Scalp Psoriasis

Psoriasis is an inflammatory skin disease estimated to affect about 2.2% of adults. In children, psoriasis can begin before age one and peak around 5-8 years. Psoriasis causes scaly, itchy bumps on the skin. It appears as red scaling, raised bumps (papules) that merge into plaques.

Some people may have a genetic predisposition to psoriasis. The affected genes seem related to immune system control.

Psoriasis typically appears on the elbows and knees, but it can affect any part of the skin. The scalp is commonly affected. Like psoriasis on the body, scalp plaques produce excess scale and can itch. Severe disease can cause hair loss, which usually returns if the disease is controlled.

Scalp psoriasis is difficult to treat when the scalp is covered with hair, as it acts as a barrier to topical medications.

Scalp psoriasis vs. seborrheic dermatitis

Sometimes, scalp issues can be mistaken for scalp psoriasis since both can cause excess scale and itchiness. Pathological examination of the skin biopsy material can help distinguish the two conditions, but it’s rarely necessary because most psoriasis patients have typical psoriatic lesions on other parts of the body. Additionally, both conditions generally respond to similar topical medications.

Causes of scalp psoriasis

Scalp psoriasis, like all psoriasis, is related to genetic defects affecting parts of the immune system. Certain environmental risk factors also trigger its development in genetically predisposed individuals.

"Emotional stress" is thought to exacerbate psoriasis but proving its causal role has been difficult. However, psoriasis of the scalp can be incredibly stressful.

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Symptoms and signs of scalp psoriasis

Psoriasis appears as small bumps, or papules, covered in scale. When these papules merge, they form plaques covered by thick layers of scale that can appear as dandruff.

Scratching these plaques is not advisable since it can worsen psoriasis due to the Koebner phenomenon. Scratching off the scale only makes things worse.

Hair loss is rare, but severe cases can cause extensive alopecia.

Physicians who diagnose and treat scalp psoriasis

Dermatologists specialize in diagnosing and treating various scalp conditions. General practitioners, family physicians, internists, and rheumatologists may also be involved in psoriasis care.

How healthcare professionals diagnose scalp psoriasis

Diagnosing and treating scalp psoriasis can be challenging due to the presence of hair. If scaling plaques are present on other parts of the body characteristic of psoriasis, then diagnosing scalp disease becomes easier.

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Scalp psoriasis home remedies and topical treatments

The primary goal in treating scalp psoriasis is to effectively deliver medication into the skin. Both hair and scale act as impediments, so removing scale is essential. Frequent shampooing can help, along with tar, selenium, or salicylic acid-containing shampoos. Gently rubbing off scale with fingertips is important.

Scaling is not caused by dryness but by excessive production of the horny layer of skin. Covering the scalp overnight with mineral oil and a shower cap can be helpful, but it’s important to avoid a mess.

For moderate to severe scalp psoriasis, a topical steroid is often necessary. The potency and type of vehicle depend on the severity and patient preference. The medication must penetrate the hair to reach the scalp skin.

Other medications like topical calcipotriene can be beneficial, and some are available as combinations of topical steroids and calcipotriene.

Medications for scalp psoriasis

If the scalp is extensively affected, topical medications may not be practical, and orally or injected medications may be required. These systemic therapies involve more risk compared to topical medication. They include oral drugs like methotrexate, cyclosporine, acitretin, apremilast, and biologic drugs administered via infusion or injection.

Regular laboratory work may be necessary to monitor the toxicity associated with systemic therapies.

Other treatments for scalp psoriasis

Triamcinolone acetonide can be injected directly into psoriatic plaques, but the effect is temporary. Ultraviolet light in wavelengths near 313 nm is effective, but the hair can hinder administration unless removed or sparse. The excimer laser is also beneficial if the scalp involvement is limited.

Prognosis of scalp psoriasis

Psoriasis is incurable, so constant care is necessary to keep it controlled. With diligent attention, scalp psoriasis can be managed.

Support groups for psoriasis

Patient support groups like the National Psoriasis Foundation can help individuals living with psoriasis.

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Frez, Maria Lorna F., et al. "Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group." Journal of Dermatological Treatment 25.1 (2014): 38-45.

Kircik, L.H., and S. Kumar. "Scalp Psoriasis." J Drugs Dermatol 9.8 Aug. 2010: s101-5.

Wang, Ting-Shun, and Tsen-Fang Tsai. "Managing Scalp Psoriasis: An Evidence-Based Review." Am J Clin Dermatol Sept. 21, 2016.

Wong, Jillian W., Faranak Kamangar, Tien V. Nguyen, John Y.M. Koo. "Excimer Laser Therapy for Hairline Psoriasis: A Useful Addition to the Scalp Psoriasis Treatment Algorithm." Skin Therapy Lett 17.5 May 2012: 6-9.