PsoriasisNet Article
Understanding Scalp Psoriasis May Head Off Hair Loss

When psoriasis develops on the scalp, hair loss sometimes follows. What surprises most people is that the root cause of this hair loss is not the psoriasis. Understanding why hair loss occurs and how to manage scalp psoriasis can help.

Root Causes of Hair Loss
When psoriasis develops on the scalp and hair loss results, the root cause is generally one or more of the following:

• Scales removed too forcefully. When scalp psoriasis is severe, very thick scales tend to develop. Forcefully removing these scales often loosens the hair as well as the scales.

• Frequent scratching. Psoriasis can be incredibly itchy, but frequently scratching the scalp can pull on the hair. Repetitive pulling can lead to a type of hair loss called traction alopecia.

• Psoriasis treatment too harsh. Sometimes the psoriasis treatment causes the hair loss. Certain medications used to treat scalp psoriasis such as salicylic acid can temporarily damage the hair and lead to hair loss. Also, any treatment that is too vigorous or frequently used can break the hairs and cause hair loss. In most cases, hair grows back when the treatment stops.

• Stress. Having psoriasis can be stressful. For some people, stress leads to hair loss. Research shows that stress can cause too many hairs to enter the resting (telogen) phase of the hair growth cycle. Hair stays in the resting phase for about 3 months. At the end of this phase, the body sheds all of the hair in the resting phase. When too much hair goes into the resting phase at one time, the body sheds large amounts of hair at once.

Dermatologists’ Tips for Controlling Scalp Psoriasis
While it may seem nearly impossible to control the causes of hair loss associated with scalp psoriasis, effectively managing scalp psoriasis can diminish hair loss. Here are tips that dermatologists often give their patients struggling to control scalp psoriasis:

Treatment

• Remove scale with gentle combing and brushing. Loosening and removing scale is an essential part of treating scalp psoriasis. The key is to do it gently. Picking at the scale can aggravate the skin and cause psoriasis to flare. Over time, the picking also can cause traction alopecia, a type of hair loss.

• Treat the scalp not the hair. When applying a topical psoriasis medication, including medicated shampoos, be sure the treatment reaches the scalp and does not sit in the hair.

• If a treatment seems too harsh, talk with a dermatologist. Skin on the scalp is thick, so treatment for scalp psoriasis may be stronger than the medication applied to other areas. If the medication causes concern, talk with a dermatologist. There are a number of treatments for scalp psoriasis. Rotating treatments can help as can switching to another treatment.

• If nothing seems to stop hair loss, consult a dermatologist. There are many causes of hair loss. The cause of a patient’s hair loss may have nothing to do with psoriasis or its treatment. Hereditary thinning or balding, which is the most common cause of hair loss, affects millions. A dermatologist can help determine the root cause of hair loss and recommend treatment options.

Hair Care

• Try alternating shampoos. Using a medicated shampoo one day and a non-medicated shampoo the next can help avoid over-drying of the scalp and hair. Be sure to discuss this strategy with a dermatologist before trying it.

• Use conditioner after every shampoo. Applying a conditioner after every shampoo can help keep the scalp moist. A non-medicated conditioner also may help reduce the odor left behind by some tar shampoos.

• Let hair air dry. Skin affected by psoriasis is extremely dry. Blow-drying can increase the dryness and exacerbate hair loss. Limiting use of blow dryers and styling products helps to reduce the dryness.

• Discuss hair styling options with a dermatologist first. While hair colors, perms, straightening, and hair sprays can boost self-esteem, they also can irritate scalp psoriasis. Sometimes the chemicals damage already fragile hair, leading to hair loss. Before using any of these hair-care products, either test the product on a small area or ask a dermatologist when such a product can be used.

Self Care

• Keep fingernails short. For many, scratching is inevitable. Short nails can prevent one from scratching the scalp so hard that it bleeds.

• Wear a hat or a scarf or shave the head bald. Until the hair grows back, these strategies can relieve some of the uneasiness that sometimes accompanies noticeable hair loss.

• Join a psoriasis support group. The psychological impact of hair loss, even when temporary, can be dramatic. Sharing common experiences can help ease feelings of loneliness and frustration. To find or start a support group, visit the National Psoriasis Foundation’s Web page about support groups.

On the Bright Side
While hair loss can leave patients feeling devastated, knowing a few key facts about scalp psoriasis may alleviate some anxiety. The first fact: Once scalp psoriasis clears, most patients find that their hair loss was temporary. Secondly, when a patient consults a dermatologist, it is rare for anyone to suffer from severe scalp psoriasis for a long time when the treatment is used as directed.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.