6 Things You Can Do About Hair Loss from Scalp Psoriasis
Treating scalp psoriasis brings its own unique set of challenges. For starters, the scalp is—in most people—covered with hair. This can obstruct the area that needs treatment and can also trap psoriasis scales, making them harder to remove. And then there’s hair loss—a common problem in people with scalp psoriasis, according to the National Psoriasis Foundation. Many people want to know if hair loss can be prevented, or, at least, slowed down. The good news is: Yes, it can be.
Know What’s Normal
To understand hair shedding and loss, it helps to understand what’s typical and what isn’t. Our scalp normally sheds about 100 hairs a day. “Most of these come out when we wash or comb our hair,” says board-certified dermatologist Sandy Skotnicki, M.D., an assistant professor in the department of dermatology at the University of Toronto. “Significant itching from psoriasis would also lead to this normal hair shed, which typically only happens with washing or combing.”
But if you’re losing more than those 100 daily hairs, or if hair is falling out at other times, this may be considered excessive and is worth having checked out by a dermatologist, according to the American Academy of Dermatology (AAD). Excessive shedding is usually temporary, so long as the cause is resolved. Hair loss is slightly different—it’s when hair stops growing for a particular reason. That reason must be resolved in order for the hair to start growing again.
Get to the Root Cause
Psoriasis itself doesn’t cause excessive shedding or hair loss, as it doesn’t harm the hair follicles, according to Skotnicki. Instead, it can usually be attributed to other factors—some related to the condition and some not. These include:
Scratching or picking the scalp: “If you pick off thick scales on the scalp and there are hair shafts stuck to the thick scales, then the hairs come off at the same time,” Skotnicki says.
Scarring: There’s a possibility that hair may fail to grow over a psoriatic plaque itself, or that scarring may lead to permanent hair loss, says London doctor and dermatology registrar Cristina Psomadakis, although she says these occurrences are rare. “We are still researching and characterizing the extent of this type of scarring alopecia, which seems to be linked to atrophy of the scalp glands,” Psomadakis says.
Stress: “Overall hair thinning and shedding is known as telogen effluvium, which is usually triggered by stress,” Psomadakis explains.
Excessive shedding and hair loss can have other causes, too, including some illnesses, some drugs, heredity, and harsh hair-care products. Your dermatologist may be able to help you determine the root cause of excessive shedding or hair loss and help you come up with a plan to stop or slow it.
Preventing hair loss with scalp psoriasis starts with a tender touch. The AAD warns that forcefully removing scales often loosens the surrounding hair. Always comb and brush any scales away gently, and try to avoid picking with your fingers. Apart from the risk of pulling out hair, this may aggravate the skin and cause a flare-up.
Of course, sometimes, it’s impossible to avoid itching the psoriasis plaques on your scalp. But you can reduce the collateral damage by keeping your fingernails short and filed, so the tips are smooth. The shorter and smoother your nails are, the less likely you are to loosen your hair or break skin when you scratch.
When it comes to applying psoriasis treatments to your scalp, it’s unlikely that the product itself will cause hair loss, Skotnicki says. But identifying the most effective treatment is key. “Getting your scalp psoriasis under control allows hair to grow on healthy scalp skin and will reduce trauma to the area from scratching or picking,” Psomadakis says.
Depending on the extent of your scalp psoriasis and past medical history, your treatment plan might be multifaceted. As well as using medicated shampoos, topical steroids and systemic medications, board-certified dermatologist Rhonda Q. Klein, M.D, of Modern Dermatology of Connecticut in Westport, treats scalp psoriasis at her office with light therapy and biologics.
Avoid Harsh Styling and Treatments
If you use a medicated shampoo on your scalp psoriasis, the AAD suggests alternating shampoos to avoid overly drying your scalp and hair, because dry hair breaks more easily.
“A medicated shampoo that loosens plaques and soothes irritation is a baseline to any treatment protocol for scalp psoriasis,” says Klein, who recommends CLn Gentle Shampoo and Free & Clear Medicated Anti-dandruff Shampoo.
The AAD suggests alternating a medicated shampoo one day with an unmedicated, gentle shampoo each time you wash your hair. Apply an unmedicated conditioner after every shampoo to make the scalp and hair feel less dry.
It might also help to let your hair air-dry, because blow-drying can dry the scalp even more. Hair color, straightening products, and hair sprays can have the same effect, so try to give your hair “off” days from these things. Test a small amount of hair-care product on your scalp and leave it there for a while to ensure you don’t experience irritation. If you do, switch it for something gentler.
If the prescribed treatment for your scalp psoriasis seems too harsh, let your dermatologist know—there are many alternatives out there.
Manage Stress and Other Triggers
A key part of managing psoriasis—wherever it appears on your body—is to try to reduce stress. “It is known that chronic inflammatory diseases put stress on the body, which could indirectly increase hair shedding,” Skotnicki says.
Looking after your mental health is paramount, Psomadakis agrees, as is having a nutritious diet filled with plenty of fresh fruits and vegetables and staying away from any known dietary triggers.
If you’ve tried all of the above and you’re still experiencing hair loss that’s causing you concern, speak to your dermatologist. It might be caused by something that’s not actually related to your scalp psoriasis. “Another body stressor, such as vitamin deficiency, life stress or an unrelated medical issue might be the root cause,” Psomadakis says. “Your doctor can give you a blood test to rule out other causes.”