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 the health of your scalp and is also a common cause of hair loss. Psoriasis is a chronic inflammatory skin condition. Its effects on the scalp and hair follicles are less talked about, but they can be even more distressing. In this article, we explore scalp psoriasis in detail, including its causes, symptoms and how to diagnose it. We 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 a 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. Scalp psoriasis also differs from person to person. It 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 it 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, treatment can be more challenging than on other parts of the body. This is due to the presence of hair and the sensitivity of the area.

What Causes Scalp Psoriasis?

We do not fully understand the exact cause of scalp psoriasis. However, the leading 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 the direct cause is unknown, several key triggers can activate or worsen the condition in predisposed individuals:

• Genetics: A strong family history is one of the most reliable 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 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. They release inflammatory cytokines that accelerate skin cell turnover and trigger inflammation.
• Stress: Psychological stress is a well-known 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 trigger 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 targets the skin instead by mistake.
• Medications: A number of prescription drugs can trigger or worsen psoriasis symptoms. These include lithium (used to treat bipolar disorder) and beta-blockers (used for high blood pressure). Others are 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 another major risk factor. Increased body fat is associated with higher levels of inflammatory cytokines that can worsen disease activity.

What are the Symptoms 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. They will also ask about other symptoms or a personal history of psoriasis. It is rare to need a skin biopsy. However, 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, like androgenetic hair loss, 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 and 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. It may not be possible to prevent hair loss entirely during a flare. However, a few tips can help minimise it:

• Be patient: Stress can worsen hair loss, and regrowth may take several months once the scalp has 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.

What are the Treatments for Scalp Psoriasis?

Effectively managing scalp psoriasis requires a tailored approach that targets inflammation, relieves discomfort and reduces the frequency of flare-ups. The right treatment depends on the severity and extent of the condition. However, 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. Meanwhile, salicylic acid and other keratolytic agents help loosen and remove thick scale, which improves the absorption of other treatments. These topicals can be used alone or in combination depending on your 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 during 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. This matters 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 reserved 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 helps. One rich in omega-3 fatty acids, fruits and vegetables may reduce overall skin inflammation and support long-term control.

Some situations call for specialist help. Consult a dermatologist if your scalp psoriasis is affecting your quality of life, causing significant hair loss or not responding to over-the-counter treatments. They can assess the severity, rule out other scalp conditions and tailor a treatment plan to your specific needs. If you are in the UK, some treatments may be available through your GP. However, access to certain options like biologics or phototherapy requires 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 does not 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 their symptoms effectively and enable healthy hair regrowth.

At City Skin Clinic, we are passionate about healthy skin and hair. Scalp psoriasis itself needs to be diagnosed and managed by your GP or a dermatologist. However, you may also be dealing with hair thinning or want to support regrowth once your scalp has settled. In that case, our doctors can help. Through our online clinic, we create personalised hair loss and regrowth treatments. Our doctors use actives such as minoxidil, caffeine and melatonin where appropriate for each patient. We also offer bespoke skincare treatments for concerns like acne, hyperpigmentation, melasma and skin ageing. You can book a video consultation or use our online consultation form to get started. The journey towards great skin and hair starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.