Mild fungal infections on the scalp can easily go unnoticed.
However, when they progress, they can have serious detrimental side effects.
One of these can be hair loss.
But, are all fungal infections and hair loss connected?
How can you treat fungal infections? Are there natural alternatives?
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Is fungal infection hair loss reversible?
I’ll answer these questions and more in this article.
Just keep reading.
Quickly, make sure you take the free hair quiz later in this article.
What Are Fungal Infections?
The term trichomycoses is used to describe fungal infections in the scalp.
Fungal infections can be caused by yeast and dermatophyte fungi (1).
They infiltrate the hair shaft, making their way to the cortex which is the innermost part of the hair shaft. As they begin to multiply, they can make their way to the follicle.
In some cases, they can even penetrate the surrounding tissue of the hair follicle causing major issues.
The three most common fungal infections are Malassezia spp. infections, tinea capitis, and piedra.
Malassezia spp. are a type of yeast that feeds off of fatty substances (2).
For this reason, they often colonize sebum-rich areas of the body like the face and scalp.
Researchers believe the issue with the Malassezia fungi is that it causes skin cells to release pro-inflammatory molecules like interleukin-1α (IL-1α) and Tumor Necrosis Factor-α (TNF-α).
If the infection doesn’t resolve, these inflammatory proteins can damage the hair follicles over time. In serious cases, it can cause scarring and fibrosis.
This yeast species is also suspected to be the cause of dandruff (2).
When Malassezia metabolizes sebum, it secretes oleic acid (1). Too much oleic acid can disrupt the skin barrier and cause irritation. The dry flakes that are typical of dandruff are a result of transepidermal water loss (TEWL), another side effect of a dysfunctional skin barrier.
This also leaves the scalp susceptible to more microbial invasion as well as free radical damage by environmental pollutants.
What is interesting about Malassezia is that it’s found at similar levels in both normal scalps and dandruff scalps. This had led researchers to suspect that Malassezia infections are something more complex than just the presence of the yeast itself. (More on this later.)
Possible explanations of this are compromised immune systems or a reactivity to specific toxins produced by the yeast.
- Malassezia spp. yeast feed off of fatty substances and thus colonize sebum-rich areas like the scalp.
- Researchers believe it causes skin cells to release pro-inflammatory molecules that can lead to hair follicle damage.
- Malassezia is believed to be the cause of dandruff because it reduces skin barrier function. The result of this is irritation and TEWL leading to flakiness. It also leaves the scalp susceptible to damage by microbial and pollutant invasion.
- Malassezia is found at similar levels in both normal and dandruff scalps suggesting the issue is more complex than just the presence of Malassezia.
Tinea capitis is another common scalp fungal infection.
It mostly affects children, but adults can suffer from tinea capitis as well.
Tinea capitis can be both inflammatory and non-inflammatory.
The inflammatory subtypes are more prone to causing damage inside the hair follicles. In the case of damage, scarring and fibrosis can occur.
- Tinea capitis is a common fungal infection in children and less common in adults.
- It can be both inflammatory and non-inflammatory.
- Inflammatory tinea capitis can damage hair follicles, possibly leading to scarring and fibrosis.
Fungus That Looks Like White Hair: Piedra
Piedra is a less common fungal infection that occurs in humid climates.
It’s characterized by the presence of black and white nodules that resemble stones. This is why it is called piedra, which means stones in Spanish.
Dermatophytes fungi in the soil are believed to be the cause of piedra (1). In tropical climates, moisture on the scalp can create the perfect environment for these fungi to thrive.
Interestingly, the application of botanical oils that is common within traditional cultures might actually exacerbate piedra.
However, this fungal infection is not common in areas without humidity.
- Piedra is a fungal infection that results in black and white nodules on the hair shaft.
- The proposed cause is dermatophyte fungi present in the soil.
- In tropical climates, moisture can get trapped on the scalp, creating the perfect environment for fungi to thrive. Traditional application of oils might also exacerbate piedra.
How Do Fungal Infections Cause Hair Loss?
The main cause of fungal infection hair loss is inflammation.
When you get a fungal infection on your scalp, the body responds by sending immune cells to the site.
Usually, this isn’t a problem. The immune system kills off the fungi, the immune cells die off, and inflammation goes away.
But, if the infection persists, inflammation becomes chronic and can cause larger issues.
The main way that inflammation causes hair loss is through tissue damage. This is because inflammatory molecules release high levels of free radicals as a byproduct. These free radicals oxidize cellular components, causing dysfunction and eventually cell death.
Cumulative cell damage leads to tissue damage which means the body needs to repair itself.
This stimulates the production of fibrous collagen proteins, manifesting as scar tissue or fibrosis.
Although this is necessary, it can also cause issues. I’ll talk about each in detail below.
Key Takeaway: The main cause of hair loss associated with fungal infections is inflammation. It is associated with various forms of hair loss.
Reduced Blood Flow
Hair loss is a side effect of scleroderma, fibrosis of the skin (5). .
To understand how this might happen, researchers look at liver fibrosis. This excess scar tissue in the liver leads to decreased blood flow, oxygen supply, and a decrease in nutrient availability.
If this truly does translate to hair follicles, then fibrosis around the follicle could reduce blood supply. This is not too far-fetched considering one characteristic of AGA is, in fact, reduced blood flow.
This is key for a couple of reasons:
- decreased blood flow reduces nutrient supply to the hair follicle.
- blood carries oxygen to the follicle.
When the nutrient supply is cut off, it prevents hair follicles from getting the vitamins, minerals, antioxidants, and amino acids it needs to stimulate hair growth.
Lack of oxygen also contributes to some forms of hair loss. In the presence of little oxygen, more testosterone is converted to dihydrotestosterone, the main driver of AGA, instead of hair-protective estrogen.
This leads to many downstream issues that can influence hair growth and loss.
Low oxygen also allows for the reproduction of P. acnes bacteria which can stimulate inflammation and free radical damage, further exacerbating the issue in the first place.
However, it’s worth noting that an increase in P. acnes bacteria might not be relevant to Malassezia infections (2). Analyses of scalps with dandruff show that P. acnes is actually lower than normal. In this case, P. acnes might actually have a protective effect.
Key Takeaways: Fibrosis around the hair follicle reduces blood supply. This leads to a drop in oxygen and nutrient content in the follicle, triggering downstream effects that can negatively impact hair growth.
Another side effect of fibrosis of the hair follicle is miniaturization (5).
As scar tissue continues to accumulate, it can press in on the follicle. This restricts growth space, forcing hair to conform to its new surroundings.
As a result, the hair can miniaturize and turn into a vellus hair (also known as peach fuzz).
While the growth is not necessarily stagnated in follicle miniaturization, it can mimic the appearance of hair loss.
Key Takeaway: Fibrosis around the hair follicle can cause the hair follicle to restrict hair growth space, reducing the size of hair. This can mimic the appearance of hair loss.
Is Dandruff a Fungal Infection?
One interesting point I discussed before was the implications of Malassezia spp. in dandruff (2).
But, it’s more complicated than just the presence of this type of yeast.
Excess sebum production, which can be caused by the presence of excess male hormones, feeds Malassezia. However, what is confounding is that subjects with excess sebum production don’t always develop dandruff. This suggests there is another issue involved.
Further research proposes that the sebum composition could be the culprit. Dandruff patients have higher levels of cholesterol and triglycerides in their sebum, whereas normal subjects have higher levels of squalene and free fatty acids.
So, Malassezia infection on the scalp could stimulate inflammation and possible hair loss. But, whether or not dandruff is a fungal infection 100% of the time remains to be proven.
Key Takeaway: There are confounding findings that suggest dandruff isn’t always a fungal issue.
Hair Follicle Fungus Treatment
The good news is that there are various treatments available for scalp fungal infections.
It’s important to catch these early to avoid serious adverse effects. If you suspect you might have a fungal infection, be sure to contact your doctor.
Once, you’ve been diagnosed, you may be prescribed some of the following anti-fungal treatments. There are also a few natural products with proposed anti-fungal effects.
Always consult your doctor before using any products to treat a possible fungal infection.
Selenium sulfide is an anti-fungal agent sold to treat dandruff. It’s usually sold in shampoo form.
One percent concentrations are sold over-the-counter. But, anything higher than that has to be prescribed.
Key Takeaway: Selenium sulfide is an anti-fungal found in shampoos. One percent concentrations are available OTC, however, anything higher requires prescription.
Ketoconazole is an anti-fungal and a possible anti-androgen (6). Research suggests it blocks the synthesis of testosterone.
By inhibiting testosterone production, ketoconazole might also lower sebum production of the scalp. This could be beneficial for dandruff sufferers.
Two percent ketoconazole shampoo is one of the most popular therapies for fungal infections. This is because it remains the hair for up to 72 hours (1).
Ketoconazole shampoo must be prescribed by a doctor.
Key Takeaway: Ketoconazole is an anti-fungal and anti-androgen which may lower sebum production. Two percent ketoconazole shampoo is a popular prescription therapy for fungal infections.
Povidone iodine is an antiseptic solution used by doctors.
It has been documented as a treatment for fungal infections on the scalp (1).
Povidone iodine is relatively easy to purchase. It can be found over the counter at local drugstores.
Key Takeaway: Povidone iodine is an antiseptic solution available OTC. It has been documented to be beneficial for scalp fungal infections.
Zinc pyrithione is probably the most common and accessible anti-fungal ingredient. It’s found in anti-dandruff shampoos and is available over the counter.
Key Takeaway: Zinc Pyrithione is commonly used to treat fungal infections and is easily accessible. It can be purchased in the form of a shampoo OTC.
Apple Cider Vinegar
Apple cider vinegar contains acetic acid which may have potential anti-fungal properties (7).
One study suggests apple cider vinegar can effectively kill Malassezia furfur, a specific strain of Malassezia.
However, the exact effects of acetic acid or apple cider vinegar on fungal infections is still a topic of debate.
Key Takeaway: Apple cider vinegar contains acetic acid which may have anti-fungal properties. The research is limited, however.
Tea Tree Oil
Tea tree oil has extensively documented anti-fungal activity (8).
Its main constituent, terpinen-4-ol, is the most active when it comes to killing fungi (9).
Research indicates it works by disrupting the cell membranes, killing fungi cells.
Tea tree oil is easy to purchase. But, make sure you purchase a high-quality, 100 percent pure, organic essential oil. Always dilute the tea tree oil in a carrier oil to prevent side effects.
Key Takeaway: Tea tree oil’s constituent, terpinen-4-ol, actively kills fungi by disrupting cell membranes. Always dilute your high-quality, 100 percent pure, organic tea tree essential oil in a carrier oil.
Oil of Oregano
Similar to tea tree oil, oil of oregano also contains terpinen-4-ol that gives it anti-fungal properties.
In the body of research, it has documented action against fungal infections.
Like I mentioned earlier, it is important to dilute 100 percent pure, organic oil of oregano in a carrier oil.
Key Takeaway: Much like tea tree oil, oil of oregano contains anti-fungal terpinen-4-ol. As always, make sure to dilute 100 percent pure, organic oil of oregano in a carrier oil.
Why You Should Avoid Oil With a Fungal Infection
Some yeast, specifically Malassezia spp., are lipophilic or fat-loving (2).
Like I mentioned, Malassezia yeast metabolize fatty substances in sebum. This is essentially their food.
Oil can also trap moisture on the scalp, creating the perfect environment for fungi to reproduce.
So, using oil masks on your scalp is not ideal when you are trying to treat or prevent a scalp fungal infection.
Key Takeaway: Some fungi species feed on fatty substances. Oil can also trap moisture on the scalp, creating the perfect environment for fungi to thribe. So, using oil masks on your scalp is not ideal when you are trying to treat or prevent a scalp fungal infection.
How to Grow Hair Back After a Fungal Infection: Is It Reversible?
Unfortunately, advanced hair loss as a result of fungal infections is likely not reversible.
If a fungal infection runs rampant, it can incite huge levels of inflammation. As a result, severe fibrosis can develop around the hair follicle.
With this severe fibrosis comes complete hair follicle damage. Essentially, these follicles have disappeared.
This means, barring hair transplants, there is no way to restore follicle function and hair loss.
Key Takeaway: Due to severe inflammation and fibrosis, hair lost as a result of fungal infections is likely not reversible.
The Verdict: Is There a Connection Between Fungal Infections and Hair Loss?
While not all fungal infections are severe enough to cause hair loss, there is definitely evidence that connects fungal infections and hair loss.
This is due to the inflammation fungal infections can cause, leading to fibrosis and hair follicle damage.
And unfortunately, hair lost as a result of severe fungal infections is often irreversible.
Have you experienced a frustrating scalp fungal infection? Leave a comment below.