How to manage diffuse hair fall due to psoriasis?

From the Guidelines

Managing diffuse hair fall due to psoriasis requires a multi-faceted approach targeting both the scalp inflammation and hair health, starting with medicated shampoos and topical corticosteroids, and considering prescription treatments and systemic therapies as needed. The treatment should be tailored to meet individual patients’ needs, taking into account the characteristics of the psoriasis being treated, patient preferences, and practical considerations 1.

Treatment Options

• Medicated shampoos containing ketoconazole, coal tar, or salicylic acid, used 2-3 times weekly to reduce scaling and inflammation
• Topical corticosteroids like clobetasol propionate 0.05% solution or fluocinonide 0.05% solution applied directly to affected areas once daily for 2-4 weeks to significantly reduce inflammation
• Prescription treatments like calcipotriene (a vitamin D analog) or tazarotene, often used in combination with steroids, for more severe cases
• Systemic treatments, including methotrexate (starting at 7.5-15mg weekly), biologics like adalimumab or secukinumab, or oral retinoids, for widespread psoriasis

Gentle Hair Care Practices

• Use lukewarm water
• Avoid harsh chemicals
• Limit heat styling
• Consider using a wide-toothed comb to prevent further hair damage

Nutritional Support

• Biotin supplements (2500-5000 mcg daily)
• Vitamin D
• Omega-3 fatty acids to help strengthen hair

The most recent and highest quality study 1 supports the use of calcipotriene foam for the treatment of scalp psoriasis, and combination treatments with vitamin D analogues and potent topical corticosteroids for more effective treatment. It is essential to consider patient education and adherence to topical treatment, as well as individual preferences for vehicles and treatment regimens 1.

From the FDA Drug Label

To treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills). The FDA drug label does not answer the question of how to manage diffuse hair fall due to psoriasis.

From the Research

Managing Diffuse Hair Fall due to Psoriasis

To manage diffuse hair fall due to psoriasis, it is essential to treat the underlying condition. Here are some key points to consider:

• Topical treatments are the mainstay of scalp psoriasis treatment, with vehicles such as shampoos, lotions, gels, foams, creams, and ointments being relevant to efficacy, tolerability, and compliance 2.
• Active ingredients for scalp psoriasis treatment include keratolytics, coal tar, dithranol, corticosteroids, and vitamin D3 analogues 2.
• Topical corticosteroids remain the primary treatment for scalp psoriasis, with rapid effects and patient-friendly formulations, although safety data for prolonged use (more than 4 weeks) is limited 2.
• Vitamin D3 analogues are a patient-friendly, tolerable, and effective alternative to corticosteroids, with optimal effects after 8 weeks 2.

Treatment Options

Some treatment options for managing diffuse hair fall due to psoriasis include:

• Clobetasol propionate shampoo 0.05%, which has been shown to be efficacious and safe for long-term control of scalp psoriasis 3.
• Short-term treatment with clobetasol lotion, which can improve skin hydration, reduce transepidermal water loss, and decrease skin erythema 4.
• Calcipotriol solution 0.005%, although clobetasol propionate shampoo has been shown to be more effective and better tolerated 5.
• Topical therapies such as salicylic acid, coal tar, and anthralin, which can be used in combination with other treatments 6.

Considerations

When managing diffuse hair fall due to psoriasis, consider the following:

• Each patient should be examined individually, and deteriorating factors should be excluded 2.
• Treatment should be chosen based on the clinical picture, with anti-inflammatory drugs like topical corticosteroids indicated for inflammatory lesions and vitamin D3 analogues indicated for scaling lesions 2.
• Intermittent use of topical corticosteroids alternating with vitamin D3 derivatives, combined or not with liquor carbonis detergens containing shampoo, may be the most suitable treatment for most patients 2.