Psoriasis affects about 125 million people worldwide. It’s a frustrating, often confounding disorder that causes itching, redness, and scaling.
What Psoriasis Is
Psoriasis is a chronic skin disorder in which skin cells multiply too quickly to shed properly. It is the result of inflammation arising from an overactive immune system.
Depending upon its type, symptoms can include red, itchy rashes, scaly patches, skin thickening, and pus-filled bumps. It can occur anywhere on the body, but it is most often seen on the knees, elbows, and scalp. Symptoms tend to follow a relapsing/remitting pattern, with symptoms that worsen during flares.
When it erupts on the scalp, patients might notice redness, itching, thickened skin, and flaking. It can cause small patches of inflammation or affect the entire scalp, as well as the back of the neck, the skin behind the ears, and the forehead.
Flaking leads many patients to initially mistake psoriasis for dandruff. However, flaking and scaling associated with psoriasis tend to be silvery-white (on lighter skin) or greyish-purple (on darker skin); by contrast, dandruff flakes are usually white. Psoriasis flakes also tend to be more powdery.
Scalp psoriasis patients often experience these symptoms:
Affected skin can become dry enough to crack.
The word psoriasis comes from the Greek word psora, meaning “itch–” that should tell you how common this symptom is! The itch can be mild, but it can also be intense enough to impact work performance and sleep. Itching often intensifies with scratching. It can also exacerbate symptoms, leading to more itching and scratching, which brings us to…
It’s normal to scratch itchy skin. Unfortunately, this can kick off an itch-scratch cycle. The more a patient scratches, the more likely they are to damage the scalp and cause bleeding.
Patients can lose patches of hair in affected areas. This is usually temporary, and hair typically regrows when the flare resolves.
Psoriasis on the scalp does not always respond to the first treatments, and hair growth can make it difficult to evenly apply topical medicines. This leads many people to wonder: should I cut my hair if I have psoriasis?
Scalp Psoriasis and Haircuts
Our relationship with our hair is often emotional and complicated. It’s one of our most noticeable features, and people have strong opinions about how it should look and be cared for. A condition like psoriasis complicates this even more; symptoms can cause significant distress and self-consciousness, and information about treatment and appropriate styling is often contradictory.
Some people fear that a visit to the salon will aggravate their psoriasis. Others feel that longer hair prolongs or even causes flares. There is at least a little validity to each concern; however, as is usually the case with skin conditions, the answers are not cut-and-dried.
Is long hair bad for psoriasis?
Long hair, particularly thick and/or highly textured hair, can make it difficult to apply treatments to the scalp. Light therapy, a common treatment for severe psoriasis, is also harder with long hair. In addition, some styling methods popular for long hair can worsen psoriasis. This includes:
- Tension. Tightly-braided hair, ponytails, buns, and twists can all pull at the scalp, causing or worsening psoriasis flares.
- Chemical treatments. These include straightening or relaxing treatments and dyeing. They are often harsh and irritating to sensitive skin and can trigger flares.
- Excessive combing and brushing. Longer hair must be detangled. However, brushing and combing can damage the scalp, causing already irritated skin to bleed.
What’s more, people with psoriasis often are prone to Koebner’s phenomenon; this is when inflammatory lesions erupt in response to injury. If you comb too roughly or pull too tightly at unaffected skin during a psoriasis flare, psoriatic lesions can erupt where they would not have occurred otherwise.
None of this means that you cannot have long hair or that you cannot style it if you do. Most dermatologists and stylists agree that longer hair isn’t necessarily worse for psoriasis; research and flexibility with styling are key.
If you enjoy braiding your long hair, you might braid it more loosely, taking care not to pull excessively at your skin. If you use chemicals to change the color or texture of your hair, you can speak to your dermatologist and stylist about gentler, less aggravating products.
Vallerie Paulin, long-time hair stylist and owner of Shimmer Salon in Birmingham, Alabama, has served many clients with psoriasis.
“I’ve never noticed a difference between those with short hair or long,” she says.
Some people find that longer hair makes them feel less self-conscious about their psoriasis. For these people, longer hair can be a symbol of their refusal to be limited by the condition.
Others feel that long hair unnecessarily complicates the application of treatment, and some feel that grooming long hair makes them more likely to scratch or pull at their scalp.
Will cutting my hair make my psoriasis worse?
While keeping long hair worries some psoriasis sufferers, others are concerned that salon visits will irritate their scalp and worsen their psoriasis. Still, others feel self-conscious about allowing a stylist to see their scalp.
Like keeping long hair, though, having your hair cut and styled need not cause you any problems. Clear communication and planning ahead will help you avoid most issues.
Not all stylists are familiar with scalp psoriasis; calling ahead of your appointment allows you to gauge their familiarity and experience with the condition. It allows them to choose the best products for your needs.
“I would say to oil your scalp the night before,” Paulin advises. "I recommend Melanin brand Pure Oil Blend because it’s gentle for skin and hair and has a nozzle.”
For clients with active flares, she recommends keeping the oil in the hair overnight beneath a cap. It can be washed out the next day ahead of your appointment.
Once you are in the chair, pay attention to how you feel and stay in communication with your stylist.
“Make sure your stylist is gentle and doesn’t scrub your scalp too hard,” Paulin tells us.
“Most of the psoriasis I see is always at the base of the neck,” she says. “Your stylist can use a barrier cream on top of it to keep irritation from happening.”
She advises those seeking coloring treatments to alert the stylist ahead of time that they have psoriasis. A patch test can be done if color has irritated the client in the past.
“As always,” Paulin concludes, “talk with your dermatologist about any changes or products you will be using.”
Will shaving my head make psoriasis better?
This is another common question. The answer? As you might have guessed, it’s highly individual.
Anecdotally, many patients report that shaving alleviates their symptoms. They feel that medicated shampoos and treatments more easily reach the scalp that way.
While this may be true, shaving also increases the risk of cuts and abrasions to the scalp, which worsen psoriasis. If you do opt to shave your head, be sure that you or your stylist use gentle motions with little pressure. Before shaving, apply a moisturizing treatment such as the oil Vallerie Paulin recommends.
Use clean, sharp shears or razors, and shave in the direction of hair growth–not against it.
Which hairstyle is best for psoriasis?
Long luxurious locks, snazzy cut, and color, or fashionably shorn–the best hairstyle is the one that works for you. A short style or a shave can make it easier to shampoo your hair, apply treatments, and get light exposure, all of which are definite benefits. On the other hand, longer hair can instill confidence and be a symbol of identity.
Whatever you choose, gentleness is key. Speak to your dermatologist about the treatments and styling products you use, and make sure that stylists are aware of your psoriasis and are experienced in dealing with it.
Taking Control of Scalp Psoriasis with SmartLotion®
As a board-certified dermatologist, Dr. Steve Harlan has treated many cases of scalp psoriasis. Seeing his patients’ frustrations up close is what inspired him to develop SmartLotion® eczema cream.
SmartLotion®’s one-of-a-kind, prebiotic formula helps restore the skin’s microbiome, which is often unbalanced in psoriatic skin. In addition, it uses a low dose of hydrocortisone to control itching and redness.
When treating adults for scalp psoriasis, Dr. Harlan begins by having them alternate between washing with a salicylic acid shampoo with a ketoconazole or tar shampoo each day.
This is followed by applying SmartLotion® directly to the scalp every night (wearing a shower cap protects your bed linens, he advises). If a flare is severe, he prescribes a stronger topical steroid to be applied every evening.
With this combination, most of his patients see a dramatic improvement within four weeks!
SmartLotion® can be applied as soon as a patient recognizes the signs of a flare, which allows them to get on top of symptoms like itching and redness. It does not cause topical steroid withdrawal or atrophy, allowing for long-term treatment if necessary.
You alone can decide which style is best for dealing with your scalp psoriasis. With your dermatologist’s guidance, make your decision based on your own personal needs. Don’t be afraid to turn to a stylist who is experienced with scalp psoriasis, and treat your hair gently. With these proactive steps and a supply of SmartLotion®, you can manage scalp psoriasis and let your unique style shine.