How to manage thinning of hair after dreadlocks?

Question

Hello doctor,

I had dreadlocks for a long time. Over the course of nine years, I did not take proper care of them, so I eventually cut them off and shaved my hair short. Now the front part of my scalp is very thin. I have been using ketoconazole shampoo and conditioner, and sometimes I apply tea tree oil and peppermint oil after washing.

I mainly do this because I have psoriasis, which causes a very dry scalp and scaly patches. What should I do to help my scalp heal and improve hair thickness?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your concern so openly.

I understand how stressful it can be to notice hair thinning after cutting your dreadlocks, especially while dealing with scalp psoriasis at the same time.

Based on your history, the thinning at the front of your scalp is most likely due to traction alopecia. This type of hair loss happens when hair is pulled tightly for a long time. Wearing dreadlocks for many years creates constant tension on the hair, especially along the front hairline. Over time, this repeated pulling reduces blood flow through the tiny blood vessels that supply nutrients and oxygen to the hair roots. As a result, the hair follicles become weak and produce thinner hair. The good news is that many of these follicles are usually still alive, just stressed, so regrowth is possible if further damage is avoided.

Your scalp psoriasis is also contributing to the problem. Psoriasis is a long-term inflammatory skin condition that causes dryness, redness, and thick scales. These scales can block hair follicles and disturb the normal hair growth cycle. The inflammation also narrows nearby blood vessels, which reduces nourishment to the hair. Psoriasis does not usually cause permanent hair loss, but if it is not well controlled, it can slow regrowth and increase hair shedding.

Some adjustment to your current treatment may help. Shampoo, which contains ketoconazole, helps reduce inflammation and yeast overgrowth on the scalp. However, using it too often can increase dryness and scaling. Using it about twice a week is usually enough.

Tea tree oil and peppermint oil, although popular for scalp care, can irritate sensitive or psoriatic skin, especially if they are not well diluted. This irritation can worsen inflammation and scaling, so it is better to stop using them for now.

Our main goals should be to calm scalp inflammation, improve blood flow to the hair follicles, and avoid any pulling or tension on the hairline. Gentle scalp care, proper treatment of psoriasis, regular moisturizing, and avoiding tight hairstyles are very important. When inflammation is controlled, blood flow improves, and weakened hair follicles often return to the growth phase over a few months.

I would suggest the following treatment plan:

Use 2.9% solubilized coal tar extract shampoo, which helps slow skin cell buildup and reduce scaling and itching in psoriasis. Use it twice a week for at least four weeks, and use a mild regular shampoo on the other days.
Betamethasone dipropionate lotion 0.05 percent is a topical corticosteroid, which means it reduces inflammation and redness. Apply a thin layer to the affected areas of the scalp once daily at night for two weeks only, then stop. This helps calm psoriasis, reduce scaling, and create a better environment for hair regrowth.
Vitamin D capsule (200,000 international units once a month).

Kindly revert if there are any queries.

Thank you.