Psoriais is a non-contagious, genetic disease of the immune system affecting the skin and sometimes the joints. Scalp psoriasis is very common, affecting at least 50% of all people who have psoriasis.
As with all psoriasis, the skin cells grow too quickly on the scalp and cause red lesions covered with scale, resulting in a flaking of the scalp. The severity of flaking can range from fine dandruff-like flakes to plaques with thick scales. Scalp psoriasis can often extend beyond the hairline down the forehead onto the face – often, the backs of the ears are involved too.
Most of the time, people with scalp psoriasis have psoriasis on other parts of their body as well. For some, the scalp is the only affected area. Other skin disorders, such as seborrheic dermatitis, may look similar to psoriasis. However, there are differences and it should be professionally diagnosed. Scalp psoriasis scales appear powdery with a silvery sheen, while seborrheic dermatitis scales often appear yellowish and greasy. Despite these differences, the two conditions can be easily confused.
Treating Scalp Psoriasis
Treating scalp psoriasis is similar to treating other forms of psoriasis, although, many of the topical ointments and creams prescribed for psoriasis can be impractical for application to the scalp. Treatments are often combined for a multi-layered approach, especially if the condition in non-responsive to a single treatment. Oral or systemic medications are often prescribed for scalp psoriasis, especially in moderate to severe cases.
The first step in treating scalp psoriasis is to try to remove the scale or psoriasis plaques. This is a necessary step since it makes it easier for topical medications to penetrate and clear the skin. To remove the scale, it should be softened with active ingredients such as salicylic acid, lactic acid or phenol, which are applied to the scalp and left for a while (sometimes overnight) to soften the skin and then shampooed off.
Soaking the scalp in warm (not hot) water can also help loosen scales. The warm water plumps up the scales and makes them easier to remove. Removing the softened scales too vigorously can break the skin and lead to an infection. To learn how to properly soften and remove scales from the scalp, please read more in this informative publication on Scalp Psoriasis by the National Psoriasis Foundation.
Salicylic Acid softens the scales and makes it easier to remove them. Salicylic acid is available in over the counter products like soaps and shampoos, or in stronger forms by prescription. Treatments with high concentrations of salicylic acid can cause irritation and may lead to temporary hair loss. This is not permanent – the hair should return to normal after stopping treatment.
Tar products are effective for treating scalp psoriasis. Tar products are readily available without a prescription in a wide variety of over-the-counter tar shampoos, creams, gels, oils, ointments and soaps. For more severe cases, your doctor may prescribe a stronger solution. Tar products may be used as a sole treatment or in combination with other treatments. A note of caution: While tar is an effective medication, it can stain bedding and gray or white hair, and has a strong odor.
Ultraviolet light therapy – Since our hair blocks UV light from reaching the scalp, delivering this beneficial treatment is done by using a hand-held device called a UV comb. The UV comb delivers a high intensity UV light to the scalp which helps heal the affected skin.
Topical steroids or corticosteroid medications (steroids) can be an effective treatment for scalp psoriasis. These prescription medications come in gels, creams, lotions, sprays, ointments and foam and should not be used for more than two weeks at a time. Abruptly stopping steroid treatments can sometimes cause psoriasis to worsen (called a rebound flare). Several topical steroid prescription medications are designed specifically for treating scalp psoriasis. These formulas are water- and alcohol-based, which makes it easier to wash them out after treatment.
Systemic treatments – there is a wide range of oral or injected treatments available for more severe cases of scalp psoriasis. These must be prescribed by a physician and are often used if psoriasis is present elsewhere on the body. Systemic treatment options should be discussed with your doctor who will determine the best approach for treating your condition.
The National Psoriasis Foundation
Coping with, and treating psoriasis, can be difficult – treatments may take 8 weeks or more to work. Some treatments may not work, or you may find that you need to try a number of methods or combinations of treatments to find what works for you.
That National Psoriasis Foundation is a fabulous resource for those suffering from psoriasis of any kind. They offer advice, support, and have an extensive library of information on psoriasis and related topics. Connecting with them is free. Simply call 800.723.9166 or go to www.psoriasis.org to join now – it will be the best first step in treating your condition you can take.
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- Cream for Psoriasis – What Are Your Options? (healthyskinsolutions.com)
- Psoriasis Treatment: Know your Options (healthyskinsolutions.com)
National Psoriasis Foundation: Scalp Psoriasis