Everything You Need to Know About Hair Removal If You Have Psoriasis

From allure.com

By Kara McGrath

We asked dermatologists for tips on how to safely get rid of unwanted fuzz, whether you prefer shaving, waxing, lasers, or tweezing

While psoriasis can come with its fair share of everyday annoyances, hair removal should be a relative breeze as long as you don’t have an active flare-up. “The truth is that most people with psoriasis are not tremendously bothered by gentle hair removal as long as their psoriasis is controlled,” says Shira Y. Wieder, MD, a board-certified dermatologist at Montefiore Einstein Advanced Care in New York City.

Anyone who hasn’t found an effective method to ward off their psoriasis flares should take serious precautions before doing any type of hair removal, as it carries a real risk of triggering new plaques even in areas that weren’t affected before. However, if your psoriasis is well managed by prescription treatments, you’ll likely be able to shave, laser, wax, and pluck almost exactly like anyone else. “The risk of triggering new plaques drops but doesn’t fully disappear,” says Divya Shokeen, MD, a board-certified dermatologist and founder of OSVI Dermatology and Surgical Institute in California. Here are a few precautions to keep in mind to avoid irritating your skin and triggering a flare-up.

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How Having Psoriasis Can Affect Hair Removal

“It’s one word: Koebnerization,” Dr. Shokeen says of what can make hair removal trickier for people with any inflammatory condition like psoriasis, especially during an active flare. For people with psoriasis, the Koebner effect occurs when trauma stimulates the immune system to develop plaques, Dr. Wieder says. In other words, if your psoriasis is active and you suffer any sort of minor skin injury (like a nick from a razor or a burn from too-hot wax), you could see more psoriasis, especially if it’s close to a psoriatic plaque, Dr. Shokeen says.

She emphasizes that this does not mean your psoriasis is “spreading” because psoriasis is not an infectious disease (meaning it’s not contagious). Instead, these minor injuries can start a new inflammatory reaction anywhere on the body, especially if your psoriasis is not controlled by medication.

In addition to the risk of Koebnerization, people with psoriasis tend to have drier skin, which compromises the skin barrier, Dr. Shokeen says. This means the skin can become irritated fairly easily. As a result, it “tends to develop more redness, stinging, or lingering marks from things that a non-psoriatic patient would tolerate,” she explains.

With all of that in mind, the first step in safe hair removal should be to manage your psoriasis with prescription treatments, many of which can completely eliminate symptoms. This is especially true if you’re taking an injectable medication like the biologics Humira or Skyrizi, says Tracy Evans, MD, a board-certified dermatologist and the medical director of Pacific Skin and Cosmetic Dermatology in California. However, since psoriasis can only be managed and not cured, the risk of Koebnerization from hair removal remains for anyone with the condition, although it’s much lower in those cases.

On the flip side, if you’re still in the process of finding a psoriasis treatment that works for you, Dr. Shokeen says all hair removal methods carry a high risk. “Anything that’s causing repeated, mechanical trauma could potentially trigger your psoriasis.”

The Best Hair Removal Methods for Psoriasis-Prone Skin

If your psoriasis is well managed and the hair removal method is performed correctly, the dermatologists interviewed here agree you’ll likely be fine to use any method as long as you do so carefully. However, they note you should ideally speak with your own doctor before trying anything new. It will ultimately be a matter of trial and error to find which one works best for you, but these are a few safer options to consider.

Shaving

All three dermatologists interviewed for this piece agree that, aside from the risk of accidental cuts that could cause skin trauma, shaving is one of the safest hair removal methods for people with psoriasis. With shaving, “you’re [removing hair] above the follicle, not pulling it out,” Dr. Evans explains.

Dr. Wieder agrees and notes that it’s especially important for people with psoriasis to use a sharp razor and shave in the direction of hair growth rather than against the grain. Both will help ward off the irritation that can trigger Koebnerization. And if you’re trying to navigate around a psoriasis plaque, proceed with caution. “Avoid shaving off the scales because it’ll bleed underneath,” Dr. Wieder says.

Laser hair removal

Laser hair removal might sound like it carries a high risk of causing trauma, but the dermatologists interviewed agree it’s actually one of the safer options for psoriasis patients, as long as it is administered correctly. (Laser burns have the potential to cause, say it with us, Koebnerization.) “Even though you would think [a laser] would be traumatic to the hair follicle, it does seem to be safe,” Dr. Wieder says, pointing to studies on lasers that have shown their potential for treating psoriasis. Dr. Evans echoes this, noting that “heat and light” don’t seem to be an issue for people with psoriasis.

“I do laser hair removal on psoriasis patients all the time,” Dr. Shokeen says. She notes her preference for long-pulsed Nd:YAG lasers (1,064 nm), though she says diode lasers (about 800 to 810 nm) can also work if the settings are dialled down. Either way, it can be a tricky balance to get the levels just right, and the settings will need to be adjusted for each patient.

“If the energy of the device is too low, you’ll actually get hair regrowth,” she says. “It’s complicated to treat a psoriatic patient [with lasers], to say the least.” That’s why she always recommends that people who have psoriasis get laser hair removal in “a physician-supervised, medical-grade setting rather than a standard laser chain. There are more med spas than McDonald’s,” she says, noting her scepticism that all the people employed in those many locations would be fully trained to treat people with psoriasis.

Hair Removal Methods to Approach With Caution

As mentioned above, if your psoriasis is well controlled, you will likely be okay no matter how you remove unwanted hair as long as it’s done carefully. However, these methods carry some extra risks worth considering.

Depilatories

Hair removal creams (depilatories) may be a good option for someone with psoriasis because, like shaving, they don’t cause much trauma to the hair follicles. However, Dr. Wieder notes that these products can be irritating to many people, with or without psoriasis, so she always recommends a patch test beforehand on the areas where you plan to apply the depilatory. If you want to use it on your face, for example, Dr. Wieder recommends trying “some spots under the chin to see if you can tolerate it.”

Waxing

Although people with psoriasis can certainly get waxed, it’s the method that arguably comes with the most risk. “Waxing could pull on the skin and create microabrasions or tears,” says Dr. Evans. She says psoriasis is more likely to develop on areas that have been injured, even if the damage is minor. Dr. Evans also cautions that if the skin is damaged by waxing, new flare-ups could occur even in areas where you didn’t have plaques before.

For this reason, Shailer Carruth, a Vermont-based oesthetician who specializes in Brazilian waxing, says she waxes with her eyes as well as her hands. “The first thing I do if I’m going to wax someone who has psoriasis is check for any broken skin,” she says.

If you’re going the DIY route, Carruth recommends using a hard wax, which adheres only to the hair, not the surrounding skin. A sticky strip wax, on the other hand, is going to exfoliate the top layer of skin, which could further aggravate a psoriatic flare-up.

Tweezing

“Plucking is very traumatic to the hair follicles,” Dr. Wieder says, so you’ll want to tweeze with caution if it is your preferred method. While Dr. Evans notes that it’s relatively uncommon to get psoriasis on the face, it’s not impossible, so you should think twice about plucking if you’re prone to getting plaques there.

What to Do If Hair Removal Causes a Psoriasis Flare-Up

Although hair removal is generally safe for people with controlled psoriasis, if you get any micro-injuries during the process, there is a small risk that it could trigger a flare-up. If that happens, Dr. Evans says you can use your topical prescription medication to treat the area. If the flare persists, reach out to your dermatologist.

Meet the experts:

• Shailer Carruth is a licensed esthetician in Brattleboro, Vermont.
• Tracy Evans, MD, is a board-certified dermatologist and the medical director of Pacific Skin and Cosmetic Dermatology in California.
• Divya Shokeen, MD, is a board-certified dermatologist and founder of OSVI Dermatology and Surgical Institute in California.
• Shira Y. Wieder, MD, is a board-certified dermatologist at Montefiore Einstein Advanced Care in New York City.

https://www.allure.com/story/hair-removal-with-psoriasis

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.

                                                             iStock

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/ 

Itchy Scalp and Hair Loss: What Causes Both Symptoms?

From verywellhealth.com

Alopecia (hair loss) is caused by a disruption in the body's hair production cycle. It can have several causes, some of which also cause an itchy scalp.

Skin conditions, infections, parasites like lice, and other factors can cause scalp pruritus (itchiness). Some conditions can cause an itchy scalp and hair loss, such as tinea capitis (scalp ringworm). Too much scratching of an itchy scalp can also cause damage leading to hair loss.

This article will discuss the causes, confirmation, and treatment of itchy scalp, hair loss, and ways to minimize itching and shedding.

Georgie Wileman / Getty Images

What Causes Hair Loss and Itchy Scalp?

Hair loss and itchy scalp both have a variety of causes, some of which can overlap.

Hair Loss Causes

Hair grows in a cycle with three phases:

Anagen: Actively growing hair (years)

Catagen: Hair stops growing and separates from the follicle (about 10 days)

Telogen: Follicle rests, and then the hair falls out (two to three months)

An interruption to this cycle or damage to the hair follicle can cause hair to fall out faster than it regenerates, leading to bare patches or thinning.

Some causes of hair loss include:

Androgenetic alopecia: Male-pattern hair loss or female-pattern hair loss

Telogen effluvium: When many follicles enter the resting phase but new growth doesn't begin, so lost hair isn't replaced; typically triggered by factors such as a medical event, physical or emotional stress, or pregnancy/childbirth; usually temporary, but can become chronic

Anagen effluvium: Rapid hair loss from medical treatment, such as chemotherapy; usually grows back

Alopecia areata: Autoimmune condition in which the immune system attacks the hair follicles, causing hair to fall out and preventing new hair from growing

Tinea capitis: Fungal infection that may cause itching, oozing sores or blisters, and /or patches of hair loss

Cicatricial alopecia (scarring alcopecia): Inflammation that destroys the hair follicle and causes scar tissue to form, preventing hair from regrowing in those areas; can cause itching, swelling, and red or white lesions that can resemble a rash; types include lichen planopilari, discoid lupuserythematosu, folliculitis decalvan, dissecting cellulitis of the scalp, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia

Hair shaft abnormalities: Causes hair strands to thin, weaken, and break

Loose anagen syndrome: Hair that's not firmly rooted to the follicle and is easily pulled out

Trichotillomania: Mental health disorder in which a person intentionally pulls out their hair and finds it difficult to stop

Traction alopecia: Results from hair strands that are damaged by tight hairstyles that pull hair away from the scalp with high force

Damage to shafts or follicles: Damage resulting from products such as dyes or perms, hot appliances like hair dryers or curling irons, or injuries such as burns

Nutritional imbalances: Such as iron, zinc, linoleic acid, alpha-linolenic acid, and protein deficiencies, or over-supplementation of vitamin A

Itchy Scalp Causes

Many things can cause the scalp to itch, including:

Seborrheic dermatitis: Skin condition that causes symptoms such as scalp itch and flaking and may cause sensations of tightness, prickling, burning, and/or pain

Scalp psoriasis: Autoimmune condition causing reddish patches, flaking, silvery-white scaling, dry scalp, and often itching. May cause increased hair shedding

Dandruff: Dry, itchy scalp with flaking

Contact dermatitis: A reaction to shampoo, conditioner, hair dye, hair care products, brushes, or other things that touch the scalp. It causes itching, dryness, flaking, and sometimes a rash

Hives: Red, raised, itchy bumps that tend to come and go within a few hours or go away and come back

Infestations: Tiny bugs such as scabies or lice

Scalp ringworm: Fungal infection on the scalp that can lead to hair loss

Atopic dermatitis (eczema): Inflammation, irritation, and redness on the scalp, often with itchiness

Neuropathy: Intense itching, without symptoms such as a rash or skin reaction, caused by a nerve problem; may be due to damage, medical condition (such as shingles or diabetes), scarring (such as from hair loss), or other abnormalities

Skin cancer: Itchiness may result from cancer that on the scalp

Red-scalp syndrome: A variant of the skin condition rosacea, marked by itching, stinging, and burning of the scalp, with redness, papules (small bumps), pustules (pus-filled bump), and telangiectasias (spider veins, small, widened blood vessels on the skin)

Sensitive scalp: Common condition causing redness and/or symptoms such as itching, prickling, burning, or pain; triggered by chemical, emotional, hormonal, and physical factors, such as shampoos, water, stress, menstrual cycle, weather, and temperature

Pollution: Can cause environmental damage to hair, and has been linked to hair and scalp problems such as itching, redness, irritation, dandruff, sensitive scalp syndrome, and hair loss

The Link Between Hair Loss and Itchy Scalp

Hair loss and scalp itch overlap in a number of ways.

Some conditions, such as tinea capitis/scalp ringworm, cicatricial/scarring alopecia, and scalp psoriasis, can have both itching and hair loss as symptoms.

Conditions that cause scalp itch can indirectly lead to hair loss if there is excessive rubbing or scratching of the scalp, leading to damage or hair breakage.

Conversely, some people with non-scarring alopecias, such as alopecia areata and androgenetic alopecia, experience itching or burning preceding the development of new patches of hair loss.

Comorbidity (co-occurrence of another condition) can also be a factor. For example, people who have androgenetic alopecia often also have seborrheic dermatitis.

Unmodifiable Risk Factors For Hair Loss

Hair loss can't always be prevented. Some causes of hair loss that are difficult (or not possible) to prevent, control, or change include:

Genetics: Male and female pattern baldness can be related to heredity

Aging: Hair loss or hair thinning is common in all sexes by about age 70 years

Hormones: Hair loss can be influenced by hormones, including changes in testosterone with age, or hormonal with pregnancy

Autoimmune conditions: Conditions such as alopecia areata, psoriasis, some thyroid conditions, lupus, and other autoimmune conditions can be associated with hair loss

Confirming Itchy Scalp and Hair Loss Symptoms

If you are experiencing itchy scalp, hair loss, or both, talk to your healthcare provider or see a board-certified dermatologist. They can help you find an accurate diagnosis and work with you to determine a treatment plan that works for you.

Your provider will likely:

• Ask about your symptoms in detail
• Discuss your hair care routines and habits
• Get your medical history, and ask about recent illnesses or medical events
• Ask about a family history of your symptoms, such as family members with hair loss
• Talk to you about your emotional well-being and stress levels
• Ask about the foods you eat and any recent changes you have made to your diet
• Perform a physical examination of your hair and scalp

If a cause for your symptoms isn't apparent after this exam, tests may be ordered, including:

• Blood tests to check for certain conditions
• Examination of a hair sample under a microscope
• Examination of a skin sample, from a skin scraping or biopsy

When to See a Healthcare Provider

If your symptoms are bothering you, your primary healthcare provider, a board-certified dermatologist, or in some cases, a pharmacist may be able to help.

See a provider if you experience any of the following:

• Hair loss in an unusual pattern
• Rapid hair loss
• Hair loss at an early age (such as before you are in your 30s)
• Red, scaly, or abnormal skin on the scalp
• Itching or pain with hair loss
• Abnormal facial hair, acne, or an abnormal menstrual cycle
• Male-pattern baldness if you are female
• Weight gain, muscle weakness, intolerance to cold temperatures, and/or fatigue
• Bald patches in your eyebrows or beard
• Infected areas on your scalp
• A lesion or lesions that could be skin cancer

How to Treat Hair Loss and Scalp Itching 

Treatment for hair loss and/or scalp itching depends on what is causing the symptoms.

If you are reacting to a product or your symptoms are triggered by identifiable factors, avoiding those triggers as much as possible is the first place to start.

Medicated shampoo may be recommended for conditions such as dandruff or psoriasis.

Infections like scalp ringworm and scabies should be treated by a medical professional who can prescribe topical and/or oral medications.

Moisturizing creams or ointments may be used to help with dryness or itchiness. Your healthcare provider may recommend medicated ointments, such as corticosteroid lotions, for conditions such as seborrheic dermatitis.

Your healthcare provider may suggest taking specific supplements if a nutritional deficiency causes your symptoms. Hormonal therapy may be suggested if there is a hormonal cause for the symptoms.

Prescription medications that may be used to help decrease hair loss and/or stimulate new hair growth include:

Rogaine (minoxidil)

Propecia/Proscar (finasteride)

A hair transplant procedure, in which a surgeon moves healthy hair from one area of the scalp to a thinning area, is another option.

Treatment options for patchy hair loss due to alopecia areata include:

• Topical corticosteroids
• Topical anthralin (a medication used for psoriasis)
• Minoxidil
• Injected corticosteroids (directly into the areas with hair loss)

Low-level light therapy (LLLT) has also been approved by the U.S. Food and Drug Administration (FDA) as a treatment option and is effective in treating androgenic hair loss.

How to Minimize or Stop Scalp Itching and Shedding

As with treatment, strategies to minimize or stop itching and shedding depend on the cause. Some general tips for caring for a scalp that is itching and/or shedding include:

• Avoid sharing items such as brushes, hats, and combs.
• If advised, wash hair regularly with medicated shampoo (like those for dandruff), as directed.
• Handle, brush, and comb hair gently.
• For hair loss, use a gentle shampoo and condition well.
• Use leave-in conditioner or detangler after you wash and condition your hair.
• Use a microfiber towel to wrap your hair after washing to reduce the time spent blow-drying.
• Skip hot oil treatments, and at-home chemical treatments such as colouring, perming, chemical straightening, and relaxing.
• Use hot appliances sparingly, and set them to the lowest heat you can manage.
• When possible, let your hair air-dry.
  
• Avoid tight hairstyles and try not to twist your hair or pull on it.
  
• Adopt healthy lifestyle habits, like eating nutrient-rich foods and avoiding smoking.

Summary

Itchy scalp and hair loss can both be caused by a number of different factors, including medical conditions, environmental factors, and genetics.

There is some overlap between itchy scalp and hair loss. Both symptoms can occur with the same condition, such as scalp ringworm. Scratching an itchy scalp can cause damage that leads to hair loss. Hair loss in conditions such as alopecia areata may cause scalp itch to occur before the hair falls out.

It's important to see a healthcare provider to get an accurate diagnosis and appropriate treatment plan.

Treatment depends on the cause but may include topical medications and shampoos, oral or injected medications, and lifestyle practices.

https://www.verywellhealth.com/itchy-scalp-and-hair-loss-8351171