Psoriatic arthritis (PsA) causes higher levels of inflammation in the body, which can cause stress-induced hair loss or telogen effluvium. Psoriasis can also cause hair loss if it affects the scalp.
Between 40 and 80% of people with psoriasis have scalp problems. Scalp psoriasis can lead to itching and scratching, which can damage the hair. Additionally, the stress associated with a persistent health condition, such as psoriasis, can make symptoms worse, leading to more hair loss.
Sometimes medications or another underlying cause can lead to hair loss.
This article examines how PSA and psoriasis can contribute to hair loss, increasing risk and treatment.
PSA is a type of arthritis. It causes inflammation and pain in the joints. For this reason, it does not directly affect the scalp or hair follicles in the head, but it can increase levels of inflammation in the body.
This can lead to a type of hair loss called 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 lead to hair loss if it affects the scalp. The scalp is a common place where psoriasis plaques develop; for many, this is the first place symptoms appear.
If psoriasis patches develop on the scalp, the inflammation and scratching can damage the hair follicles, causing hair loss. The medical name for this is psoriatic alopecia. If stress makes a person’s psoriasis worse, it can also contribute to hair loss.
Medications can also indirectly cause hair loss. Certain medications that doctors prescribe to control PA or psoriasis can cause hair loss as a side effect.
Learn how PSA affects the body here.
Hair lost due to psoriatic alopecia and telogen effluvium will almost always grow back. For this to happen, individuals must manage their psoriasis well with medication and self-care. Once a person has psoriasis under control, hair will likely grow back.
Psoriasis plaque scars
Yes, some medications that reduce the symptoms of PsA and Psoriasis can cause temporary hair loss. These include:
- Methotrexate: Doctors commonly prescribe this disease-modifying antirheumatic drug (DMARD) to slow the progression of PA, but it is responsible for hair loss in 1-3% of people.
- Leflunomide: This is another DMARD that doctors often prescribe along with methotrexate. It can cause hair loss in 1 in 10 people.
- Biological agents: These DMARDs target other immune system pathways and rarely cause 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 too vigorously to the scalp can also damage the scalp and hair follicles.
Learn more about scalp psoriasis treatments.
How do PSA drugs cause hair loss?
The reason DMARDs can cause hair loss is due to their mode of action. These drugs reduce the symptoms of psoriasis by preventing cell growth. This prevents the development of skin flaking and plaques, but can affect the hair follicles. In some people, this leads to hair loss and prevents hair regrowth.
Scientists don’t know why some people develop psoriatic alopecia while others don’t. However, some things can make the condition worse, such as:
- vigorous scraping of scalp psoriasis
- taking medications with a higher risk of hair loss
According to the Arthritis Foundation, people with hereditary male or female pattern baldness may also find that their hair loss begins or progresses more quickly due to arthritis medications and other hair loss triggers.
There is no cure for psoriasis, so treatment for psoriatic alopecia focuses on reducing the patches on the scalp and preventing more from forming. For people with scalp psoriasis, it can 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, mousses and mousses containing 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
- medicines to slow the disease by reducing the activity of the immune system
If hair loss is the result of medication, people can approach it in different ways.
For some, the benefits of the drug on their symptoms and quality of life outweigh the side effects. People who want to continue taking their medication but want to conceal their hair loss may consider using head coverings or wigs instead.
If the impact of hair loss outweighs the benefits of medication, a person can speak with their doctor about changing their treatment plan. Do not change the medication without first talking to a healthcare professional.
In addition to medical treatment, there are ways to reduce psoriasis-related hair loss at home. The AAD recommends:
- avoiding rubbing or scratching the scalp
- wash the hair gently, lather the shampoo without rubbing the scalp
- remove scale with a scale softener instead of rubbing or picking
- managing and relieving stress, for example by regularly practicing relaxation techniques
The National Institute for Health and Care Excellence (NICE) in the UK also recommends taking steps to reduce exacerbations by:
- stop smoking, if applicable
- drinking alcohol within the recommended limits or not at all
- maintain a moderate weight
- seek support for mental health issues, such as anxiety or depression
Learn more about living with psoriasis here.
Psoriatic arthritis (PsA) does not directly cause hair loss, but psoriasis and some PsA medications can. If a person has psoriasis on the scalp, it can cause itching and scratching, which can damage the hair follicles. If the 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 through medications, topical treatments, and lifestyle changes. Once the condition is under control, the hair can often grow back.
Talk to a doctor about managing PA and psoriasis and get advice on how best to take care of your scalp.