Psoriatic arthritis (PsA) causes higher levels of inflammation in the body, which can cause stress hair shedding, or telogen effluvium. Psoriasis can also lead to hair loss if it affects the scalp.
Between 40–80% of people with psoriasis experience problems with their scalp. Scalp psoriasis can lead to itchiness and scratching, which may damage the hair. Additionally, the stress associated with an ongoing health condition, such as psoriasis, can worsen symptoms, leading to more hair loss.
Sometimes, medication or another underlying cause may cause hair loss.
This article looks at how PsA and psoriasis may contribute to hair loss, what increases the risk, and the treatment.
PsA is a type of arthritis. It causes inflammation and pain in the joints. Because of this, it does not directly affect the scalp or hair follicles on the head, but it can raise levels of inflammation in the body.
This can lead to a type of hair loss known as telogen effluvium. Telogen effluvium is a form of temporary hair loss that occurs due to stress or shock.
Psoriasis, the skin condition that accompanies PsA, can also cause hair loss if it affects the scalp. The scalp is a common place for psoriasis plaques to develop; for many, this is the first place symptoms appear.
If psoriasis plaques develop on the scalp, inflammation and scratching may damage the hair follicles, causing hair to fall out. The medical name for this is psoriatic alopecia. If stress worsens a person’s psoriasis, this may also contribute to hair loss.
Medications can also indirectly lead to hair loss. Some drugs that doctors prescribe to control PsA or psoriasis can cause hair loss as a side effect.
Hair lost due to psoriatic alopecia and telogen effluvium will almost always grow back. For this to happen, individuals need to manage their psoriasis well with medications and self-care. Once a person has psoriasis under control, the hair will likely regrow.
Scarring from psoriasis plaques
Yes, certain medications that reduce the symptoms of PsA and psoriasis may cause temporary hair loss. These include:
- Methotrexate: Doctors commonly prescribe this disease-modifying antirheumatic drug (DMARD) to slow the progression of PsA, but it is responsible for hair loss in 1–3% of people.
- Leflunomide: This is another DMARD that doctors often prescribe with methotrexate. It can cause hair loss in 1 in 10 people.
- Biologic agents: These DMARDs target other pathways in the immune system and rarely result in hair loss. However, specific types, such as etanercept or adalimumab, may increase the risk.
- Retinoids: Hair loss is a possible side effect of oral retinoids, which doctors sometimes prescribe for psoriasis.
Applying topical treatments to the scalp too vigorously can also damage the scalp and the hair follicles.
Learn more about treatments for scalp psoriasis.
How do PsA medications cause hair loss?
The reason why DMARDs can cause hair loss is due to how they work. These drugs reduce psoriasis symptoms by stopping cells from growing. This prevents the development of flaking skin and plaques but can affect the hair follicles. In some people, this results in hair loss and prevents hair regrowth.
Scientists do not know why some people develop psoriatic alopecia while others do not. However, certain things may make the condition worse, such as:
- vigorous scratching of scalp psoriasis
- stress
- taking medications with a higher risk of hair loss
According to the Arthritis Foundation, people with inherited male or female pattern baldness may also find that their hair loss begins or progresses faster due to arthritis medications and other hair loss triggers.
There is no cure for psoriasis, so treatment for psoriatic alopecia focuses on reducing plaques on the scalp and preventing others from forming. For people with scalp psoriasis, this may stop hair loss.
Keeping psoriasis symptoms under control can involve a combination of lifestyle changes, topical treatments, therapies, and medications. Treatment may include:
- medicated shampoos, foams, and mousses that contain salicylic acid, coal tar, or wood tar
- vitamin D creams
- corticosteroid solutions
- light treatment
- oral or injectable steroids to reduce inflammation
- non-immunosuppressive treatments to reduce inflammation, such as apremilast
- medications to slow down the disease by reducing the activity of the immune system
If the hair loss results from medications, people can approach it in various ways.
For some, the benefits of the medication on their symptoms and quality of life outweigh the side effects. People who want to continue with their medications but want to conceal their hair loss could consider using head wraps or wigs instead.
If the impact of hair loss outweighs the benefits of the medication, a person can speak with their doctor about changing their treatment plan. Do not change the medication without speaking to a medical professional first.
In addition to medical treatment, there are ways people can reduce psoriasis-related hair loss at home. The AAD recommends:
- avoiding rubbing or scratching the scalp
- washing the hair gently, lathering shampoo without rubbing the scalp
- removing scales with a scale softener instead of scrubbing or picking
- managing and relieving stress, such as by regularly practicing relaxation techniques
The National Institute for Health and Care Excellence (NICE) in the United Kingdom also recommends taking steps to reduce exacerbations by:
- stopping smoking, if relevant
- drinking alcohol within recommended limits or not at all
- maintaining a moderate weight
- seeking support for mental health conditions, such as anxiety or depression
Psoriatic arthritis (PsA) does not directly cause hair loss, but psoriasis and certain PsA medications can. If a person has psoriasis on the scalp, this may cause itchiness and scratching, which can damage the hair follicles. If psoriasis is not on the scalp, there may be another cause for this symptom.
A treatment plan for psoriatic alopecia focuses on reducing flare-ups via medication, topical treatments, and lifestyle changes. Once the condition is under control, hair can often grow back.
Speak with a doctor about managing PsA and psoriasis and for advice on how best to care for the scalp.