Flaky Scalp? Your Hormones Might Be to Blame

The other day, I dropped my kids off at daycare and went to the dermatologist — not for a skin cancer check or a face peel, but to get a good look at my scalp, which has been flaky, scaly, and all-around out of whack for months. I knew to expect hair loss after having my second baby, but the accompanying scalp issues surprised me — and I wasn’t sure what was going on. The dermatologist took a few quick looks at my scalp and determined that I had a classic case of seborrheic dermatitis, a condition related to dandruff in which the sebaceous glands go into overdrive, and your body launches an immune response to a yeast that naturally lives on the scalp. (Cute!)

But while I’d had a flaky scalp in the past (typically in line with seasonal changes), this felt different: My scalp had been comfortable and not flaky whatsoever when I was pregnant, and now this. So, was this — like postpartum hair loss — the work of hormones? Turns out, it’s definitely possible. While there’s little to no published data on postpartum seborrheic dermatitis, “flares are definitely common, based on clinical experience,” says Jason Miller, M.D., a board-certified dermatologist at Schweiger Dermatology in Freehold, NJ. And it fits into a larger trend of seborrheic dermatitis popping up at other major hormonal events in life, from adolescence to perimenopause. Here’s why it happens, and what you can do about it.

The Hormone-Seborrheic Dermatitis Connection, Explained

Hormones can influence seborrheic dermatitis, but only indirectly. How? Hormones control many functions in your body, including how much oil you produce. Androgens, a group of hormones that includes testosterone, control that. “Oil glands respond to androgens, and estrogen keeps them in check — so when estrogen falls after delivery, oil production surges,” says Michael Tassavor, M.D., a board-certified dermatologist in New York, NY.

That uptick in oil feeds a type of yeast, Malassezia, that naturally lives on everyone’s skin. It effectively “feeds on that oil and produces irritating byproducts, which is what your immune system reacts to,” Tassavor says. Cue redness, flaking, and scaliness. Nursing can also make matters worse: “Prolactin — the breastfeeding hormone — may also nudge oil production upward,” he says.

One challenge with seborrheic dermatitis is a case of mistaken identity: Even if you know it exists (like me), you might think you’re dealing with a typical dry scalp or another condition like psoriasis. What sets it apart are greasy, yellowish flakes over pinkish skin, according to Tassavor. Up close, it looks like “reddish, poorly defined patches with greasy yellowish-white flakes — mostly on the scalp, eyebrows, sides of the nose, behind the ears, the center of the chest, or in skin folds,” he says. Psoriasis, on the other hand, has thicker, silvery scales with a sharp border.

It’s Not Just a Postpartum Issue

If you’ve had seborrheic dermatitis in the past, then you’re more likely to get it from a swing in hormones, according to Miller. But you can also experience a flare if you’ve never dealt with flakes before. “A big hormonal swing can push someone over the line into their first-ever case,” says Tassavor. Case in point? Seborrheic dermatitis can show up in newborns (from maternal hormones, sorry!) and pops up when androgens surge during puberty. In fact, “puberty is a classic trigger — the androgen surge sends oil production into overdrive,” he says.

You might even clock symptoms of seborrheic dermatitis as you move toward menopause. “Again, studies here are minimal — however, some perimenopausal women do report flares as part of the changes seen during this period,” says Miller. It’s less likely that you’ll get it for the first time (since the erratic levels of estrogen can actually reduce oil production), but for those of us already prone to it, it’s absolutely possible.

What You Can Do For Relief

There’s no shortage of treatment options for seborrheic dermatitis — and the good news is that you don’t have to do anything special even if you suspect that your case is linked to hormones. “Standard therapies will usually work for hormone-induced seborrheic dermatitis as well, and are considered safe with nursing,” says Miller.

For mild cases, you can head to the drugstore. “Start with an antifungal, like a ketoconazole 1% shampoo for the scalp,” says Tassavor. “Massage it in and leave it on a few minutes before rinsing.” If you don’t have luck with the OTC options, you might need to trek to a dermatologist to get other options. It can take a few weeks to see a difference, too, so you’ll need to be consistent.

And even once your hormones level out, you might still have to continue whatever treatment works for you. “Seb derm is chronic, so plan for maintenance,” says Tassavor. The treatment controls it but doesn’t cure it, he says, so you may be in it for the long haul. As my hair grows back (and I follow my derm’s protocol), the flakes have eased up — but mostly I’m just glad to know it’s not just me.

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