What To Do About Scalp Psoriasis: Dermatologist-recommended Treatments

Itchy scaling on your scalp may be more than dandruff.

Psoriasis is a chronic autoimmune skin condition that affects millions of people worldwide, and when it strikes the scalp, it can lead to a particularly uncomfortable and sometimes socially challenging experience. While there is no cure for psoriasis, understanding its characteristics, causes, symptoms, and treatment options can provide valuable insights for those dealing with this condition.

What Is Scalp Psoriasis?

Scalp psoriasis is a variant of psoriasis that specifically affects the scalp. It is characterized by the presence of raised plaques and scales on the scalp, which can be itchy, burn, and sting. This condition arises from an overactive immune system that accelerates the growth of skin cells. Due to this increased growth rate, the skin cells accumulate on the scalp rather than shedding naturally, resulting in the formation of the plaques that are often visible.

Scalp psoriasis can extend beyond the hairline, sometimes affecting the forehead, neck, and even areas around the ears. Approximately 45-56% of individuals with psoriasis experience scalp involvement, making it a relatively common manifestation of this autoimmune disorder.

Why Do People Get Scalp Psoriasis?

The precise reasons why some individuals develop scalp psoriasis while others do not remain a subject of ongoing research. Dermatologists like Adam Friedman, MD, believe that a combination of genetic predisposition and environmental factors plays a significant role in its development.

Interestingly, individuals with scalp psoriasis often exhibit a propensity for other forms of psoriasis, such as inverse psoriasis, which affects skin folds like those found in the groin and underarms. In these areas, psoriasis may have a different appearance, sometimes leading to misdiagnosis as conditions like yeast infections or sexually transmitted diseases. Therefore, accurate diagnosis is crucial in these cases.

Robert T. Brodell, MD, also points out that some individuals may experience scalp psoriasis alongside psoriasis on their elbows, knees, or even fingernail pitting, while others may have it isolated to the scalp. This wide variability in presentation underscores the complexity of the condition.

Symptoms of Scalp Psoriasis

The symptoms of scalp psoriasis can be distressing and include:

1. Thick, crusted plaques on the scalp.
2. Scales that may appear powdery and have a silver sheen.
3. Scaling that can cover parts of the scalp or the entire scalp.
4. Scaling that may extend beyond the hairline onto the neck.

These symptoms can lead to discomfort, pain, and social challenges. Dr. Friedman emphasizes that the impact of scalp psoriasis goes beyond physical discomfort; it can also result in anxiety and misunderstanding, as people unfamiliar with the condition may assume it’s related to hygiene or other issues.

Effects on Scalp and Hair

Psoriasis on the scalp can sometimes cause hair loss. Even minor inflammation can disrupt the hair growth cycle, leading to hair loss. To minimize the risk of further hair loss, individuals with scalp psoriasis can:

1. Gently comb and brush away scales.
2. Avoid picking off scales, which can worsen inflammation.
3. Allow hair to air dry rather than using excessive heat.
4. Keep fingernails short to prevent scratching the scalp.
5. Use conditioner after shampooing to keep the scalp moisturized.
6. Use medicated shampoos and alternate with regular shampoos.

While hair loss can be a distressing aspect of scalp psoriasis, it’s important to note that hair typically grows back once the psoriasis clears.

Treatment Options for Scalp Psoriasis

Effective treatment is essential for managing scalp psoriasis and alleviating its symptoms. Dermatologists have several treatment options at their disposal, and the choice of treatment depends on the severity of the condition and individual factors. Common treatment options include:

1. Topical Ointments: These are the first-line therapy for plaque psoriasis on any part of the body, including the scalp. Topical treatments may include medicated shampoos, steroids, tars, and prescription topicals. The challenge with scalp application lies in the presence of hair, which can make the use of ointments or creams difficult. In such cases, foams, liquids, or gels may be preferred.

2. Over-the-Counter (OTC) Options: Some topical treatments are available without a prescription and contain ingredients like salicylic acid or tar. These ingredients help soften plaques and scales, reducing itching and scaling. Look for products with a Seal of Recognition, indicating they are safe for people with psoriasis.

3. Phototherapy: This treatment involves exposing the affected area to ultraviolet (UV) rays, which can slow down skin cell growth, reduce inflammation, and relieve itching. For scalp psoriasis, dermatologists may use handheld devices that emit UV rays.

4. Systemic Therapies: In cases where topical treatments and phototherapy do not provide adequate relief, dermatologists may prescribe oral medications or biologics. Oral medications like methotrexate, apremilast, tofacitinib, cyclosporine, and acitretin can help slow down the overactive immune system. Biologics, delivered through injection or IV infusion, target specific immune system components and include medications like adalimumab, ustekinumab, secukinumab, infliximab, and golimumab.

It’s important to note that the choice of treatment should be tailored to the individual’s specific condition and needs. Dermatologists like Dr. Friedman often prescribe systemic agents for scalp psoriasis, as they can be more effective for the scalp and may reduce the risk of psoriatic arthritis, which is more common in individuals with scalp psoriasis.

In Conclusion

Scalp psoriasis can indeed be a profoundly challenging dermatological condition that takes a toll on both physical and emotional well-being. This chronic autoimmune disorder often manifests as red, scaly patches on the scalp, causing discomfort, itchiness, and sometimes even pain. The persistent nature of scalp psoriasis can have a significant impact on an individual’s self-esteem, as the visible symptoms can be quite distressing.

It’s essential to recognize that, at present, there is no known cure for scalp psoriasis. However, there is a range of treatment options available to manage its symptoms effectively and improve one’s overall quality of life. These treatment modalities encompass topical medications, phototherapy (light therapy), systemic medications, and lifestyle modifications.

Effective management of scalp psoriasis often necessitates a personalized approach tailored to an individual’s specific condition and needs. This underscores the importance of consulting a dermatologist, a medical specialist with expertise in skin disorders, for a comprehensive evaluation and the development of a suitable treatment plan.

Dermatologists can recommend and prescribe the most appropriate treatments based on the severity of the scalp psoriasis, its impact on the patient’s daily life, and any potential contraindications or side effects associated with the treatments. They may also provide guidance on how to properly care for and moisturize the scalp to alleviate discomfort and prevent further flare-ups.

Furthermore, it’s crucial for those affected by scalp psoriasis to stay informed about the condition and its triggers. Lifestyle choices, stress management, and dietary considerations can play a role in managing the condition. By understanding the nature of scalp psoriasis and actively seeking appropriate care, individuals can take proactive steps toward a more comfortable, healthier, and confident life, despite the considerable challenges posed by this condition. With the right guidance and support, it is possible to effectively manage scalp psoriasis and minimize its impact on daily life.