Hair Loss Behind the Ears: Causes and Treatments
Patchy or thinning hair behind the ears has several distinct causes. A UK pharmacist explains what each one looks like and how it's treated.
Written by:
Medically reviewed by Callum Armstrong, MPharm, Independent Prescriber (IP)
Key Takeaways
Hair loss behind the ears is usually alopecia areata, seborrhoeic dermatitis, a fungal infection, contact dermatitis, or friction from glasses or hearing aids. Each has a different treatment. Most causes are reversible with the right approach.
Hair loss behind the ears is more common than most people expect, and the cause matters enormously because each condition needs a different treatment. The most likely culprits are alopecia areata, seborrhoeic dermatitis, tinea capitis (ringworm), contact dermatitis, and mechanical friction. Scarring alopecias and systemic conditions such as thyroid disease or iron deficiency are less common but worth ruling out.
What each cause actually looks like#
Knowing how to describe your symptoms to a pharmacist or GP saves time. Here is a quick reference:
| Condition | What you typically see | Skin feeling |
|---|---|---|
| Alopecia areata | Smooth, round or band-like bald patches | Normal skin, no scale |
| Seborrhoeic dermatitis | Flaky, yellowish scale at scalp edges | Itchy, greasy |
| Tinea capitis | Scaly, sometimes inflamed patches; broken hair stubs | May be tender |
| Contact dermatitis | Redness and hair thinning where an allergen touches skin | Itchy, sometimes blistered |
| Mechanical friction | Gradual thinning along the frame or device contact line | Normal skin |
Alopecia areata and the ophiasis pattern#
Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks hair follicles. It commonly produces smooth, clearly defined bald patches. When it runs in a band along the lower scalp, temples, and postauricular (behind the ear) area, clinicians call this the ophiasis pattern. Ophiasis can be more treatment-resistant than round patches elsewhere on the scalp. The skin underneath looks completely normal, which is a useful distinguishing feature.
Seborrhoeic dermatitis#
This is a very common inflammatory skin condition driven by an overgrowth of a yeast called Malassezia. It tends to affect areas rich in sebaceous glands, including the scalp margins and the skin behind the ears. You will usually see yellowish, greasy scale and feel itchiness. The hair loss associated with it is not caused by follicle destruction; it comes from inflammation and scratching. That means it is reversible with treatment.
A pharmacist can recommend a ketoconazole 2% shampoo (available over the counter as Nizoral) without a prescription. Leave it on the affected area for 3 to 5 minutes before rinsing. Using it twice weekly for 2 to 4 weeks usually settles an active flare.
Tinea capitis (ringworm of the scalp)#
Ringworm is a fungal infection, not a worm. In children it commonly appears as scaly, grey or inflamed patches with broken hair shafts. A severe variant called kerion presents as a boggy, pus-filled swelling and can cause permanent scarring if untreated. Tinea capitis cannot be cured with antifungal shampoo alone; it requires oral antifungal treatment (terbinafine or griseofulvin) prescribed by a GP. Children with tinea capitis do not need to be excluded from school once treatment has started.
Contact dermatitis#
Contact dermatitis behind the ears is often triggered by hair dye (particularly paraphenylenediamine, or PPD, in dark dyes), nickel in spectacle frames, or the silicone or plastic parts of hearing aids. The area becomes red, itchy and sometimes blistered where the allergen contacts skin, and hair may thin where the inflammation is severe. A GP can arrange patch testing to identify the exact allergen. Avoiding the trigger usually resolves mild cases. If a topical corticosteroid is needed, note that the skin behind the ears is thinner than many other sites and more prone to atrophy; use should be limited to the shortest effective course and under the guidance of a pharmacist or GP.
Mechanical and friction hair loss#
Spectacle arms, hearing aids, and tight headwear can cause gradual hair thinning along the exact line of contact. This is called traction alopecia when repeated physical force is the cause. The fix is often practical: an audiologist can refit a hearing aid, and an optician can adjust the temple arms of glasses to reduce pressure. Switching to thinner or rubberised frames sometimes helps. The hair typically regrows once the friction stops, provided the follicles have not been permanently damaged by prolonged pressure.
NHS treatment options by condition#
Alopecia areata: For mild or moderate patches, a GP may prescribe topical corticosteroids to suppress the immune attack. Because the postauricular area has thinner skin and is more susceptible to atrophy and systemic absorption, the choice and potency of any topical steroid at this site should be determined by a GP or dermatologist rather than self-selection. Very potent topical corticosteroids require specialist initiation. Intralesional steroid injections, given in a dermatology clinic, are effective for stubborn patches. For severe or rapidly spreading alopecia areata, NICE has approved two JAK inhibitors — baricitinib and ritlecitinib — through the NHS for eligible patients, though access currently depends on meeting clinical criteria and local commissioning. A routine dermatology referral is appropriate if the condition is spreading or not responding to topical treatment; NHS waiting times for non-urgent dermatology vary but the 18-week referral-to-treatment standard applies.
Seborrhoeic dermatitis: Start with ketoconazole shampoo from a pharmacy under the NHS Pharmacy First scheme before booking a GP appointment. If the scalp is inflamed, a short course of mild topical steroid (hydrocortisone 1%) can be used on the surrounding skin for up to 7 days; take particular care near the thinner skin behind the ears. For persistent cases, a GP can prescribe ketoconazole cream or a combined product such as Daktacort (hydrocortisone plus miconazole).
Tinea capitis: GP prescription for oral antifungal treatment. Terbinafine is first line for most species; however, griseofulvin remains first line for Microsporum canis infections, which are prevalent in some UK communities. Treatment lasts 4 to 6 weeks in most cases.
Contact dermatitis: Remove the trigger and ask a GP for patch testing if the allergen is not obvious. If a topical corticosteroid is recommended by a pharmacist or GP, hydrocortisone 1% cream may be used on mildly inflamed skin for up to 7 days; given the thinness of postauricular skin, duration should be kept to a minimum and a healthcare professional should be consulted if symptoms persist. Stronger topical steroids may be prescribed by a GP for more severe reactions.
Scarring alopecias (lichen planopilaris, discoid lupus): These conditions destroy follicles permanently if left untreated. Red flags include scarring at the patch edges, pain, itching, or redness around hair follicles. If you notice these, ask your GP for an urgent dermatology referral rather than waiting. Some treatments for lichen planopilaris may require an Individual Funding Request (IFR) on the NHS.
Will the hair grow back?#
Prognosis varies. Seborrhoeic dermatitis and contact dermatitis: full regrowth is expected once inflammation is controlled, usually within 3 to 6 months. Alopecia areata: spontaneous regrowth occurs in roughly half of people with limited patches within a year, but ophiasis-pattern disease tends to be slower and less predictable. Tinea capitis: hair regrows after treatment unless a kerion caused scarring. Mechanical hair loss: regrowth is likely if friction is removed early. Scarring alopecias: the goal of treatment is to halt progression, not to restore lost hair.
For male pattern hair loss affecting the temples (which can extend near the ears), evidence-based treatments such as finasteride and minoxidil are available. Finasteride works by blocking the hormonal pathway that drives follicle miniaturisation, while minoxidil acts through a separate vasodilatory mechanism to support hair regrowth. Totiva's hair loss service offers free online consultations for men aged 18 and over, with no subscription required.
Alopecia UK (alopecia.org.uk) is a patient charity with peer support and practical resources for people living with alopecia areata.
Medical Information: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, stopping, or changing any treatment.
