Does Scalp Psoriasis Cause Hair Loss?

No one likes dry skin or dandruff, but scalp psoriasis can be a whole different challenge to deal with if you’re not careful.

Psoriasis is an autoimmune disorder that causes skin cells to form faster than normal. With an increase in inflammation, these skin cells pile on to each other, causing silver or red itchy plaques to form on your skin. If you have psoriasis, you can show signs of the disorder in your nails, on your knees or elbows and other parts of your body. Additionally, about 50% of people who have psoriasis show signs of the disorder on their scalp.

Dermatologist Christine Warren, MD, explains some of the unique challenges that come with scalp psoriasis and why it may cause potential hair loss if agitated or left untreated.

Can scalp psoriasis cause hair loss?

In response to an increase in inflammation, your hair follicles can become weak and brittle. Paired with an itchy, dry scalp, you might feel inclined to scratch or pick at the scales caused by psoriasis.

“When you do that, you can make your scalp psoriasis worse,” says Dr. Warren. “As you try to relieve your symptoms with scratching, you could actually be causing some hair loss.”

Because of the inflammation, hair can fall out on its own, but further agitation can speed that process along.

Is hair loss permanent?

In most cases, hair loss as a result of scalp psoriasis is only temporary if the condition is adequately treated.

“The only reasons it possibly wouldn’t grow back are if you had chronic, severe scalp psoriasis that was left untreated or you had scratched so much or you had done so much damage, you were bleeding or causing sores on your scalp — and that could lead to scarring,” explains Dr. Warren. “If we can calm the psoriasis down, treat it and get it under control, then in most cases, we can get that hair to regrow.”

Tips for reducing hair loss when you have scalp psoriasis

So, how do you overcome all the discomfort and itchy feelings associated with scalp psoriasis without making it worse or furthering hair loss? Dr. Warren offers several tips to help manage symptoms.

1. Avoid scratching or picking scales

“As you’re rubbing or scratching your scalp, it’s causing your hair to break,” says Dr. Warren. Overall, you should avoid touching your scalp, but if you have to relieve some of that itchy feeling, gently rub the area with the soft part of your fingers.

2. Keep your fingernails trimmed

To avoid picking or unintentionally scratching your scalp, keep your fingernails trimmed. “It can sometimes feel like it’s impossible to resist scratching, but you can do less damage to your skin and your hair if your nails are trimmed,” advises Dr. Warren.

3. Rely on gentle hair care

Gently comb your hair and don’t try to use the bristles of your brush or comb to forcibly lift the scales on your scalp. Concentrate on your hair itself and don’t apply too much pressure when combing, washing or drying.

4. Use medicated shampoos

Stronger shampoos can be prescribed, and there are some over-the-counter options specifically for psoriasis. Often, these shampoos contain salicylic acid. They soften the scale on your scalp and help loosen it so you don’t have to forcibly remove it. “Salicylic acid breaks down some of that scale, which is basically dead skin cells,” says Dr. Warren.

5. Use a conditioner after every shampoo

Medicated shampoos can dry out your hair, though, so it’s important to use a conditioner after you use them. Anytime your hair becomes drier, it’s going to be more brittle, which is why it’s important to be gentle and follow up with a conditioner.

6. Avoid blow-drying

As much as possible, allow your hair to air dry because your scalp is already dry from the psoriasis or medicated shampoo. “If your hair is dryer than usual during your treatment, allowing it to air dry is preferred,” says Dr. Warren.

7. Prescribed treatments can include ointments, lasers and injections

Your doctor can prescribe a number of topical medications that can be applied directly to your scalp that can assist with decreasing the amount of scales you have. Topical steroids come in a variety of types, including lotions, solutions and thicker ointments. These can help clear some of the scales without damaging your hair.

But for more difficult cases, there are also handheld laser treatments and steroid injections available. “Many patients need something more because their scalp psoriasis is stubborn,” says Dr. Warren. If you have moderate to severe psoriasis, you might also be prescribed oral or injectable medications to target psoriasis, not only on your scalp, but also on other parts of your body, nails or joints.

8. Wear a hat when you’re outside

A bad sunburn can cause an increase in inflammation or a flare of psoriasis on your scalp, so remembering to wear a hat when you’re outdoors is important.

9. Avoid drinking and stress-inducing activities

“Different people have different triggers for psoriasis, and unfortunately, these aren’t things you can always completely avoid,” says Dr. Warren. Since heavy drinking and high stress levels can be common triggers that cause psoriasis to flare up, it’s important to avoid these triggers when possible and practice relaxation techniques when you start feeling stressed.

When you should see your doctor

It’s easy to confuse scalp psoriasis with dandruff or a mild rash. Unfortunately, psoriasis in most cases is a lifelong condition that can flare up at any time. If you’re experiencing a consistently itchy scalp, you’re finding white or gray scales, and over-the-counter anti-dandruff shampoo isn’t working, you should see your healthcare provider.

“The primary goal here is to seek treatment and help manage your scalp psoriasis to decrease the possibility of hair loss,” says Dr. Warren.