Scalp Psoriasis & Hair Loss, Here’s What You Should Know

Scalp psoriasis is a common but very often misunderstood skin condition. It can significantly impact not only the health of your scalp but is also a common cause of hair loss. Whilst psoriasis is a chronic inflammatory skin condition, its effects on the scalp and hair follicles are less talked about but can be even more distressing. In this article, we’ll explore scalp psoriasis in detail including its causes, symptoms and how to diagnose it. We’ll also review the connection between scalp psoriasis and hair loss as well as the most effective treatment options.

What is Scalp Psoriasis?

This is a chronic autoimmune condition where the immune system triggers an accelerated production of skin cells on the scalp. As a result, there is rapid buildup of dead skin which then forms thick raised patches known as plaques. These areas of skin are typically red, inflamed and covered in silvery-white scale. This form of psoriasis often presents with persistent itching, flaking, burning and tightness of the scalp. In more severe cases, the skin may crack, bleed or become sore. Moreover, scalp psoriasis differs between person to person. It can can range from mild, dandruff-like scaling to severe crusting that extends beyond the hairline.

Scalp psoriasis is not contagious and can occur at any age but usually first appears in early adulthood. It tends to follow a cycle of flare-ups and remissions. For some people, the scalp is the only site of psoriasis. However, most people have plaque psoriasis (the most common type of psoriasis) that affects multiple parts of the body. The areas that may have psoriasis alongside the scalp include the elbows, knees, lower back or nails. According to the National Psoriasis Foundation, about 50% of people with psoriasis will develop scalp involvement. However, due to the presence of hair and sensitivity of the area, treatment can be more challenging than on other parts of the body.

Causes of Scalp Psoriasis

So we do not fully understand the exact cause of scalp psoriasis. However, the going theory is that it is due to a combination of genetic, immune and environmental factors. The key driver is an overactive immune system that mistakenly targets healthy skin cells which then triggers rapid turnover and inflammation. Although we don’t know what causes scalp psoriasis directly, there are some key triggers that can activate or worsen the condition in predisposed individuals:

• Genetics: A strong family history is one of the most well-established risk factors for psoriasis, including on the scalp. If one or both parents have psoriasis, the likelihood of developing the condition increases significantly. Whilst no single gene is responsible, researchers believe have identified several genetic markers (e.g. HLA-Cw6) that are commonly found in people with psoriasis.
• Immune Dysregulation: Scalp psoriasis is an autoimmune condition, meaning the immune system mistakenly attacks healthy skin cells. In psoriasis, T-cells (a type of white blood cell) become overactive and release inflammatory cytokines that accelerate skin cell turnover and trigger inflammation.
• Stress: Psychological stress is a well-known trigger and trigger factor for many chronic skin conditions, including scalp psoriasis. Stress can increase systemic inflammation and disrupt the skin’s natural barrier function. This makes flare-ups more likely and more severe. In some people, stress can even precipitate the initial onset of psoriasis.
• Infections: Certain infections, particularly streptococcal throat infections, may trigger the onset or worsening of psoriasis in genetically susceptible individuals. This may occur through a phenomenon known as molecular mimicry where the immune system’s response to infection mistakenly targets the skin.
• Medications: A number of prescription drugs can trigger or worsen psoriasis symptoms. These include lithium (commonly used to treat bipolar disorder), beta-blockers (used for high blood pressure), antimalarials like hydroxychloroquine and some non-steroidal anti-inflammatory drugs (NSAIDs). These medications can disrupt immune pathways or provoke inflammation in the skin.
• Lifestyle: Certain lifestyle factors can significantly influence the severity and frequency of scalp psoriasis flare-ups. Smoking has been shown to increase the risk and intensity of psoriasis, likely due to its pro-inflammatory effects. Excessive alcohol intake can also aggravate the condition and reduce treatment efficacy. Obesity is also another major risk factor. The increased body fat is associated with higher levels of inflammatory cytokines that can worsen disease activity.

Symptoms & Diagnosis of Scalp Psoriasis

Scalp psoriasis can present in many forms. Symptoms range from mild and barely noticeable flaking to painful and widespread plaques. Whilst severity varies, scalp psoriasis typically presents with one or more of the following symptoms:

• Red raised patches of skin covered with a silvery-white scale.
• Persistent itching which can be severe and disruptive.
• Burning, stinging or soreness usually if the skin becomes raw or cracked.
• Dryness and tightness of the scalp that is often accompanied by irritation.
• Flaking which may resemble dandruff but is usually thicker and more adherent.
• Cracking or bleeding in areas of severe inflammation.
• Plaques extending beyond the scalp often onto the forehead, back of the neck or behind the ears.

Diagnosis is usually through clinical examination. The doctor or health provider will assess the appearance of the plaques and ask about other symptoms or personal history of psoriasis. It is rare to need a skin biopsy but your doctor may recommend one to rule out other scalp conditions like seborrhoeic dermatitis or fungal infections.

How Does Scalp Psoriasis Cause Hair Loss?

One of the most distressing concerns is that scalp psoriasis also causes hair loss in some people. The hair loss associated with scalp psoriasis is typically non-scarring (e.g. androgenetic, telogen effluvium, trichotillomania and traction alopecia). This means that the hair follicles remain intact and regrowth is possible. The main factors that cause hair loss in scalp psoriasis include:

• Inflammation: Chronic inflammation can weaken the hair shaft and disrupt the normal hair growth cycle.
• Scratching & Picking: Persistent itching often leads to scratching or forcibly removing scales. This can traumatise the scalp and cause hair to fall out.
• Topical Treatments: Some scalp psoriasis treatments may irritate the scalp or weigh down the hair. This contributes to hair breakage or shedding.
• Stress: The psychological toll of dealing with a visible skin condition may also exacerbate stress-related hair loss (telogen effluvium).

However it is important to note that scalp psoriasis usually only leads to temporary hair loss. As it does not directly destroy the follicles, it is possible for hair to regrow. Whilst it may not be possible to prevent hair loss entirely during a scalp psoriasis flare, here are a few tips that can minimise it:

• Patient: Anxiety and stress worsen hair loss and hair regrowth may take several months once the scalp is healed.
• Be Proactive: Treat flare-ups early and consistently.
• Maintenance: Use prescribed treatments as directed even during remission phases.
• Gentle Hair Care: Avoid hairstyles that pull on the scalp, like tight ponytails or braids. Also limit the use of heat tools and harsh hair products.

Scalp Psoriasis Treatments

Effectively managing scalp psoriasis requires a tailored approach that targets inflammation, relieves discomfort and reduces the frequency of flare-ups. Whilst the right treatment depends on the severity and extent of the condition, many people find that a combination of therapies offers the best results. Below are the main options used to treat scalp psoriasis:

• Topical Treatments: These are typically the first line of defence for mild to moderate scalp psoriasis. They include corticosteroids which help reduce inflammation and itching. Vitamin D analogues such as calcipotriol work by regulating the overproduction of skin cells. Coal tar products slow down cell turnover and ease scaling. Salicylic acid and other keratolytic agents help loosen and remove thick scale, improving absorption of other treatments. These topicals can be used alone or in combination depending on your scalp psoriasis symptoms.
• Medicated Shampoos: Specialist shampoos are often used alongside other treatments to help control symptoms and maintain scalp health. Products containing coal tar, salicylic acid or antifungal agents like ketoconazole are commonly prescribed or available over the counter. They can help reduce flaking, itching and inflammation in flares and are great for ongoing maintenance.
• Phototherapy: For widespread or treatment-resistant scalp psoriasis, light therapy may be necessary. UVB phototherapy involves exposing the skin to controlled doses of ultraviolet B light to slow down skin cell growth and reduce inflammation. For scalp involvement, this is often done through handheld UV combs that allow light to penetrate through the hair to affected areas. Phototherapy must be supervised by a dermatologist to ensure safe and effective use, especially as prolonged exposure can increase the risk of premature skin ageing. In rare cases, it can also cause skin cancer.
• Systemic Treatments: In cases where scalp psoriasis is severe, extensive or unresponsive to topical therapies, systemic medications may be necessary. Oral drugs such as methotrexate, cyclosporine and acitretin work by suppressing the immune system’s overactivity. For individuals with chronic or disabling symptoms, biologic therapies offer a more targeted approach. These injectable medications block specific inflammatory pathways involved in psoriasis and can lead to significant improvement. However, due to potential side effects and cost, systemic treatments are usually for more severe or refractory cases. They also require close medical supervision.
• Lifestyle: Supportive scalp care and healthy habits can make a substantial difference in managing symptoms and preventing flare-ups. Using gentle, fragrance-free shampoos and conditioners helps reduce irritation. Avoiding scratching or picking at plaques can minimise trauma and lower the risk of hair loss. Stress management techniques such as mindfulness, regular exercise or therapy are beneficial. Some people also find that an anti-inflammatory diet rich in omega-3 fatty acids, fruits and vegetables may help reduce overall skin inflammation and support long-term control.

If your scalp psoriasis is affecting your quality of life, causing significant hair loss or not responding to over-the-counter treatments, it’s important to consult a dermatologist. They can assess the severity, rule out other scalp conditions and tailor a treatment plan to your specific needs. If you’re in the UK, some treatments may be available through your GP, but access to certain options like biologics or phototherapy require referral to a specialist.

Scalp psoriasis can be challenging to live with, particularly when symptoms impact your comfort and contribute to hair loss. Although it doesn’t typically cause permanent damage to the hair follicles, persistent inflammation and irritation can lead to significant shedding. With the right treatment and early intervention, most people can manage scalp psoriasis symptoms effectively and enable healthy hair regrowth.

At City Skin clinic, we are devoted about personalised skincare. Our virtual skin clinic offers safe and effective custom skin and hair loss treatments. Where appropriate our doctors use ingredients such Tretinoin and Hydroquinone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Connect with one of our doctors today with an online consultation. The journey towards great skin starts here.