Did you know that approximately 2 to 3% of the global population is affected by psoriasis, with nearly half experiencing scalp psoriasis? If you are dealing with scalp psoriasis and noticing more hair fall than usual, you may wonder if the two are connected. Experiencing psoriasis hair loss can be frustrating, especially when it affects your confidence and well-being.
Psoriasis doesn’t directly cause hair loss; however, the toll psoriasis takes on the scalp through itching, inflammation, and scratching can weaken hair and lead to noticeable shedding. Fortunately, in most cases, this hair loss is temporary, and hair regrowth is often achievable with proper treatment.
This blog breaks down the connection between psoriasis and hair loss, its causes, and effective ways to manage and restore hair health.
Table of Contents
Key Takeaways
- Psoriasis itself does not trigger hair loss, but scalp psoriasis can initiate temporary thinning.
- Managing inflammation, avoiding scratching, and adhering to proper treatment can minimize hair damage.
- Mostly, psoriasis hair loss is temporary, with regrowth possible once symptoms are managed.
What Is Psoriasis, and How Does It Affect the Scalp?
Psoriasis, a chronic autoimmune disease, affects over 125 million people worldwide, with up to 50% of individuals experiencing symptoms on the scalp. Although psoriasis mainly affects the skin, causing red, itchy patches called plaques, it can also manifest on the scalp, leading to a condition known as scalp psoriasis.
Understanding Psoriasis
Psoriasis is a chronic autoimmune skin disorder in which the immune system triggers the rapid buildup of skin cells. This process leads to characteristic symptoms, including:
- Salmon-colored patches on fair skin tones, dark brown or purplish patches on darker skin tones.
- Silvery scales or flakes
- Itching
- Arthritis (psoriatic arthritis)
- Psoriatic nail dystrophy (pitting, oil drop sign, Beau’s lines)
There are different types of psoriasis, and each type generally affects different parts of the body. The most common forms include plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Each type has its own unique symptoms and affected areas.
However, psoriasis typically appears on the extensor surfaces of the elbows, knees, and scalp. Although these are the most commonly impacted regions, psoriasis is not limited to them.
Scalp Psoriasis Explained
Scalp psoriasis is a chronic, non-contagious autoimmune disorder that causes raised, discolored, thick, scaly plaques on the scalp. Plaques mainly target your hairline and the back of your head but extend onto the forehead or behind the ears, making them more visible and distressing for individuals. Other symptoms of scalp psoriasis are:
- Dandruff like flaking
- Extreme itching
- Hair loss
- Burning sensation
- Gray scales
Psoriasis Plaques and Hair Health
Does psoriasis cause hair loss? The thick, scaly plaques formed by scalp psoriasis can interfere with hair follicles, making it difficult for hair to grow. Research suggests that psoriasis hair loss is usually caused by scratching or picking at the itchy, scaly lesions, which can lead to inflammation and trauma. The inflammation and trauma further contribute to the hair loss phenomenon in psoriasis.
How Psoriasis Leads to Hair Loss
You may wonder, can psoriasis cause hair loss? While psoriasis itself does not directly cause hair loss, several secondary factors associated with scalp psoriasis can lead to thinning hair.
Inflammation and Hair Loss
Inflammation plays a central role in scalp psoriasis. Chronic inflammation can interfere with the normal hair growth cycle by forcing a higher number of hair follicles into the resting phase. This disruption can lead to telogen effluvium, a condition characterized by temporary hair shedding and thinning. This temporary form of psoriasis hair loss is more likely during severe flares.
A study published in MDPI highlights how psoriasis involves systemic inflammation that may contribute to hair weakening and loss when the scalp is affected.
Physical Damage From Scratching
Persistent itching and scratching can harm hair follicles, leading to breakage or even follicular damage. Vigorous or repetitive scratching can dislodge hair shafts from follicles. Scratching causes micro-tears in the surrounding skin, creating inflammation and infection risks.
Does psoriasis cause hair loss? Although most hair loss from scratching is temporary, excessive or prolonged scratching may cause scarring. This scarring can lead to permanent hair loss in severe cases.
Side Effects of Treatments
Potent topical or oral steroids like methotrexate and UV therapy are the mainstay treatments for psoriasis. However, some corticosteroids, like prednisolone, can cause scalp hair thinning as a side effect. Corticosteroids are not often prescribed for psoriasis, usually only used during serious flare-ups. Therefore, it’s crucial to balance effective psoriasis management with minimizing side effects.
Dr Betsy Wernli, a board-certified dermatologist, emphasizes the proper treatment of psoriasis: “Treating psoriasis can become a daily burden to patients if the medications are not optimized for each patient.”
Preventing and Managing Hair Loss From Psoriasis
As mentioned above, psoriasis hair loss is often temporary. Adopting proactive strategies can help minimize its impact. Dr. Warren, a dermatologist from Cleveland Clinic, states that “ the primary goal here is to seek treatment and manage scalp psoriasis effectively to decrease hair loss.”
Before & after 8 months of scalp psoriasis hair loss treatment
Gentle Hair Care Routine
A thoughtful hair care routine can significantly reduce hair damage caused by scalp psoriasis.
- Use medicated shampoos containing coal tar, salicylic acid, or ketoconazole.
- Stay away from harsh ingredients, heat-styling tools, and tight hairstyles. If you need a gentle, irritant-free shampoo, try Sensitive Scalp Shampoo by The Better Scalp Company.
- Opt for soft bristled brushes and gentle scalp massages to prevent irritation.
Tip: For an effective coal tar shampoo application, massage it gently into your scalp and allow it to sit for five to ten minutes before rinsing away. While this is highly effective, it has a few downsides, like hair or skin staining and a strong odor. To tackle the scent, a non-medicated conditioner after shampooing can work wonders.
Effects of coal tar on psoriasis, before & after (image source)
Treating Scalp Psoriasis
Managing scalp psoriasis effectively is the first step in preventing hair loss. Common treatments include.
Topical Medications
Corticosteroids, vitamin D analogs, coal tar shampoos, and salicylic acid creams are commonly prescribed to reduce inflammation and scales. Regular use helps improve scalp conditions, reducing irritation and psoriasis hair loss.
A systematic review concluded that combination treatments containing corticosteroids and vitamin D analogs were more effective than using either alone for managing scalp psoriasis.
Phototherapy
UV light therapy helps slow down cell growth and reduce inflammation. PUVA therapy, or Psoralen plus ultraviolet A therapy, is a specialized treatment for severe psoriasis. It involves administering a medication called psoralen, which increases the skin’s sensitivity to ultraviolet light.
Once the medication takes effect, the affected scalp areas are exposed to UVA light, which targets inflammation and reduces psoriasis symptoms.
Systemic Medications
Systemic medications, such as methotrexate, acitretin, and cyclosporine, can be used in severe cases. TNF alpha inhibitors, such as infliximab, etanercept, and adalimumab, can be used in moderate to severe psoriasis. Other biologics, like IL-17 and IL-23 inhibitors (Ustekinumab), can also be used in severe psoriasis.
Properly controlling scalp psoriasis reduces the risk of hair follicle damage and promotes a healthier environment for hair growth.
Managing Stress and Triggers
Various research has found a strong relationship between stress and psoriasis. In 31 to 88% of situations, patients found stress as a trigger for psoriasis flares, which can lead to psoriasis hair loss. Stress can trigger psoriasis by activating the hypothalamic pituitary adrenal axis, which secretes pro-inflammatory cytokines that can worsen psoriasis. To reduce stress and other triggers:
- Practice relaxation techniques like yoga or meditation.
- Avoid known irritants like smoking and alcohol and eating an unhealthy diet that includes processed foods and gluten.
- Stay hydrated and eat a nutrient-rich diet rich in omega-3 fatty acids.
Is Hair Loss From Psoriasis Permanent?
Hair loss caused by psoriasis is usually temporary, resolving once the condition is effectively managed. However, in rare cases, permanent hair loss can occur due to prolonged inflammation or damage caused by excessive scratching, which can scar hair follicles. Therefore, early intervention is important to restore hair health.
Temporary vs. Permanent Hair Loss
Most individuals with scalp psoriasis experience hair thinning due to factors such as inflammation, scratching, or treatments that can stress hair follicles. This hair loss, known as telogen effluvium, is usually reversible.
Once inflammation subsides or scratching ceases, hair typically regrows within several months. However, repeated scratching can lead to permanent scarring of hair follicles, resulting in irreversible hair loss.
Hair Regrowth Expectations
Hair regrowth depends on the extent of the damage and the success of psoriasis management. For many people, regrowth begins within three to six months after symptoms subside. Eating a healthy diet and managing stress can foster a positive hair growth environment, and practicing gentle scalp massages can promote circulation and stimulate new hair growth.
When to See a Doctor
Persistent hair loss can signal an underlying condition, such as alopecia areata or a fungal infection that requires medical attention.
Persistent Hair Loss
It is crucial to consult a dermatologist if you notice bald patches. These could indicate alopecia areata, which is when the immune system targets hair follicles. You must visit a dermatologist if you notice no hair regrowth after several months of undergoing scalp psoriasis treatment.
Getting a Proper Diagnosis
Dermatologists play an essential role in distinguishing psoriasis hair loss from other types of hair shedding. They perform a scalp examination, review your medical history, and sometimes request blood tests to pinpoint the root cause.
A tailored treatment plan can address both the psoriasis and any concurrent conditions contributing to hair thinning.
Conclusion
Can psoriasis cause hair loss? While psoriasis itself does not directly trigger hair loss, scalp psoriasis can lead to temporary thinning due to inflammation, scratching, and adverse effects of treatment. Thankfully, psoriasis hair loss is usually temporary and manageable with early intervention and a tailored approach.
Can Psoriasis Cause Hair Loss: Frequently Asked Questions
Can Hair Grow Back After Scalp Psoriasis?
Yes. Hair usually regrows once scalp psoriasis is effectively managed. Topical medications like coal tar, vitamin D analogs, and salicylic acid can be used to ease symptoms.
Does Scratching Psoriasis Make Hair Loss Worse?
Yes. Excessive scratching can weaken hair follicles and cause breakage or hair loss.
What Treatments Are Best for Scalp Psoriasis?
Medicated shampoos containing coal tar and salicylic acid, topical corticosteroids, and UV light therapy are common and standard treatments for scalp psoriasis hair loss. For severe cases and exacerbations, systemic medication like oral steroids and biologics can be required to control inflammation.
Header Image Courtesy of The Cleveland Clinic
