When Your Hair Won't Cover Your Psoriasis

Has psoriasis caused you a lack of self-confidence or embarrassment because of hair loss or visible lesions? This is not uncommon. If you have psoriasis, you have a good chance of developing it on your scalp at least once — about 50 percent of people with psoriasis do, according to the American Academy of Dermatology.

Sometimes scalp psoriasis is just a minor annoyance, with only slight, fine red scales in some spots that are barely noticeable. But it also can be very severe, with thick, crusted plaques covering your entire scalp. Severe scalp psoriasis can go beyond your hairline, across your forehead to your neck and around your ears. As a result, having scalp psoriasis can be embarrassing and make you want to stay out of view.

People with severe scalp psoriasis also may experience some hair loss, but you don’t have to worry too much. Your hair is likely to grow back, says Paul Yamauchi, MD, a dermatologist at the Dermatology Institute and Skin Center in Santa Monica, California.

Here’s what can cause you to develop bald spots from scalp psoriasis:

  • If you're too aggressive about removing the thick scales, you can take out your hair along with the scales.
  • If you’re constantly scratching your scalp because it itches, you can pull your hair out.
  • If you’re using vigorous drugs or salicylic acid to remove your scales, it can damage your hair and cause it to fall out.
  • If you’re under a great deal of stress, it can cause psoriasis to flare and your hair to fall out. Researchers have found that when you’re under stress, your hair can enter a resting phase known as telogen. After about three months, at the end of this phase, your body sheds the hair. If too much of your hair goes into telogen at once, you can lose a great deal of hair at the same time.

Treatment Options

Melodie Young, NP, RN, an advanced practice nurse focusing on gerontology and dermatology at Baylor Scott and White Modern Dermatology in Dallas, Texas, remembers patients in the 1980s telling her they had been advised to shave their heads because of their psoriasis. “That’s crazy,” she says. “We have so many fantastic ways to clear psoriasis and to treat scalp psoriasis.”

Here’s how you can treat scalp psoriasis:

Use medicated shampoos. You will find lots of coal tar and other medicated shampoos on your pharmacy shelf that can help clear up psoriasis. Be sure to massage the shampoo into your scalp. After all, it’s your scalp you’re treating, not your hair. Apply topical treatments to your bald spots in addition to using shampoos.

Use conditioner. Conditioners help keep your scalp moist. Also, using a non- medicated conditioner can help rid your hair of the odor from medicated or tar shampoos.

Go natural. Avoid the blow-dryer and harsh chemicals from perms, straighteners, hair sprays, and stylers. The blow-dryer can make your scalp even drier than it already is and worsen hair loss. Chemicals can further damage hair, resulting in hair loss. If you want to use a bleach or hair dye, test it on a small area of your scalp first to make sure it’s not irritating.

Cut your nails. If you keep your fingernails clipped, you won’t be able to scratch the psoriasis hard enough to make it bleed and cause hair loss.

Take systemic drugs. “Methotrexate in low doses will help the scalp tremendously,” says Young. Doctors don’t typically prescribe systemic medicines for scalp psoriasis alone, but if you have moderate-to-severe psoriasis on the scalp, you’re likely to have it elsewhere too. And systemic medication can really help, says Colby Evans, MD, a dermatologist in Austin, Texas, and chairman of the board of trustees of the National Psoriasis Foundation.

Dermatologists also may treat mild scalp psoriasis with steroids, injecting scalp lesions with the medication. Just be careful not to overdo the steroids, as the skin on your scalp is thin and your body can easily absorb them.

Managing Self-Confidence

A bigger problem with scalp psoriasis is often self-esteem. People with psoriasis on their scalp and other areas where it's visible often lack self- confidence. Some things you can do to boost your self-confidence when you have scalp psoriasis are:

Wear a scarf or hat. You may feel better if people can’t easily see your scalp and the psoriasis on it. If missing patches of hair bother you, you may want to shave your head and let your hair grow back at the same rate everywhere.

Join a support group. Many people find comfort from seeing they're not alone and sharing their stories with others in the same boat. You can join a psoriasis support group online through the National Psoriasis Foundation.

Talk to yourself. “You need to tell yourself you're not the psoriasis,” says Stanley Teitelbaum, PhD, a clinical psychologist in New York City and New Jersey. Remind yourself of your strengths and what you have accomplished. Don’t dwell on visual imperfections. “You just have to keep it in perspective,” he says.

Talk to Your Dermatologist

Hair loss can make having scalp psoriasis even more devastating.

If you talk with your doctor, you can find a treatment that works for you. Once your scalp clears, you will find that your hair loss is only temporary and that you can resume your normal activities.

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