Psoriatic Arthritis: Understanding Its Impact on Hair and Scalp

Quick answer: Psoriatic Arthritis (PsA) is a chronic inflammatory condition that, while primarily affecting joints and skin, can also impact the scalp and hair. This often manifests as scalp psoriasis, which can lead to increased hair shedding or breakage. The precise extent of direct hair loss solely from Psoriatic Arthritis itself, separate from associated scalp psoriasis or medication side effects, is not fully understood.

Key takeaways

• Psoriatic Arthritis is an autoimmune condition that can cause inflammation in various body parts, including the scalp.
• Scalp psoriasis is a common co-occurrence with Psoriatic Arthritis and is a primary cause of hair shedding or breakage in affected individuals.
• Inflammation from scalp psoriasis can disrupt the hair growth cycle and physically dislodge hair during scaling.
• Some medications used to treat Psoriatic Arthritis, such as methotrexate, may contribute to hair thinning.
• Gentle hair care practices, along with medical management of scalp psoriasis and Psoriatic Arthritis, are crucial for supporting hair health.
• It's important to differentiate between hair shedding (telogen effluvium), hair breakage, and true hair loss (follicular damage or alopecia) when discussing PsA's impact.

Psoriatic Arthritis: what the evidence shows regarding hair and scalp

Psoriatic Arthritis (PsA) is a chronic inflammatory condition that affects some individuals with psoriasis. While it is primarily known for causing joint pain, swelling, and stiffness, its inflammatory nature can extend to the skin, including the scalp. The connection between Psoriatic Arthritis and hair concerns primarily stems from the common co-occurrence of scalp psoriasis, a form of psoriasis that affects the scalp, rather than Psoriatic Arthritis directly causing hair loss on its own.

Approximately 30% of people with psoriasis will develop Psoriatic Arthritis, and a significant proportion of those with psoriasis experience scalp involvement. The inflammation associated with scalp psoriasis can affect the hair follicles, leading to various hair-related issues.

Scalp Psoriasis and Hair Concerns

Scalp psoriasis presents as red, itchy patches of skin often covered with silvery-white scales. When severe, these scales can be thick and extensive, forming plaques that can cover large areas of the scalp. The inflammation and constant shedding of skin cells associated with scalp psoriasis can lead to several problems for the hair:

• Increased Hair Shedding: The inflammatory process on the scalp can disrupt the normal hair growth cycle, potentially pushing more hairs into the shedding phase (telogen effluvium). This results in increased hair shedding, where hairs naturally detach from the follicle but the follicle itself is not necessarily damaged permanently.
• Hair Breakage: The thick scales and crusts of scalp psoriasis can physically trap hair strands. When these scales are removed, either through natural exfoliation or due to scratching, they can pull out hair or cause the hair shaft to snap, leading to hair breakage. Additionally, hair growing through an inflamed scalp may be weaker and more prone to breakage. This is different from hair loss where the follicle stops producing hair.
• Itching and Trauma: The intense itching often experienced with scalp psoriasis can lead to scratching, which can traumatise the scalp and hair follicles. This physical irritation can further contribute to hair breakage and discomfort.

What the Evidence Does Not Show (and what it does)

There is currently insufficient evidence to suggest that Psoriatic Arthritis directly causes permanent hair loss (follicular alopecia) independently of associated scalp psoriasis or medication side effects. While the systemic inflammation of PsA might theoretically have some effect, most hair concerns are linked to the local effects of scalp psoriasis. Some studies have noted increased rates of telogen effluvium (temporary increased hair shedding) in individuals with psoriasis, which may or may not be concurrent with PsA.

It is crucial to distinguish between hair shedding (temporary hair loss where follicles are preserved), hair breakage (hair snapping along the shaft), and alopecia (where follicles cease to produce hair). Psoriatic Arthritis and its common co-morbidities are more frequently associated with increased shedding and breakage.

Mechanisms of Hair Impact

The hair follicle is highly sensitive to changes in its environment. In scalp psoriasis, the rapid turnover of skin cells and chronic inflammation creates an unfavourable environment for healthy hair growth. Inflammatory cytokines, which are signalling molecules involved in the immune response, are elevated in psoriasis. These cytokines can negatively influence the hair cycle, potentially leading to premature entry into the resting (telogen) phase.

Furthermore, the physical barrier created by thick scales can impede the normal emergence of hair strands, and their removal can mechanically stress the hair, leading to breakage. The compromised integrity of the skin barrier in scalp psoriasis can also lead to dryness and irritation, further impacting hair health.

Signs to Look For

If you have Psoriatic Arthritis or psoriasis, be aware of the following signs that might indicate scalp and hair involvement:

• Red, inflamed patches on the scalp, often covered with silvery-white scales.
• Intense scalp itching, which may lead to scratching and irritation.
• Increased hair shedding when brushing, washing, or styling your hair.
• Visible patches of thinner hair or areas where hair strands appear shorter due to breakage.
• Scalp tenderness or pain.

What You Can Do: Managing Hair and Scalp with Psoriatic Arthritis

Managing hair and scalp concerns in the context of Psoriatic Arthritis requires a two-pronged approach: effective medical treatment of the underlying condition and gentle, supportive hair care.

Medical Management

Working closely with your dermatologist and rheumatologist is essential. Treatments for scalp psoriasis aim to reduce inflammation and scaling:

• Topical Treatments: These include corticosteroids, vitamin D analogues (like calcipotriene), salicylic acid (to soften and remove scales), and coal tar shampoos. These are applied directly to the scalp.
• Phototherapy: Controlled exposure to ultraviolet light, often supervised by a dermatologist, can be effective for widespread scalp psoriasis.
• Systemic Medications: For more severe Psoriatic Arthritis and widespread psoriasis, oral medications or biologic therapies may be prescribed. These target specific parts of the immune system to reduce inflammation throughout the body. Some systemic treatments, such as methotrexate, may have hair thinning as a side effect. Always discuss potential side effects with your healthcare provider.

Gentle Hair Care Practices

Adopting a gentle hair care routine can help minimise further irritation and support healthier hair growth. You may find more information in sibling articles such as 'Understanding Scalp Health' and 'Hair Damage: Causes, Signs, and Solutions'.

• Mild Cleansing: Use a gentle, sulfate-free shampoo to cleanse the scalp without stripping its natural oils. Over-cleansing or using harsh products can exacerbate dryness and irritation. Consider 'Sulfate-Free Shampoo Benefits' for more details.
• Conditioning: Regular conditioning is important to moisturise the hair fibre and scalp. Look for conditioners with humectants and emollients to help with 'Hair Hydration: The Science Behind Keeping Hair Moist'. You may also find 'Choosing the Right Hair Conditioner' helpful.
• Lukewarm Water: Wash and rinse your hair with lukewarm water instead of hot water, as hot water can dry out the scalp and hair.
• Gentle Drying: Pat hair gently with a towel rather than vigorous rubbing. If using a blow dryer, use the lowest heat setting and hold it at a distance, as discussed in 'Heat Styling Safety Best Practices'.
• Avoid Trauma: Minimise scratching. Use a wide-tooth comb or a soft-bristle brush to detangle hair gently, working from the ends upwards. Avoid tight hairstyles that pull on the roots, which can worsen breakage.
• Moisturise the Scalp: If your scalp is dry and flaky, apply leave-on scalp treatments or light, non-comedogenic oils to help soothe and moisturise. Ingredients like salicylic acid in specific scalp treatments can also help manage scaling.
• Limit Heat and Chemical Treatments: Reduce the use of heat styling tools and chemical treatments like perms, relaxers, or colour treatments, as these can stress compromised hair and scalp. Refer to 'Chemical Hair Treatments: What They Are and How They Affect Hair'.

When the Cause May Be Something Else

While Psoriatic Arthritis and scalp psoriasis are strong contenders, other factors can also lead to hair shedding or breakage:

• Nutritional Deficiencies: A lack of essential vitamins and minerals, such as iron, vitamin D, or zinc, can contribute to hair shedding.
• Thyroid Disorders: Both an overactive and underactive thyroid can affect hair growth.
• Stress: Significant emotional or physical stress can trigger telogen effluvium, leading to increased shedding.
• Other Skin Conditions: Conditions like seborrhoeic dermatitis or fungal infections can also affect scalp health and hair.
• Medication Side Effects: Beyond PsA treatments, many other medications can list hair thinning as a side effect.

When to Get Professional Advice

It's always advisable to consult a healthcare professional if you experience persistent or significant hair concerns. See your general practitioner or a dermatologist if:

• You notice sudden or extensive hair shedding or breakage.
• Your scalp psoriasis symptoms worsen or do not respond to over-the-counter treatments.
• You experience new or worsening scalp pain, redness, or itching.
• You are concerned about potential side effects of your Psoriatic Arthritis medications.

Frequently asked questions about Psoriatic Arthritis

Can Psoriatic Arthritis cause permanent hair loss?

Psoriatic Arthritis itself is not directly known to cause permanent hair loss where follicles are destroyed. Hair concerns are typically linked to associated scalp psoriasis, which can lead to increased shedding (telogen effluvium) or hair breakage from scales and scratching. With effective treatment of scalp psoriasis, hair shedding often normalises, and breakage can be reduced, allowing for regrowth. Permanent hair loss is rare and usually associated with severe scarring alopecia, which is not a typical feature of PsA.

How can I stop my scalp from itching with Psoriatic Arthritis?

Managing an itchy scalp with Psoriatic Arthritis often involves treating the underlying scalp psoriasis. Your dermatologist may prescribe topical corticosteroids, vitamin D analogues, or medicated shampoos containing coal tar or salicylic acid. Gentle washing with lukewarm water and avoiding harsh hair products can also help. Stress reduction techniques and keeping your scalp moisturised can reduce discomfort and the urge to scratch.

Do Psoriatic Arthritis medications cause hair thinning?

Some medications used to treat Psoriatic Arthritis and severe psoriasis can indeed cause hair thinning or increased shedding as a side effect. Methotrexate is a common example. However, not everyone experiences this side effect, and its severity can vary. It is important to discuss any concerns about medication side effects with your doctor, who can assess your treatment plan and explore alternatives if necessary.

Is it safe to colour my hair if I have Psoriatic Arthritis on my scalp?

If you have active scalp psoriasis due to Psoriatic Arthritis, it's generally advised to avoid chemical treatments like hair colouring, perms, or relaxers until your condition is well-managed. Dyes and chemicals can irritate an already sensitive and inflamed scalp, potentially worsening psoriasis symptoms. Always consult your dermatologist before undertaking any chemical hair treatments to ensure it's safe for your specific scalp condition.

What type of shampoo is best for Psoriatic Arthritis-related scalp issues?

For scalp issues related to Psoriatic Arthritis, particularly scalp psoriasis, a dermatologist might recommend medicated shampoos containing ingredients like salicylic acid or coal tar to help manage scales and itching. For regular washing, a gentle, sulfate-free shampoo is often recommended to avoid irritation and excessive drying. Look for formulations designed for sensitive scalps to maintain moisture and minimise discomfort.

Supporting your hair health with Psoriatic Arthritis

Living with Psoriatic Arthritis can present challenges, including those related to hair and scalp health. Understanding the link between Psoriatic Arthritis and scalp psoriasis is key to managing potential hair shedding and breakage. By combining medical treatment for your condition with a consistent, gentle hair care routine, you can help maintain a healthier scalp and support the vitality of your hair. Remember, holistic management, including stress reduction and a balanced diet, contributes to overall well-being and can positively impact your hair health.

Watermans product recommendations

While managing Psoriatic Arthritis and scalp psoriasis requires medical treatment, supporting overall hair and scalp health with gentle, nourishing products can be beneficial. Watermans offers products designed to be gentle and support hair vitality:

• Watermans Grow Me® Shampoo and Conditioner: These formulations are designed to cleanse gently and provide essential nutrients to the scalp and hair, promoting a healthy environment for growth and reducing breakage. The sulfate-free nature of the shampoo can be particularly beneficial for sensitive scalps.
• Watermans Grow More® Elixir: This leave-in scalp treatment can be applied directly to the scalp to deliver targeted ingredients, supporting a healthy scalp environment and helping to minimise shedding due to breakage.

These products are not a treatment for Psoriatic Arthritis or scalp psoriasis but can form part of a supportive hair care routine when your medical condition is being managed appropriately by a healthcare professional. Always consult your dermatologist before introducing new products if you have an active scalp condition.

Sources and references

• National Psoriasis Foundation. (n.d.). Psoriatic Arthritis. Retrieved from psoriasis.org
• American Academy of Dermatology Association. (n.d.). Psoriasis: Scalp psoriasis. Retrieved from aad.org
• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2023). Psoriatic Arthritis. U.S. Department of Health and Human Services. Retrieved from niams.nih.gov
• Fuchs, E., & Stenn, K. S. (2001). The hair follicle: a perspective on an enigma. Journal of Investigative Dermatology, 116(1), 1-2. (General reference for hair follicle biology)
• Christophers, E., & Mrowietz, U. (1999). Psoriasis. In Dermatology in General Medicine (5th ed., pp. 493-513). McGraw-Hill. (General reference for psoriasis pathology)
• Mayo Clinic. (n.d.). Psoriatic arthritis. Retrieved from mayoclinic.org

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Find these ingredients in Watermans products

• Zinc: you will find this ingredient in our Hair Vitamins.