Can Psoriatic Arthritis Cause Hair Loss?

From everydayhealth.com

Psoriatic arthritis (PsA) is an autoimmune disease that causes inflammation of the joints, tendons, and nails. It usually occurs in people with psoriasis, an inflammatory condition causing rashes on the skin.

Symptoms can include joint pain, swelling, stiffness, and fatigue. Hair loss (alopecia) isn’t typically a sign of the disease, but it can affect some people with PsA in a roundabout way. 

“Psoriatic arthritis and hair loss are not directly linked,” explains Jennifer E. Yeh, MD, PhD, a clinical assistant professor of dermatology at Stanford University School of Medicine in California. “However, having psoriatic arthritis may predispose one to hair loss from psoriatic arthritis inflammation, from psoriatic arthritis treatment, or from an increased likelihood of having another type of autoimmune condition.” 

Physical or Psychological Stress Can Lead to Hair Loss

Psoriatic arthritis can significantly impact your emotional well-being, leading to anxiety, depression, diminished self-esteem — and particularly, stress. Chronic stress can worsen inflammation and immune dysregulation, leading to increased disease activity and more severe symptoms. Researchers note that stress may also disrupt neuroendocrine pathways, affecting cortisol levels and further dysregulating the immune system in PsA. According to the American Academy of Dermatology, stress is linked to hair loss and thinning hair.

Dr. Yeh says that both the physical and psychological stress associated with PsA can trigger a temporary type of hair loss called telogen effluvium. 

With telogen effluvium, more hairs than normal are forced into their resting phase. When this happens, they fall out at once. Most people lose about 100 strands of hair a day. But if you have telogen effluvium, you may lose up to 300 strands a day.

“While telogen effluvium is characterized by an increase in daily hair shedding, it usually reverses, and hair regrows once the underlying stressor is removed,” Yeh says.

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Medications for PsA May Cause Thinning Hair

Treatments for PsA can contribute to hair loss. Some common culprits are: 

• Methotrexate It stops cells from growing — including hair follicles. About 1 to 3 percent of people who use it experience hair loss.
• Leflunomide This medicine works like methotrexate and causes hair loss in about 10 percent of people.
• Anti-TNF Therapy Research has shown that “a sizable minority” of people on TNF inhibitors develop alopecia areata, the most common inflammatory hair loss disease, at a higher prevalence than the general population, though it’s not clear why this happens.

“Treatment-related alopecia typically improves with discontinuation of the offending medicine,” says Yeh.

Comorbid Psoriasis and Hair Loss

Most, but not all, people with PsA also have psoriasis. And, if you have psoriasis, you have a 45 to 56 percent chance of developing scalp psoriasis.

Scalp psoriasis causes a dry, itchy, and inflamed scalp. “Scalp psoriasis that is not controlled irritates the hair follicles, disrupting normal hair follicle function, and thereby causing hair shedding,” says Yeh. 

If you scratch or pick at the lesions, you can also damage hair follicles. This can result in additional hair loss.

The good news is that hair loss due to scalp psoriasis is usually temporary. “Most cases show complete hair regrowth after treatment,” says Yeh.

If you have severe psoriasis plaques, you should be aware that the oral medication acitretin, occasionally used to treat persistent psoriasis, can cause hair loss.

What to Do About Hair Loss

If you have PsA and experience hair loss, talk to your doctor. If you’re not already seeing a dermatologist to manage your condition, your rheumatologist can refer you to one who may be able to determine the underlying cause of your hair loss.

Getting your symptoms under control can also help preserve your hair. “Hair loss from uncontrolled PsA reverses once the inflammation is well-controlled,” says Yeh. “It’s critical to treat concomitant scalp psoriasis so that local inflammation surrounding hair follicles on the scalp does not contribute to increased hair shedding.”

Here are some ways you can help prevent hair loss caused by scalp psoriasis.

• Try not to touch, pick, or scratch your scalp.
• Keep your fingernails short.
• Be gentle when brushing, combing, washing, or drying your hair.
• Wear a hat when you’re outside.
• Use a medicated shampoo that contains salicylic acid and follow with a moisturizing conditioner. 
• Don’t take extremely hot showers.
• Ask your doctor about a prescription treatment that can help your symptoms.
• Avoid blow-drying your hair. If you do, use a low-heat setting.
• Try to keep stress levels low.
• Follow a healthy diet.
• Avoid heavy drinking.

While hair loss associated with PsA can be frustrating, the right treatments and lifestyle habits can help you minimize shedding — and protect the hair you have.

The Takeaway

• If you have psoriatic arthritis and you’re experiencing hair loss, consult your doctor to determine the underlying cause and effective treatment strategies.
• Medications such as methotrexate and leflunomide, commonly used to manage PsA, might contribute to hair thinning, so discuss potential side effects with your healthcare provider to explore any necessary adjustments.
• Emotional and physical stress linked to PsA can cause temporary hair loss; reducing stress levels and effectively managing the disease can lead to regrowth and a healthier scalp condition.
• If you’re dealing with scalp psoriasis, measures such as medicated shampoos and avoiding scalp irritation can prevent additional hair loss and support recovery.

https://www.everydayhealth.com/rheumatic-conditions/can-psoriatic-arthritis-cause-hair-loss/