Psoriasis and Alopecia: Unveiling the Links
Keywords:
psoriasis, alopecia, alopecia areata, hair loss, lichen planopilarisAbstract
Introduction: Psoriasis is a chronic inflammatory disease that may lead to scalp involvement, with a significant impact on patients' quality of life. Although most patients with scalp psoriasis do not experience alopecia, alopecia in the context of psoriasis is a multifaceted issue on which studies are limited.
Objectives: The purpose of this review was to investigate different types of alopecia in psoriasis and the potential mechanisms.
Methods: A thorough literature review was performed, focusing on the relationship between psoriasis and alopecia areata (AA), drug-induced alopecia, and psoriatic alopecia.
Results: Psoriasis and alopecia are related through several pathways. Regarding psoriatic alopecia, in most cases of psoriasis patients with scalp involvement, hair loss is attributed to telogen effluvium. In late-stage lesions, destruction of the hair follicle, perifollicular fibrosis, and free bare hair shafts in the dermis are revealed. However, hair loss in psoriasis is almost always non-scarring and reversible. In drug-induced alopecia, both conventional systemic treatments and biologics may cause hair loss in psoriatic patients. Specific side effects have been reported with TNF-α inhibitors and IL-17 blockers. TNF-α inhibitors may cause several types of alopecia: i) TNF-α inhibitor-associated psoriatic alopecia, ii) TNF-α inhibitor-associated AA, and iii) TNF-α inhibitor-associated lichen planopilaris. In concomitant psoriasis and alopecia areata, there is strong and convincing evidence that patients with psoriasis are at increased risk of developing AA, suggesting a complex interplay of autoimmune mechanisms.
Conclusion: Understanding the types and causes of alopecia in patients with psoriasis is crucial to proper management, thus highlighting the need for more research.
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