What to know about scalp psoriasis
Symptoms can affect the entire scalp or only small patches. They can also spread to the ears, the hairline, and the neck.
The most common type of psoriasis causes dry, red patches, or plaques, to form on the skin. On black skin, the patches may be purple or violet, rather than red.
According to the American Academy of Dermatology (AAD), at least 50 percent of all people with plaque psoriasis experience at least one flare-up on the scalp.
Scalp psoriasis can cause red or silvery patches in and around the hair.
If scalp psoriasis is mild, the only symptom may be small, scaly patches of skin.
Symptoms of severe scalp psoriasis can include:
- dry, flaky skin and red bumps
- a burning sensation
- hair loss, which is usually temporary, in the affected areas
Psoriasis does not cause hair loss, but it can happen if a person scratches or picks at the patches of skin. Scratching can also result in bleeding and infection.
The condition may spread from the scalp to areas of the ears, neck, and forehead.
Is it scalp psoriasis?
Some other skin conditions can cause similar symptoms.
Seborrheic dermatitis, or cradle cap, often affects babies. It causes a patchy, red rash that looks greasy or moist to form on the scalp.
Ringworm, a fungal infection, can cause a crusty, red rash to form on the scalp, usually in the shape of a ring. With scalp psoriasis, the affected patches of skin are scaly and dry and do not usually form a ring.
Causes, risk factors, and triggers
Psoriasis, including scalp psoriasis, is a common condition that appears to develop when the immune system sends the wrong signals to the body.
When the immune system sends these messages to the skin cells, the cells multiply too quickly.
Normally, new cell formation on the scalp may take weeks. With psoriasis, cells form within days. This makes it difficult for the body to shed the excess cells. As the skin cells build up on the surface of the scalp, they form scaly patches.
The exact cause of scalp psoriasis is unknown, but research suggests there is a genetic link.
People who have a family member with the condition have a higher risk of developing scalp psoriasis.
In 2016, research published by nutritionists noted that psoriasis may be more likely in people who have:
- inflammatory factors that occur with obesity
- dietary factors, such as gluten sensitivity
The National Psoriasis Foundation note that a number of other factors may trigger a flare-up of symptoms in people who are prone to scalp psoriasis.
- 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
- the use of certain medications, such as Indomethacin, used to treat arthritis, and Quinidine, a heart medication
Anecdotal evidence suggests that allergies and the weather may play a role, but there is a lack of scientific evidence to show this.
When to see a doctor
A doctor will examine the scalp and may take a skin biopsy for further investigation.
Anyone who has a new rash on the scalp or the body should seek medical help.
A doctor will carry out a physical exam and ask the person about their symptoms.
A dermatologist may be able to diagnose scalp psoriasis by examining the rash. Sometimes, they may recommend a skin biopsy to rule out other conditions.
Scalp psoriasis may flare up periodically, but it is not usually a serious medical condition. Appropriate treatment can usually control symptoms.
Currently, there is no cure for scalp psoriasis, but over-the-counter and prescription treatments are available.
Both topical and systemic medications can help. Some sources also recommend natural remedies. The type of treatment may depend on the extent or severity of the symptoms.
The National Psoriasis Foundation note that people may need to rotate treatments as their response to one medication can lessen after repeated use.
A person will apply a topical treatment directly onto the affected area, usually as a cream or a shampoo.
The treatment may contain one or a combination of the following:
- coal tar
- salicylic acid
- clobetasol propionate
Shampoos may contain one or a combination of the following.
Salicylic acid: Some treatments contain salicylic acid. This helps the outer layer of the skin to shed and softens the scales that develop with scalp psoriasis.
However, shampoos and topical ointments that contain salicylic acid can irritate the skin and weaken the hair. This may lead to breakage.
Coal tar products: These are derived from coal. Coal tar is thought to slow the growth of skin cells, to restore a normal appearance to the skin, and to decrease itching and inflammation.
Some studies suggest that using a shampoo that contains a 2–10 percent coal-tar solution may help. However, many people do not like the smell and concerns have arisen about safety.
Clobetasol propionate: Research has shown that shampoos containing clobetasol propionate at 0.05–percent strength are "highly effective" and safe for both initial treatment and maintenance, once other treatments have helped bring the psoriasis under control.
According to the United States Food and Drug Administration (FDA), treatment should be used for no more than 4 weeks, and people under 18 years of age should not use it.
Various shampoos and other products are available to purchase online, but you should check with a doctor first that the ingredients are suitable for you to use.
Studies have found that products containing salicylic acid at 5–10 percent strength can help reduce scaling and enable other products to penetrate the skin more effectively. However, it may be difficult to get out of the hair, and the hair may weaken and break.
Coal tar products may help, but their popularity has waned as new products have appeared. However, research has suggested that coal tar may be neither safe nor effective, and many people do not like the smell.
Topical corticosteroids are the most common treatment. They are available in various forms, including creams, ointments, foams, and shampoos. However, they can lead to skin atrophy.
Vitamin D-based medications, such as Dovonex (calcipotriene) can slow the growth of skin cells and remove scales.
Vitamin-A derivatives, such as Tazorec (tazarotene) also slows skin cell growth, but the skin's appearance may become very red before it improves.
Some products combine vitamin D with a corticosteroid.
If scalp psoriasis is moderate to severe and topical treatments do not work, systemic medication is another option. The person takes the drug by mouth, and it works throughout the body.
- oral retinoids
- biologic therapies
New medications are available that target specific molecules within immune system cells. These are known as biologic drugs.
Brodalumab, with the brand name SILIQ, is one example. It received approval from the FDA for the treatment of psoriasis in 2017.
Brodalumab may have adverse effects, however. It carries a boxed warning of an increased risk of suicidal thinking or behavior.
Other options include:
By targeting selective cells, biologic drugs correct the overactive immune response that causes the increase in cell production.
However, as these drugs reduce the body's immune response, they can leave a person more susceptible to infections. A doctor will monitor a person who is taking these drugs.
Anyone who has latent tuberculosis (TB) or recurrent or frequent infections should tell their doctor about this before using a biologic drug.
Topical medications containing steroids may help decrease inflammation and itching.
In mild and limited cases of scalp psoriasis, a doctor may inject a lesion on the scalp with steroid medication. They will do this sparingly, because steroids can have a range of adverse effects.
Light therapy may help treat scalp psoriasis. It involves exposing the scalp to ultraviolet light on a regular basis, using a special lamp that emits UVB light.
The therapy needs a doctor's supervision to avoid burns or overexposure.
People with psoriasis should not use tanning beds, because they emit significant amounts of UVA light. This can be dangerous.
Herbal and natural remedies
The National Psoriasis Foundation suggest that the following alternative preparations may help reduce the symptoms of psoriasis:
Products containing aloe vera or tea tree oil may help, but you should check first with a doctor to make sure they are safe.
Apple cider vinegar: Applying organic apple cider vinegar directly to the scalp may help reduce itching. However, it can also cause irritation. To avoid this, dilute it in equal parts with water or rinse the scalp after the vinegar dries. Do not use it on open wounds.
Aloe vera: Applying gel or creams containing 0.5 percent aloe vera may help reduce redness and scaling.
Oatmeal: Adding oatmeal to a bath or applying an oatmeal paste to areas with psoriasis helps reduce symptoms in some people, although there is no research evidence to support this.
Tea tree oil shampoo: This may help relieve symptoms, although there is no scientific evidence to prove it. Try a little first, because some people have an allergic reaction to tea tree oil.
Turmeric: Consuming turmeric (curcumin) as a spice in food, as a supplement, or in a topical gel may help reduce symptoms or psoriatic activity.
The Office of Dietary Supplements (ODS) note that turmeric is "generally considered safe when taken by mouth or applied to the skin." However, people should check with a doctor before using any complementary therapies or supplements.
Capsaicin ointment: This may help reduce itching by numbing the nerve endings, but it may also cause a burning sensation. More research is needed to guarantee its safety and effectiveness.
Dead Sea salts: Adding these to a warm bath can help relieve itching and scaling, but the person should apply a moisturizer afterward.
Oregon grape: Topical creams containing a 10-percent concentration of Oregon grape, or mahonia aquifolium, may help treat mild to moderate psoriasis.
Soratinex: Producers of a "natural" product marketed as Soratinex claim that it is effective in reducing the symptoms of psoriasis.
It contains "a coal-tar solution, herbal oils, and emulsifiers."There is limited research into its effectiveness, and it does not have FDA approval.
The manufacturers suggest that people check the list of ingredients before using it.
Anyone who is considering using a complementary therapy should speak to a doctor first. Some remedies can interact with other medications.
Tips for managing scalp psoriasis
The following tips can help people to manage scalp psoriasis:
Seek treatment: A health professional can provide a topical ointment or oral medication that will help manage symptoms and itchiness.
Treat the scalp gently: People with this condition should avoid washing and combing the hair vigorously, as this can lead to breakage, especially if the hair is fragile due to treatment.
Avoid scratching: Scratching can lead to bleeding and possibly an infection.
Moisturize: Keeping the scalp moist will not cure psoriasis, but it may help improve the appearance of the skin.
Avoid triggers: If possible, individuals should identify their triggers for scalp psoriasis and consider things ways to limit them.
It is important to seek treatment, as this can reduce the risk of further complications, such as hair loss or cracked and bleeding skin on the scalp.
Prevention and outlook
It is difficult to prevent scalp psoriasis, because the exact cause remains unclear.
However, treating the condition as soon as symptoms appear may prevent it from becoming worse.
Scalp psoriasis affects individuals differently. Some people have an occasional flare-up while others deal with the condition frequently.
If a person knows what triggers symptoms for them, they can try to avoid these factors.
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