4 months huge hair loss everywhere on scalp (Pohto)

Hi there,

Thank you for sharing your story and photos — I can understand how stressful this must feel, especially when you’ve already seen several dermatologists without clear answers. Sudden, diffuse hair loss accompanied by redness, pain, and small bumps can be frustrating and concerning.

Here’s what might be going on:
It’s possible that what started after microneedling was scalp inflammation or irritation rather than infection. When the scalp barrier is disrupted — especially by microneedling or harsh topical products — it can trigger folliculitis, seborrheic dermatitis, or even telogen effluvium (shedding of hairs due to inflammation or stress on the follicles). Even if there’s no deep infection, persistent redness and tenderness suggest the scalp needs time and gentle care to recover.

What you can consider:

Pause microneedling and harsh topicals for now to let the scalp heal.

Use a gentle medicated shampoo (such as one containing ketoconazole, zinc pyrithione, or ciclopirox) a few times weekly to reduce inflammation and yeast overgrowth linked to seborrheic dermatitis.

Topical anti-inflammatory treatments like mild corticosteroids or non-steroidal options (e.g., topical calcineurin inhibitors) can help calm the irritation.

Continue Finasteride if tolerated and approved by your dermatologist — it helps with long-term stabilization of hair loss.

If the redness and pain persist, a scalp biopsy can provide definitive answers — this helps distinguish seborrheic dermatitis from other inflammatory scalp conditions like folliculitis decalvans or lichen planopilaris.

You’ve done the right thing by being proactive and thorough. The key step now is calming the inflammation before pursuing additional hair growth treatments. Once the scalp is healthy again, regrowth often follows.

Sudden and significant hair loss over a short period, such as four months, can be alarming and may be caused by various factors. Here are some common causes:
**Telogen Effluvium**: A common form of hair loss triggered by stress, illness, surgery, or significant life changes. It causes a large number of hair follicles to enter the resting phase and fall out.
**Nutritional Deficiencies**: Lack of essential nutrients such as iron, protein, vitamins (especially vitamin D and B vitamins), and minerals can lead to hair loss.
**Hormonal Changes**: Conditions like thyroid disorders can cause hair loss.
**Medications**: Certain drugs used for cancer, arthritis, depression, heart problems, and high blood pressure can cause hair loss as a side effect. **Autoimmune Disorders**: Conditions such as alopecia areata, where the immune system attacks hair follicles, can cause sudden hair loss.
**Infections**: Scalp infections like ringworm can lead to hair loss.
**Hairstyling Practices**: Frequent use of heat styling tools and chemical treatments can damage hair and lead to hair loss.
**Medical Conditions**: Chronic illnesses, like lupus or diabetes, can cause hair loss. I suggest a complete workup and blood tests.
**Sudden Weight Loss**: Rapid weight loss or eating disorders can lead to nutrient deficiencies and hair loss.
**Psychological Stress**: High levels of stress and anxiety can trigger hair loss.
Ir is essential to consult an experienced hair loss expert to determine the underlying cause and appropriate treatment. Good luck.
Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor

Hello and thank you for your question. I understand your concern. There are lots of possibilities as to why you have sudden hair loss. I think the best place to start is to get a complete blood work up and take it from there. Best of luck to you.

Dr. T

In your case, the differential diagnoses would be telogen effluvium, alopecia areata incognito or even seborrheic dermatitis. I would still recommend you to see a dermatologist who is specialized in trichology to help you getting the right diagnosis and treatment.
Further investigations like complete blood count, serum ferritin, thyroid function test, serum vitamin D may be helpful if there's an abnormality. A scalp biopsy might be necessary if your hair loss is not getting better even after some treatment.