion. There may be other ingredients in the shampoo you used which caused the stinging. Zinc pyrithione in 1 and 2% does not sting the scalp in my patients.

 Oral ketoconizole has been safely used for decades in the treatment of Seborrheic Dermatitis.  It can interfere with androgen metabolism if taken daily for months. I did not suggest you take it for months but for ten days at a time and perhaps 400 mg once a week. This is a common treatment in the US for resistant Seborrheic Dermatitis and is well documented in the medical literature. See a dermatologist for this to monitor when you will need it.

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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