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Psoriasis is an immune-mediated, chronic inflammatory condition. It often affects the skin and can cause raised, itchy, and scaly plaques on the scalp. Treatments for scalp psoriasis can include over-the-counter and prescription medications.
Scalp psoriasis can affect the entire scalp or appear in patches. It can also reach the hairline, behind or inside the ears, and the upper neck.
Psoriasis is more common in adults, but it can also develop in children. Around
The causes of scalp psoriasis are similar to those of psoriasis on other parts of the body, but it can be more challenging to treat on the scalp.
The appearance can depend on a person’s skin color. Affected areas may be pink or dark red in people with lighter skin. In People of Color, the affected areas may be red, purple, or brown. For anyone, thick scales may cover the affected skin.
If scalp psoriasis is mild, the only symptom may be itchy, small, scaly patches of skin.
Symptoms can include:
- dry, flaky skin and discolored patches
- extreme itchiness
- a burning sensation or other types of pain
- temporary hair loss in the affected areas
The condition can extend to a person’s forehead, neck, and ears. The hair loss can occur if a person scratches or irritates the affected patches of skin. Scratching can also result in bleeding and infection.
Scalp psoriasis vs. dandruff
Scalp psoriasis can look like dandruff, also known as seborrheic dermatitis. As a result, doctors often misdiagnose scalp psoriasis, but it can cause a thicker buildup of dead skin cells.
Dandruff causes small, dry or greasy flakes that may appear on the scalp. The affected skin may be discolored, itchy, and covered in fine scales. Dandruff can also occur around the eyebrows, nose, armpits, mid-chest, back, and groin.
Other skin conditions
Other skin conditions, such as those below, can cause similar symptoms to scalp psoriasis.
Ringworm, a fungal infection, can cause a crusty rash to form in the shape of a ring. With scalp psoriasis, the affected patches of skin are scaly and dry, but not usually ring-shaped.
Pityriasis amiantacea causes thick scaling of the scalp.
Psoriasis is an immune-mediated inflammatory condition that causes skin cells to build up, typically with injury to the skin.
New cell formation on the scalp usually takes weeks. However, with psoriasis, the cells form within days, making it difficult for the body to shed the excess cells. As the skin cells build up on the scalp’s surface, they form scaly patches.
The exact cause of scalp psoriasis is unknown, but
- inflammatory factors that occur with obesity
- dietary factors, such as gluten sensitivity and nutritional deficiencies
- a sedentary lifestyle
The National Psoriasis Foundation notes that other factors may trigger a flare-up of symptoms in people prone to scalp psoriasis. These include:
- an injury to the skin, such as a burn, cut, or bruise
- an infection, especially strep throat
- stress, which may worsen symptoms or trigger them for the first time
- indomethacin, which is used to treat arthritis
- some chemotherapy drugs
- rapid withdrawal of oral steroids
- antimalarial drugs, such as chloroquine
- monoclonal antibodies
Anyone who has a new rash should seek medical advice.
A doctor will examine the area and ask about symptoms, medical conditions, and family health history. A dermatologist may diagnose scalp psoriasis simply by examining the rash, or they may recommend a skin biopsy to rule out other conditions.
Scalp psoriasis may flare up periodically, but appropriate treatment can usually control the symptoms.
There is no cure for scalp psoriasis. In addition, while scalp psoriasis shares many of the same symptoms as psoriasis on other parts of the body, the presence of hair on the head can make it more challenging to treat.
The best way to manage scalp psoriasis is to apply medication according to the instructions of a healthcare professional.
Over-the-counter (OTC) treatments can also help. In fact, this is usually the first approach, according to the National Psoriasis Foundation.
OTC topical treatments
A person may need to rotate treatments, as the body’s response to one medication can lessen after repeated use.
OTC treatments come in different forms, such as shampoos or solutions for the scalp. They can help moisturize and soothe the skin, remove scales, and relieve itching.
Treatments may contain one or more of the following ingredients:
- Coal tar: This has anti-inflammatory properties, but its popularity has waned as new topical medications have become available.
- Salicylic acid:
Studieshave found that products containing salicylic acid at 5–10% strength can help reduce scaling and enable other products to penetrate the skin more effectively. However, it may weaken the hair and cause it to break.
- Aloe vera: If a product contains aloe vera, it will likely reduce discoloration and scaling.
- Capsaicin: In creams, capsaicin may block nerve endings that transmit pain. However, more research is needed to assess its long-term benefits and safety.
Various shampoos are available to purchase online. However, before making a purchase, check with a healthcare professional that the ingredients are suitable.
Doctors may also prescribe medications to treat moderate or severe psoriasis. Scalp psoriasis often requires a prescription medication in combination with OTC treatments.
Examples of steroids include:
However, long-term use of these products may thin the skin and possibly change its pigment.
According to the Food and Drug Administration (FDA), people should use hair treatments that contain these products for no more than 4 weeks, and people under 18 years of age should not use them.
In mild, limited cases of scalp psoriasis, a doctor may also inject a steroid medication. They usually restrict this type of treatment, however, because steroids can have a range of adverse effects.
If psoriasis does not show signs of improving, involves the joints, and covers a large area, doctors may recommend the following medications:
Systemic and biologic drugs
Systemic and biologic drugs address the underlying cause of psoriasis, rather than just relieving the symptoms.
Biologics and biosimilars are newer medications that target specific parts of the immune system to treat psoriasis. Some block the action of a type of immune cell called a T lymphocyte. Others block proteins such as tumor necrosis factor-alpha, interleukin 17-A, or interleukins 12 and 23.
Doctors administer these drugs via injections or intravenous infusions.
Some FDA-approved biologics for this purpose are:
Common side effects include an increased risk of infection and flu-like symptoms. A person and their doctor should discuss the possible benefits and risks carefully.
While biologic and biosimilar drugs block specific parts of the immune system, systemic medications can target it in its entirety. These may be oral or injectable medications, and a person usually takes or administers them at home.
Examples of prescribed oral medications include:
Phototherapy is an
People can receive this light therapy in hospitals and other clinical centers. Usually, a dermatologist provides the treatment, which may take place three times a week for 6–8 weeks or until the psoriasis has cleared to an acceptable degree.
The most common adverse effect was pain, which generally subsided after 7 days.
The National Psoriasis Foundation suggests that the following alternative preparations may help reduce the symptoms of psoriasis:
Apple cider vinegar
Applying organic apple cider vinegar directly to the scalp may help reduce the itchiness. However, it may also irritate the area.
To avoid irritation, dilute the vinegar with water in equal parts. Or, rinse the scalp after the vinegar dries. Doctors warn against using vinegar on areas of open skin.
Tea tree oil shampoo
Tea tree oil may help relieve the symptoms, due to its antiseptic properties.
Dead Sea salts
Adding Dead Sea salts to a warm bath can help relieve itchiness and scaling, but apply a moisturizer afterward.
Topical creams containing a 10% concentration of Oregon grape, or Mahonia aquifolium, may help treat mild to moderate psoriasis.
Anyone considering a complementary therapy should speak with a doctor first. Some remedies can interact with other medications or cause skin irritation, which may worsen psoriasis.
Having psoriasis anywhere on the body can increase the risk of other health issues, including:
- psoriatic arthritis
- Crohn’s disease
- heart disease
- heart attack
- metabolic syndrome, including diabetes and obesity
Understanding the signs of these complications can help a person know when to contact a doctor.
The following strategies can help people manage scalp psoriasis:
- Seek treatment: This is an important way to prevent complications, such as hair loss and cracked or bleeding skin. A healthcare professional may recommend one or two topical medications and possibly an oral, injected, or infused treatment.
- Treat the scalp gently: Avoid washing and combing the hair vigorously. This can lead to breakage, especially if the hair is fragile.
- Avoid scratching: Scratching can lead to bleeding and infection.
- Avoid triggers: Identifying and avoiding what triggers psoriasis symptoms is a key step.
- Following the treatment plan: Using topical medications consistently and exactly as prescribed is important, as it can take a while for symptoms to improve.
Also, ointments and creams may not spread easily on the scalp, so a person may prefer a spray, foam, or gel option if these are available.
If a person has sebopsoriasis, in which symptoms of seborrheic dermatitis and psoriasis overlap, the dandruff may worsen the symptoms of psoriasis. A doctor will recommend alternating an antifungal shampoo with a coal tar shampoo, as well as prescription medications.
It is difficult to prevent scalp psoriasis because the exact cause remains unclear. However, receiving treatment as soon as possible after the symptoms arise can help prevent them from worsening.
Scalp psoriasis affects people differently. Some have an occasional flare-up, while others have more consistent symptoms. Beyond seeking treatment, identifying and avoiding psoriasis triggers can help manage the condition.