Symptoms--Hair Loss

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

Psoriasis is a chronic autoimmune condition that causes raised, inflamed, and scaly patches called plaques to appear on the skin. Plaques can occur anywhere on the body, but the scalp is a common location--around half of people with psoriasis have symptoms on the scalp1.

Can psoriasis cause hair loss?

Many people with scalp psoriasis may worry that they will lose their hair. Some people who have psoriasis will experience hair loss, but it is usually only temporary2. Hair loss is not very common in people who have mild or moderate psoriasis. People who have more severe psoriasis may have small areas of hair loss, but psoriasis rarely causes permanent hair loss3.

What are the possible causes of hair loss?

Hair loss that is caused by psoriasis is called psoriatic alopecia. Psoriatic hair loss can affect the hair on the head as well as body hair. Hair loss occurs most often on areas of the scalp where there are plaques. A smaller number of people experience more general hair shedding all over the scalp1.

When hair loss happens on the scalp, it is usually caused by removing the silvery scale covering the top layer of the plaque. Scratching the plaque, by combing the hair, for example, can pull off parts of the scale. In some cases, patches of hair may come out along with the scale. When the plaque on that area of skin heals, hair usually grows back completely and there is no scarring2.

Certain types of psoriasis treatments may also have the side effect of hair loss for some patients3. These include acitretin, which is a Vitamin A analogue, and certain kinds of biologic therapies. Patients who need to apply topical treatments to the scalp on a regular basis might also experience hair loss due to the friction of rubbing in the medication4.

What are treatment options for hair loss?

An effective way to treat hair loss is to prevent it, by treating the psoriasis plaques that can cause hair to fall out. Products made from coal tar and salicylic acid can work well on scalp psoriasis that is milder. Other topical treatments for scalp psoriasis include anthralin, Tazorac (tazarotene), Taclonex (calcipotriene) and Dovonex (calcipotriene)3. More severe scalp psoriasis may need to be treated with phototherapy or stronger medications such as systemic or biologic treatments that affect the entire body to reduce psoriasis symptoms.

Itching on the scalp is very common for people with scalp psoriasis. It is important to treat the itch because itching leads to scratching, which can cause hair loss if scales on the plaques are removed. There are various medical shampoos available that can help reduce itching. They are usually rubbed into the scalp and left to sit for a while so that the treatment can penetrate the scalp through the hair. Over-the-counter antihistamines taken by mouth can also help to relieve itching.

Tips for living with hair loss caused by psoriasis

Although scalp psoriasis can be very itchy, it is best to minimize scratching as much as possible. In addition to causing hair loss, scratching can cause the scalp plaques to bleed. Being very gentle while shampooing (whether or not it is medicated shampoo) is also important because scrubbing and scratching can make the plaques worse1.

If you need to remove scale for psoriasis plaques on your scalp, it must be done very carefully and gently by first applying oil or ointment to soften the scale, then loosening it to remove it. Picking at the scale can make the plaque worse and also cause hair loss.

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