Scalp Psoriasis and Transplants

Does a history of scalp psoriasis (assuming it is under control with treatment) rule out using minoxidil or transplants to offset hair loss?

Psoriasis is an autoimmune disease that has a genetic preference in its victim selection. It comes in all degrees of activity. Simple dandruff may be a very low active state of psoriasis and as it becomes more severe, it takes on more of the characteristics of the disease state, where scaling of the skin and red areas in the affected area can become painful. Flaking of the skin can be easily seen when psoriasis affects the scalp. Baldness is also a genetic process but it is unrelated to psoriasis. Both processes can co-exist in the same person and both can be treated independently at the same time.

People with psoriasis often ask about transplanting the disease from one area of the scalp to another. Can, for example, skin taken from the area where psoriasis is active, move the disease to areas in the recipient area that are not showing signs of the disease? The answer here is no, as the disease seems to be localized in the area where the scaling exist and moving the hair from the scaling area does not impact the normal recipient area, assuming the recipient area is normal. Psoriasis can be aggravated in the area where the disease is active by any trauma and surgery is a trauma. Some people who tend to pick at their skin and hair can develop traction alopecia (hair loss) if they persist on picking over a prolonged period of time.

I generally tell my patients to use a topical treatment (steroids) on any active area of psoriasis prior to a hair transplant so that the scaling that occurs will be less bothersome during the transplant process. I try to get good control of any scalp psoriasis prior to a hair transplant.

With regard to minoxidil, if this medication does not produce skin side-effects, then one can use it with psoriasis. If side effects should appear or the psoriasis should become worse with minoxidil, then the medication may not be a good choice.