Can Psoriasis Cause Hair Loss?

Psoriasis is a chronic autoimmune condition that affects millions of people, and about 50% of those with psoriasis develop it on their scalp. If you're dealing with scalp psoriasis and noticing hair thinning, you're not alone—and there's good news about recovery.

Let's explore the relationship between psoriasis and hair loss, and what you can do to protect your hair.

Understanding Psoriasis

Psoriasis is an autoimmune disorder that causes skin cells to multiply faster than normal. While typical skin cell turnover takes about a month, psoriatic skin cells can turn over in just a few days. This rapid cell growth leads to the buildup of thick, scaly patches called plaques.

Types of Psoriasis

• Plaque psoriasis: Most common type; raised, red patches with silvery-white scales
• Scalp psoriasis: Specifically affects the scalp; can extend onto the forehead, neck, and ears
• Guttate psoriasis: Small, dot-like lesions; often triggered by strep infections
• Inverse psoriasis: Appears in skin folds; smooth, red patches
• Pustular psoriasis: White pustules surrounded by red skin

Scalp Psoriasis Symptoms

Scalp psoriasis can range from mild to severe and may include:

• Red, scaly patches on the scalp
• Silvery-white or gray scales
• Intense itching
• Dry scalp that may crack and bleed
• Burning or soreness
• Temporary hair loss
• Patches extending beyond the hairline onto the forehead, neck, or ears

How Psoriasis Causes Hair Loss

Scalp psoriasis can lead to hair loss through several mechanisms:

1. Inflammation

The inflammatory response in psoriasis directly affects hair follicles:

• Weakened follicles: Chronic inflammation makes hair follicles weak and brittle
• Disrupted growth cycle: Inflammation can push follicles into the resting (telogen) phase prematurely
• Reduced blood flow: Inflamed skin may have compromised circulation, affecting nutrient delivery to follicles

2. Physical Trauma from Scratching

The intense itching of scalp psoriasis often leads to scratching:

• Hair breakage: Scratching physically breaks hair shafts
• Follicle damage: Vigorous scratching can damage follicles
• Worsening plaques: Scratching triggers the Koebner phenomenon, causing new psoriasis in scratched areas
• Secondary infection: Open scratches can become infected, further damaging follicles

3. Scale Buildup

The thick scales characteristic of psoriasis can affect hair:

• Hair trapped in scales: Hair can get caught in thick plaques and pull out when scales are removed
• Blocked follicles: Heavy scale buildup can obstruct hair growth
• Tight plaques: Plaques can physically tighten around hair shafts, pulling hair out

Psoriasis vs. Other Scalp Conditions

It's important to distinguish scalp psoriasis from other conditions that can cause similar symptoms:

How to Prevent Hair Loss from Psoriasis

While you can't always prevent scalp psoriasis, you can take steps to minimize hair loss when flares occur:

1. Resist Scratching

• Keep nails trimmed: Short nails cause less damage if you do scratch
• Use gentle pressure: If you must relieve itching, use the soft pads of your fingers, not nails
• Cool compresses: Apply a cool, damp cloth to itchy areas
• Distraction techniques: Find ways to keep hands busy during intense itching episodes

2. Use Medicated Shampoos

Specially formulated shampoos can help soften and remove scales without damaging hair:

• Salicylic acid: Breaks down and softens scales for gentle removal
• Coal tar: Slows cell turnover and reduces inflammation
• Ketoconazole: Antifungal that may help with scalp inflammation
• Prescription-strength options: Stronger formulations available from dermatologists

3. Handle Hair Gently

• Gentle combing: Use a wide-toothed comb; don't use bristles to lift scales
• Avoid pulling: Be careful when removing scales—let treatments soften them first
• Air dry when possible: Heat from blow-dryers can dry out already-stressed skin
• Loose hairstyles: Avoid tight ponytails or braids that pull on affected areas

4. Manage Triggers

Identifying and avoiding your psoriasis triggers can prevent flares:

• Stress: Stressis a major psoriasis trigger; practice relaxation techniques
• Alcohol: Heavy drinking can trigger or worsen flares
• Weather: Cold, dry weather often worsens psoriasis
• Skin injuries: Cuts, burns, or sunburns can trigger new plaques (Koebner phenomenon)
• Infections: Strep throat and other infections can trigger flares

Treatment Options for Scalp Psoriasis

Treating the underlying psoriasis is the best way to prevent hair loss. Treatment options range from over-the-counter to prescription medications:

Topical Treatments

• Corticosteroid solutions/foams: Reduce inflammation and slow cell turnover; available in various strengths
• Vitamin D analogs: Calcipotriene slows skin cell growth
• Anthralin: Slows cell growth and removes scales
• Tazarotene: A retinoid that normalizes skin cell growth
• Salicylic acid preparations: Help lift and remove scales

Phototherapy

• UVB light therapy: Exposure to controlled UVB light can slow skin cell turnover
• Excimer laser: Targeted laser treatment for localized plaques
• Handheld devices: Some patients use at-home UV devices under medical supervision

Systemic Treatments (Moderate to Severe)

For moderate to severe scalp psoriasis, systemic medications may be necessary:

• Methotrexate: Suppresses immune response
• Cyclosporine: Immunosuppressant for severe cases
• Biologics: Target specific parts of the immune system (adalimumab, secukinumab, etc.)
• Oral retinoids: Affect how skin cells grow

Steroid Injections

For stubborn, localized plaques, dermatologists can inject corticosteroids directly into the affected area for rapid improvement.

Will Hair Grow Back?

The good news is that most hair loss from scalp psoriasis is temporary and reversible.

When Hair Typically Regrows

• After effective treatment: Once psoriasis is controlled, hair usually begins regrowing within a few months
• Timeline: Noticeable regrowth typically occurs 3-6 months after successful treatment
• Full recovery: Complete restoration may take 6-12 months

When Hair Loss May Be More Lasting

Permanent hair loss from psoriasis is rare but can occur with:

• Chronic, untreated psoriasis: Long-standing severe plaques can eventually scar follicles
• Repeated trauma: Years of scratching can cause scarring alopecia in affected areas
• Secondary infections: Infections in damaged scalp skin can cause permanent follicle damage

Psoriasis and Alopecia Areata

Interestingly, people with psoriasis have a higher risk of also developing alopecia areata—another autoimmune condition that causes patchy hair loss. Both are autoimmune disorders, and having one increases the risk of having another.

If you notice distinct bald patches (rather than general thinning from scalp plaques), this may indicate alopecia areata rather than psoriasis-related hair loss. A dermatologist can distinguish between the two.

When to See a Doctor

Consult a dermatologist if you experience:

• Persistent scalp symptoms: Itching, scaling, or redness that doesn't improve with over-the-counter treatments
• Significant hair loss: Noticeable thinning or bald patches
• Plaques spreading: Psoriasis extending beyond the scalp
• Signs of infection: Increased pain, warmth, swelling, or pus
• Severe itching: Itching that significantly impacts your daily life or sleep
• Joint pain: May indicate psoriatic arthritis

Frequently Asked Questions

Can scalp psoriasis cause permanent hair loss?

In most cases, no. Hair loss from scalp psoriasis is typically temporary and reverses once the condition is treated. Permanent loss can occur only with severe, chronic, untreated psoriasis that causes scarring, or from repeated damage due to scratching. Early treatment prevents this progression.

How do I know if my hair loss is from psoriasis or something else?

Psoriasis-related hair loss is usually associated with visible scalp symptoms—red patches, silvery scales, and intense itching. The hair loss typically occurs in or near areas affected by plaques. If you're losing hair in a pattern typical of androgenetic alopecia (receding hairline, crown thinning) without scalp inflammation, other causes are likely.

Will treating my psoriasis make my hair grow back?

Usually, yes. Once scalp psoriasis is effectively controlled and the inflammation resolves, hair typically regrows. This may take several months after treatment begins. Continuing to manage your psoriasis helps maintain hair growth.

Can I use hair dye if I have scalp psoriasis?

Hair dye can irritate psoriatic skin and potentially worsen flares or trigger the Koebner phenomenon. If you want to color your hair, wait until your scalp is in remission, do a patch test first, and consider using gentler, ammonia-free dyes. Discuss with your dermatologist before dyeing.

Does scratching really make that much difference?

Yes, significantly. Scratching is one of the main causes of hair loss in scalp psoriasis. It breaks hair shafts, damages follicles, and can trigger new plaques through the Koebner phenomenon. Resisting the urge to scratch is one of the most important things you can do to protect your hair.

What shampoo should I use for scalp psoriasis?

Medicated shampoos containing salicylic acid or coal tar can help. For mild cases, over-the-counter options may be sufficient. For moderate to severe cases, your dermatologist may prescribe stronger medicated shampoos. Always follow medicated shampoo with conditioner to prevent excessive drying.

Is psoriasis hair loss different from alopecia areata?

Yes. Psoriasis causes diffuse thinning in areas affected by plaques, associated with visible inflammation and scaling. Alopecia areata causes distinct, smooth bald patches without scaling. However, both are autoimmune conditions, and having psoriasis increases your risk of developing alopecia areata.

Conclusion

Scalp psoriasis can be frustrating, especially when it affects your hair. The inflammation, scaling, and irresistible urge to scratch can all contribute to temporary hair thinning. But there's good news: with proper treatment, most psoriasis-related hair loss is reversible.

The key is managing your scalp psoriasis effectively. Use appropriate medicated treatments, resist scratching, handle your hair gently, and avoid known triggers. Work with a dermatologist to develop a treatment plan that keeps your psoriasis under control.

Remember that early intervention is important. The longer psoriasis goes untreated, the higher the risk of permanent damage. If you're experiencing scalp symptoms and hair loss, don't hesitate to seek professional help from a dermatologist.