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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 45–56% of people with psoriasis have scalp psoriasis. However, up to 90% of people with psoriasis can experience scalp psoriasis during their lifetime.

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.

Research has found that people with scalp psoriasis may have a higher risk of developing psoriatic arthritis.

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.

Seborrheic dermatitis is called “cradle cap” when it affects infants. In this case, it causes thick, greasy scales on the scalp, and it peaks at around 3 months of age.

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.

Sebopsoriasis is an overlap between seborrheic dermatitis and psoriasis. It causes symptoms that resemble both conditions.

Pityriasis amiantacea causes thick scaling of the scalp. Researchers have reported it as a clinical manifestation of other inflammatory diseases of the scalp, including scalp psoriasis, eczema, and, less commonly, tinea capitis.

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 research suggests that the immune system and genetics play a role.

A 2016 review notes that psoriasis might be more common in people with:

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

Drug-induced psoriasis can result from:

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: Studies have 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.

Prescription treatments

Doctors may also prescribe medications to treat moderate or severe psoriasis. Scalp psoriasis often requires a prescription medication in combination with OTC treatments.

Topical steroids are the most common treatment, as they decrease inflammation and itching.

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 addition to a topical steroid, a doctor may also prescribe topical nonsteroidal treatments, such as the vitamin A derivatives tazarotene and anthralin, which slow the growth of skin cells.

Other products combine vitamin D with a corticosteroid, such as calcipotriene (Dovonex). This slows skin cell growth, flattens lesions, removes scales, and reduces itchiness and inflammation.

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

Phototherapy is an effective psoriasis treatment that involves regularly exposing the scalp to UV light, using a special tool that emits UVB rays. The tool may be like a laser or a comb, and the doctor may use a blow dryer to separate the hair.

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.

Turmeric

Consuming turmeric as a spice in food or as a supplement, or applying a curcumin gel may help reduce the symptoms and activity of psoriasis. Curcumin is the primary active ingredient in turmeric.

The Office of Dietary Supplements reports that turmeric is generally safe when people consume it or apply it to the skin. However, it is a good idea to check with a doctor before using complementary therapies or supplements.

Dead Sea salts

Adding Dead Sea salts to a warm bath can help relieve itchiness and scaling, but apply a moisturizer afterward.

Oregon grape

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:

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.

Here are some frequently asked questions about scalp psoriasis.

Can scalp psoriasis go away?

There is no cure for scalp psoriasis, but treatments can help a person manage symptoms. A person’s doctor can help them determine the best psoriasis treatment for them.

Should I wash my hair often if I have scalp psoriasis?

How often a person washes their hair will be different for each individual. Regularly washing the hair with medicated shampoos may actually help to alleviate itchiness and other symptoms. However, washing vigorously or using fragranced products may irritate the scalp.

A person’s doctor can assess their symptoms and advise on how regularly they should wash their hair.

What causes psoriasis on the scalp only?

Scalp psoriasis has the same causes as psoriasis in general. Although the exact cause is unclear, it happens when something causes an overactive immune system, resulting in skin cells building up quickly. A person may have scalp psoriasis only, or they may also have another type of psoriasis.

What deficiency causes scalp psoriasis?

Vitamin D deficiency or low vitamin D levels may be a risk factor for scalp psoriasis. However, more research into the links between psoriasis and nutritional deficiencies is necessary.

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.