Could Your Thinning Hair Be From Psoriasis?

Psoriasis is a chronic (long-term) inflammatory skin condition that can affect any part of the body, including the scalp. Scalp psoriasis can cause dryness, red patches, bleeding, and dandruff-like flaking. You may also experience hair loss.

Hair loss from psoriasis is usually temporary. In rare cases, you can develop scarring alopecia, which is a condition that can result in permanent hair loss and scarring.

If you are losing hair, you may notice your hair gradually thinning. Your hair may not look as full, and you may have a widening hair part or bald spots.

You’ll also likely see other symptoms of scalp psoriasis, such as:

Reddish patches
Dry scalp
Bleeding
A burning sensation of the scalp
Itchiness
Dandruff-like flakes
Silvery-white scales

Psoriasis causes inflammation that can damage hair follicles on the scalp, which can lead to temporary hair loss.

Research shows that scalp psoriasis can affect the interfollicular epithelium (the skin located between the openings of hair follicles) and lead to perifollicular inflammation, which is inflammation of the tissues surrounding hair follicles.

Inflammation from scalp psoriasis can also lead to hair loss by reducing sebaceous glands (which produce and secrete an oily substance called sebum) and disrupting the hair growth cycle through increased hair shedding.

In rare cases, people with severe scalp psoriasis may experience scarring alopecia, which causes permanent hair loss. A person may develop scarring alopecia from psoriasis due to persistent scratching, a secondary infection, or not treating other psoriasis symptoms like inflammation, which can cause irreversible damage to the scalp and hair growth cycle.

Seek medical help for scalp psoriasis if you are experiencing hair loss or painful or uncomfortable symptoms. It’s also important to seek treatment if hair loss or other symptoms, such as scales and flakes, affect your self-esteem or interfere with your ability to enjoy daily life.

A dermatologist (a doctor specialized in skin, hair, and nail conditions) can diagnose and treat scalp psoriasis.

There are many ways to treat hair loss from psoriasis. The root cause of this hair loss is psoriasis, so treatments that manage the psoriasis symptoms should also help with your hair loss.

Treatment options include topical (applied to the skin) medications, oral (taken by mouth) medications, and in-office treatments. Your healthcare provider will prescribe the appropriate medication based on the severity of your symptoms.

If hair loss continues after treatment, speak to your healthcare provider about other treatment options or whether another medical condition may be causing it.

Topical Medications

Medications for scalp psoriasis applied directly to the skin may include:

Topical corticosteroids: Corticosteroids treat inflammation. Your healthcare provider may prescribe a topical corticosteroid medication that reduces scales, redness, swelling, and itchiness. Long-term corticosteroid use isn’t recommended, so your provider may prescribe another treatment alongside corticosteroids to help reduce possible side effects such as itching, rash, skin thinning, and burning.
Medicated shampoos: Shampoos for psoriasis containing clobetasol propionate (a steroid) are safe to use daily for up to four weeks, then once or twice weekly to maintain results. If symptoms don’t improve, your healthcare provider may prescribe something else. Side effects may include burning, itching, redness, and dry skin. Your healthcare provider may also recommend over-the-counter (OTC) shampoos made with coal tar, a thick black liquid derived from coal.
Calcitrene (calcipotriene): This treatment involves applying a synthetic form of vitamin D directly to the scalp at night. It helps heal thicker psoriasis patches and is sometimes prescribed as a combination medication containing calcipotriene and a corticosteroid. Possible side effects include itching, redness, burning, and worsening psoriasis symptoms.

Oral Medications

Medications taken by mouth that your healthcare provider may prescribe include:

Soriatane (acitretin): This oral retinoid treats severe psoriasis by slowing fast-growing skin cells and reducing swelling and redness. Possible mild side effects include hair loss, chapped lips, and increased sensitivity to light. Acitretin isn’t recommended for people who are pregnant, are planning to get pregnant, or have liver disease, as it can cause potential birth defects, liver damage, and inflammation (hepatitis).
Trexall (methotrexate): An overactive immune system leads to psoriasis, so your provider may prescribe methotrexate, which suppresses the overactive immune system. Methotrexate is often prescribed for more severe cases of psoriasis, especially if other treatment options have not been effective. Side effects may include nausea and vomiting.
Biologics: Biologics are strong drugs derived from plants or animals and their cells. They can be given orally or through injections. Biologics slow or stop inflammation and target the overactive part of the immune system that causes psoriasis. Possible side effects include an upper respiratory tract infection, flu-like symptoms, urinary tract infections (UTIs), and headaches.

In-Office Treatments

Some people may require in-office treatments if scalp psoriasis doesn’t improve with topical treatments or if they have thick scales on their scalp. In-office treatments include:

Corticosteroid injections: A dermatologist injects a corticosteroid directly into the sites of scalp psoriasis. This treatment method takes place over a few sessions and isn’t effective for long-term use.
Laser treatment: A dermatologist performs this treatment using an excimer laser, which delivers high-intensity ultraviolet B (UVB) light to areas affected by psoriasis. Excimer laser treatment can reduce inflammation and promote faster healing. It’s most effective if performed 2-3 times weekly for several weeks. Though usually pain-free, potential side effects may include sunburn-like pain and redness.
Phototherapy (light therapy): This uses UVB radiation light to treat psoriasis all over the body, including the scalp. During treatment, you would either stand inside a light box, which simulates natural light, or a dermatologist will directly pass a UVB light over your body. Phototherapy is a good option for children and people who are pregnant or have compromised immune systems. Possible side effects from this treatment include red or tender skin, stinging, burning, dark spots, itching, and, in rare cases, blisters or burns.

Psoriasis is a chronic condition that can flare up even with treatment, but it is possible to reduce your risk of hair loss due to scalp psoriasis.

You can reduce your chances of psoriasis-related hair loss if you:

Loosen and remove any scales by gently brushing your hairKeep your nails cut short, and avoid picking at scales with your fingersUse a medicated shampoo and alternate it with a gentle, non-medicated shampoo every other wash; some medicated shampoos can dry out your hair, making it more likely to breakCondition your hair after shampooing to prevent dry scalp and hairAir-dry your hair; a blow dryer can make a dry scalp worsePatch test hair care and styling products; if a product causes irritation or redness after a few hours, discontinue use and try another product

Scalp psoriasis is a chronic inflammatory skin condition that can cause hair loss. Other symptoms include scalp dryness, red patches, itchiness, and bleeding.

While psoriasis hair loss is usually temporary, it can sometimes cause scarring alopecia. It’s important to see a healthcare provider for scalp psoriasis treatment to manage your symptoms and minimize hair loss.