Psoriasis affects up to 7.5 million Americans. Medical opinion suggests that it is likely due to the immune system not working correctly.
Scalp psoriasis can occur in one or two patches, or it can be widespread. It may affect the whole scalp, the forehead, the back of the neck, or behind the ears.
Psoriasis and scalp psoriasis
Scalp psoriasis involves skin changes on the scalp and around the hairline.
Psoriasis is an autoimmune disorder that causes skin cells to grow too quickly, resulting in scaling and inflamed skin and other symptoms. Scalp psoriasis can lead to hair loss.
When skin cells grow, they form deep within the skin and slowly move to the surface. There, the new cells replace dead cells, and the dead skin cells are shed. This process normally takes around a month to complete.
Psoriasis speeds up this process of skin regeneration. When a person has psoriasis, it takes only a few days for new cells to form and rise to the surface. The speed at which this happens causes the skin to build up in patches on the surface.
A buildup of skin is known as plaque. Plaque psoriasis is the most common form of psoriasis.
As the skin builds up, patches of red, thickened skin with silver streaks begin to form. These patches may be itchy or painful. A person may experience dry, cracked skin that bleeds, plus swelling and stiffness in their joints.
In scalp psoriasis, these patches of excess cells affect the skin of the head.
Scalp psoriasis is a type of plaque psoriasis, but other kinds of psoriasis can affect the scalp. There may be intense itching. Scratching can then cause skin damage.
In scalp psoriasis, skin changes can appear on the scalp, forehead, back of the neck, and behind the ears.
A person may notice:
- red patches on the scalp, ranging from barely noticeable to pronounced and inflamed lesions
- flaking and scales that may at first resemble dandruff but have a silvery sheen
- a dry scalp that may crack and bleed
- itching that ranges from a mild annoyance to extreme that interferes with life and sleep
- burning, soreness, or pain on the scalp
- temporary hair loss, as a result of scratching the scalp or removing the scales
Bleeding can occur if the skin becomes dry and cracked while scratching can make this worse. If breaks in the skin occur, a fungal or other infection may result.
If a person notices swollen lymph nodes in the neck or crusting on the scalp, they may wish to see a doctor, as they may need treatment for an infection.
Psoriasis, including scalp psoriasis, typically goes through phases of flares and remission.
During a flare, symptoms appear and may become severe. During a phase of remission, the symptoms may disappear for a long time. With scalp psoriasis, the hair usually regrows during periods of remission.
Prevention and treatment
Preventing an outbreak of scalp psoriasis before it starts is the best way to avoid hair loss.
Proper treatment is crucial to prevention, and a dermatologist can provide medical treatment that can clear up an outbreak quickly before symptoms become severe or cause complications.
Depending on how severe the symptoms are, a doctor may suggest applying the following treatments to the affected area:
- corticosteroid injections to reduce inflammation and itching
- vitamin D cream for topical application
- light therapy, depending on the thickness of a person's hair
- medications to apply directly to the skin
a scale softener, which softens skin patches to allow medication to penetrate the surface
Psoriasis is a condition that affects the whole body, although symptoms appear on the skin. If the symptoms are severe, a doctor may prescribe systemic medications, which a person takes by mouth or injection.
- biologics, a type of drug that targets specific genes in the body
- methotrexate, a disease-modifying drug that affects the way the immune system works
- retinoids, a form of vitamin A
- cyclosporine, an immunosuppressant that slows the immune system
Sometimes, a doctor will prescribe a combination of drugs or treatment types.
Medicated shampoos, containing salicylic acid or coal tar, may help. However, shampoo with salicylic acid can also lead to further hair breakage, since the acid may weaken hair follicles.
People should ask their doctor about a suitable shampoo and wash the hair gently.
Some home remedies and lifestyle changes can help people to take control of their scalp psoriasis and prevent outbreaks.
When symptoms occur, the American Academy of Dermatologists suggest the following:
- seek medical advice as soon as possible
- avoid scratching or picking
- shampoo gently to prevent further irritation
- gently brush and comb out flakes and scales
- apply any treatment to the scalp, not just the hair
- let the hair dry without using a hair dryer
- alternate shampoos and use a conditioner to reduce the risk of dryness
Some types of shampoo are more suitable for people with scalp psoriasis. Click here to read our article about how to choose a suitable shampoo.
Medicated and coal-tar shampoos are available for purchase online, but people must check with a doctor which one they should use.
Tips for preventing flares
Other tips to prevent symptoms of scalp psoriasis from flaring or worsening include:
- giving up smoking
- avoiding alcohol
- limiting exposure to cold weather
- limiting stress
- maintaining a healthy body weight
- monitoring any skin injuries, such as cuts or insect bites, for psoriatic changes
- informing a doctor if you have psoriasis before taking any new medication
Some sources have suggested using a vitamin called biotin to prevent hair loss.
In 2015, scientists reported on a case study involving one person with psoriasis. The participant increased her intake of vegetables while limiting meat, processed, and sugary foods for 6 months. She also took supplements, including biotin. The team reported that the symptoms disappeared in this time.
This study involved only one participant, however, and other factors or nutrients might have contributed to the result. There appears to be no evidence that biotin alone will specifically help prevent hair loss due to psoriasis.
A review of literature published in 2017 concluded that there is not enough evidence to recommend biotin for this purpose.
Causes, risk factors, and triggers
The cause of psoriasis remains unclear, but it may be due to a problem with the immune system.
In psoriasis, white blood cells known as T cells appear to attack healthy skin cells. T cells play a role in the immune system where they fight off bacteria, viruses, and other "invaders."
In psoriasis, the excessive activity of these T cells may lead to faster production of skin cells. As this cycle speeds up, more skin cells move to the surface.
A number of triggers may start up the cycle. Once it starts, a person may need treatment to halt it.
Risk factors and triggers
Several factors and triggers appear to increase the risk of psoriasis appearing or a flare starting.
When people know about these triggers, it can help them to avoid outbreaks. It might also prompt a person to seek treatment sooner when it can be more effective.
Risk factors appear to include:
- a family history of psoriasis
- certain viral and bacterial infections, such as HIV and recurrent strep throat
- weakened immune system
People with scalp psoriasis may have a higher risk of psoriatic arthritis or another autoimmune disease.
A person with scalp psoriasis may have symptoms of psoriasis in other parts of the body.
In addition, people with psoriasis sometimes experience further complications, and they may have a greater risk of certain health conditions than someone without the condition. In addition, psoriasis can affect a person's quality of life.
Medical conditions that can occur alongside psoriasis include:
- psoriatic arthritis where psoriasis damages the joints
- metabolic syndrome
- eye diseases, such as conjunctivitis
- high blood pressure
- heart disease
- Parkinson's disease
- kidney disease
- other autoimmune disorders, including Crohn's disease, celiac, and inflammatory bowel disease
Psoriasis can affect a person's quality of life in the following ways:
- sleep disruption due to itching
- tiredness and fatigue
- feelings of grief or embarrassment over hair loss and skin patches
- low self-esteem
- problems at work or school
- social isolation
It is important for people to know that psoriasis is not contagious, meaning you cannot catch it from another person.
Other skin conditions linked to hair loss
Scalp psoriasis is not the only skin condition that may cause hair loss.
To diagnose scalp psoriasis, a doctor can examine a skin sample under a microscope and rule out other causes.
Conditions with similar symptoms include:
Treatment is available for all of these conditions.
Psoriasis is a condition that affects the whole body, but symptoms can appear on the skin and the scalp. On the scalp, it can lead to hair loss, although the hair can grow back when skin symptoms disappear.
According to the American Academy of Dermatology, a flare of scalp psoriasis should disappear quickly once a person starts treatment. As long as they follow the treatment plan correctly, early treatment can prevent hair loss.