What I Wish I Knew About the Triggers of My Scalp Psoriasis

For Priyanka Borpujari, managing her scalp psoriasis meant being able to wear black again.

As I prepare to head out to a vibrant party, I catch a glimpse of myself in the mirror while fashioning my curly hair into a chic and intentionally disheveled bun. What makes me smile is the clear expanse of my forehead. There are no telltale signs of the relentless flaking that once plagued my scalp, interrupting moments of joy with its persistent presence. I pause to reflect on the journey that brought me here and wish I had known sooner about the triggers that could transform my hairline into a canvas of cascading flakes.

Several years ago, I found myself grappling with an incessant itchiness on my scalp, and it was this insistent itch that ultimately led me to a diagnosis of scalp psoriasis. The relentless scratching had taken its toll, causing my scalp to bleed, and beneath my fingernails lay a disconcerting combination of pink-tinged blood and a sticky, white substance.

Psoriasis, as explained by dermatologists, is a complex autoimmune skin condition characterized by the acceleration of skin cell turnover. This acceleration results in the formation of raised, reddish patches on the skin surface, often adorned with distinct white scales. These distinctive patches, referred to as plaques, have the propensity to appear on various parts of the body, including the elbows, knees, and, notably in my case, the scalp. When psoriasis affects the scalp, it may confine itself to the hairline or extend its reach to encompass the forehead, ears, and the nape of the neck.

While psoriasis is typically associated with flare-ups during cold and dry weather conditions, my experience was atypical. Even amidst the humid and sweltering summer months of Mumbai, where I resided at the time, my scalp remained relentlessly itchy. My dermatologist prescribed vitamin A supplements and antihistamines to alleviate the incessant itching, but relief was elusive.

The turning point arrived when I relocated to Tokyo in 2019, exposing myself to a much colder climate. The biting cold further exacerbated the itchiness and exacerbated the snowy landscape on my forehead. Medicated shampoos provided temporary respite, but the flakes returned with a vengeance after just a couple of days.

The winter of 2019 was marked not only by its frigid temperatures but also by a particularly harsh personal breakup that left me emotionally raw. The ensuing psoriasis flare-up was unlike any I had experienced before; my scalp seemed to be in a perpetual state of agitation, demanding my attention through incessant itching. The stress and emotional turmoil from the breakup disrupted my sleep patterns and fueled an unhealthy appetite for comfort foods. The late nights spent in tearful solitude meant that I often missed my morning showers, unwittingly adding to the turmoil.

Fortunately, the cold winter afforded me some solace as I could conceal my scalp beneath a warm woolen hat. It was only upon returning to Mumbai the following spring for a visit to my hairstylist that the full extent of the issue became glaringly apparent. My hairstylist, with a compassionate touch, documented the condition of my scalp in a photograph and shared it with me. The sight of the damage inflicted by the psoriasis and my own incessant scratching brought tears to my eyes.

During that visit, my hairstylist worked her magic, allowing my scalp to stay blissfully free of flakes for an unprecedented ten days. However, the global pandemic forced me to remain in India for an extended period, presenting a new set of stressors. Early morning virtual meetings with colleagues in different time zones, the incessant cries of a stray kitten in need of rescue, and conflicts with my mother, with whom I shared living space, all conspired to resurrect the psoriasis flare-up.

Upon finally returning to Tokyo after borders reopened, life took on a more tranquil pace. It was during this period of relative calm that I embarked on a journey of introspection and self-awareness, connecting the dots between my life circumstances and the ebb and flow of my psoriasis.

A discernible pattern began to emerge: Each time I felt stifled, dismissed, or abandoned, a psoriasis flare-up ensued. It was as though the clenched fists I had used in my futile attempts to break down the emotional barriers encasing my spirit were instead manifesting on my scalp’s skin, resulting in the eruption of pent-up emotions in the form of those conspicuous flakes. It became evident that my emotional state was intricately linked to my psoriasis triggers.

To compound matters, I had developed unhealthy coping mechanisms, turning to comfort foods such as chips and copious amounts of cheese when stress overwhelmed me. Binge-watching Netflix to escape the pressures of deadlines only exacerbated my anxiety. These revelations shed light on a couple more potential triggers for my psoriasis flare-ups.

Psoriasis, as experts explain, follows a pattern of symptoms that come and go in waves referred to as flare-ups. Certain factors, including stress, skin injuries like bug bites or scratches, illness, cold weather, heated or dry indoor environments, excessive alcohol consumption, and smoking, have all been known to trigger or exacerbate psoriasis flare-ups. Additionally, many individuals with psoriasis have reported certain foods as potential triggers for their symptoms.

Fortunately, I have been experiencing a period of contentment and stability for the past few weeks. I have moved on from the tumultuous breakup that had triggered a massive psoriasis flare-up, and I’ve taken a more mindful approach to my diet, reducing my consumption of indulgent treats like fries and alcohol. My current residence in Ireland has introduced an unexpected element of exercise into my routine, as the unpredictable public transportation system in Dublin often requires me to walk nearly three miles each day. These walks, accompanied by the invigorating beats of 90s house music, provide a substantial boost of endorphins. I have also become more disciplined in meeting my deadlines and waking up earlier to ensure regular showers and a clean scalp. This newfound equilibrium, devoid of known triggers, has translated into a welcome respite from psoriasis flare-ups.

As I prepare to head out to the party, my reflection in the mirror is no longer accompanied by concerns of psoriasis-induced flakes marring the evening’s festivities. I am hopeful that this era of serenity and balance will persist. I look forward to donning glittery black turtlenecks for gatherings without the looming specter of psoriasis flare-ups. In this chapter of my life, I am not only celebrating personal growth but also the understanding that, sometimes, the true path to healing lies in recognizing the intricate dance between our emotions, our bodies, and the world around us.