Psoriasis is a long-term, inflammatory condition that affects the skin and other parts of the body. Skin changes can affect the scalp.

Experts believe psoriasis happens when a problem with the immune system results in the rapid production of skin cells. As the cells build up on the surface, they create a thick, scale-like appearance to the skin.

Authors of a study from 2016 note that psoriasis will affect the scalp in up to 80% of people with the condition. Topical treatments, such as shampoos, can help.

No single shampoo will be best for everyone, but knowing which options are available can help a person know what to look out for.

This article looks at the types of shampoos that can treat psoriasis and the differences between them.

Sometimes a topical treatment does not relieve the symptoms. Find out also in this article when to see a doctor and what type of treatment they might suggest.

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Using psoriasis shampoos can help a person manage skin changes on the scalp..

Psoriasis shampoos are intended to treat the scalp, not to clean the hair. A person will usually need to use a regular shampoo to wash their hair after using a psoriasis shampoo.

Psoriasis shampoos can work in different ways to reduce the incidence and relieve the symptoms of the condition. How they work depends on what ingredients they contain. Psoriasis shampoos will usually reduce inflammation and scalp scaling.

A doctor may recommend someone changes the type of shampoo they use and other topical treatments regularly, as the shampoos become less effective with frequent use.

Different types of shampoo have different ingredients, and their effects will vary.

Examples of ingredients commonly present in shampoos for scalp psoriasis include:

Salicylic acid

Salicylic acid is a medication that a person can apply directly to the affected skin. It helps treat scalp psoriasis by reducing the incidence of scaling on the scalp. The plaques will soften, and the scales are easier to remove.

However, some people who use salicylic acid in psoriasis shampoos find that it irritates their skin. High concentrations of salicylic acid can lead to irritation and temporary hair loss.

This type of shampoo is available for purchase online or over the counter at a pharmacy.

Coal tar

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Coal tar shampoos may help relieve itching.

Coal tar shampoo is available in over-the-counter (OTC) preparations that come from coal and wood.

It may be helpful if scalp psoriasis causes itching.

Coal tar contains a compound that helps reduce the excessive development of skin cells. It can also help relieve itching and soreness, which are symptoms of psoriasis.

OTC coal tar shampoos are available, or people can buy them online. More potent coal tar preparations are available by prescription.

Clobetasol propionate

If scalp psoriasis does not respond to other shampoos or treatments, a doctor may prescribe a shampoo containing clobetasol propionate.

A person can use a shampoo containing this medication every day for up to 4 weeks. Once the symptoms improve, they can use it once or twice a week to maintain the scalp condition, according to the American Academy of Dermatology.

After applying the shampoo to the scalp, it is best to leave it on for 5–10 minutes and then wash it off and reapply.

People with a sensitive scalp may only be able to apply psoriasis shampoos about twice a week.

According to the Psoriasis and Psoriatic Arthritis Alliance, a person should consider alternative options if the psoriasis shampoo does not improve symptoms after 8 weeks.

Sometimes, a person will need to apply a psoriasis shampoo every 2–3 weeks to keep their scalp psoriasis at bay.

Scalp psoriasis can involve mild to severe scaling with crusted plaques on the scalp. This can be uncomfortable, leading to itching and sometimes pain. It may also extend to a person's forehead, ears, and back of their neck.

At first, the flaking of dead skin cells can resemble dandruff. However, scalp psoriasis will have a scaly, silver appearance.

Other symptoms may include:

  • bleeding, if a person scratches the scalp
  • a dry scalp, which may result in cracking and bleeding or itching
  • soreness, due to the skin scaling and as a result of itching
  • temporary hair loss, due to repeated itching or severe scaling on the scalp
  • loss of sleep, as a result of discomfort at night

Some people may feel embarrassed about the changes they see, and this can lead to depression and anxiety.

Although most people with scalp psoriasis know they should not scratch their scalp when it itches, it can be hard not to. However, scratching an itchy scalp can worsen symptoms and cause the areas of psoriasis to grow or become infected.

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If topical treatments are not effective, a doctor may recommend another option.

Scalp psoriasis can be challenging to treat, and it is hard to know which treatments will be effective.

A person should speak to a doctor if:

  • they experience symptoms for the first time
  • symptoms are severe, including cracking or bleeding
  • OTC shampoos or medicated shampoos do not help

If there is cracking or bleeding, it can cause an infection. A doctor may recommend a systemic treatment in moderate to severe cases of scalp psoriasis.

OTC scalp shampoos are not the only way to treat scalp psoriasis. Other options include treatments that a person can apply to the scalp and leave for a short time, sometimes overnight.

Examples include:

Topical steroids: A gel, lotion, or foam that contains steroid medication can reduce the itching and redness that people associate with scalp inflammation. However, they do not tend to help with scaling as well as coal tar and salicylic acid shampoos do. Also, long-term steroid use can lead to unwanted side effects.

Coconut oil compounds: These combine coal tar, salicylic acid, and sulfur with coconut oil, which softens skin plaques. Coconut oil compounds work best when the person rubs them into the scalp, leaves them on overnight, and washes them off in the morning.

Dithranol: This is a plant-based treatment that people have used for more than a century to treat the condition. It may help treat psoriasis, but it can also stain the hair and skin. For this reason, it is less popular than some other options.

Other topical medications

Some creams, gels, lotions, or ointments work to slow down or normalize excessive cell reproduction and reduce inflammation.

Most people can manage mild symptoms of psoriasis with topical treatments.

Some of the more common medications include:

  • calcipotriene, a form of vitamin D-3 (Dovonex)
  • calcipotriene and betamethasone dipropionate (Taclonex)
  • tazarotene (Tazorac)
  • clobetasol propionate (Clobex)

Light therapy

If symptoms do not improve with topical treatments, a doctor may recommend phototherapy, which applies ultraviolet rays to the scalp.

Laser ultraviolet B (UVB) treatments may help treat scalp psoriasis. A provider will target the laser precisely to a psoriasis lesion, to focus the light where the lesions can withstand higher doses of UVB light than healthy skin. There may be fewer side effects than with many medications.

How can XTRAC laser treatment help? Learn more here.

Systemic drugs

Systemic drugs work throughout the body.

They include:

  • oral retinoids
  • cyclosporine
  • methotrexate

These medications can help prevent inflammation and the buildup of skin cells.

Find out more here about oral systemic therapies for psoriasis.

Biologics

In moderate to severe cases, a doctor may prescribe a biologic drug. These newer drugs affect a specific part of the immune system and aim to treat the underlying cause of psoriasis.

Biologics can reduce the risk of flares and help manage symptoms.

People with scalp psoriasis tend to experience periods where their symptoms worsen, followed by times where the symptoms improve or go away.

Topical treatment — such as shampoos — can help relieve symptoms when a flare occurs. However, there is no single best option and no one shampoo that is best for everyone.

Psoriasis affects people in different ways. An individual may need to try a variety of options before finding one that works well, or alternate between treatments if one becomes less effective.

Anyone with new or worsening symptoms of scalp psoriasis should ask their doctor about the options available.

Q:

Which shampoo or treatment is best to use during pregnancy?

A:

For pregnant or breastfeeding women who have scalp psoriasis, it is important to talk with your doctor and make a plan for treatment options during pregnancy because your usual treatment regimen may need some adjustments. Scalp psoriasis could worsen or flare during pregnancy, and treatment will depend on the severity of your scalp psoriasis.

Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.