10 Things Dermatologists Wish You Knew About Scalp Psoriasis

Scalp psoriasis–and the itching it causes–can drive you to distraction. Here's what dermatologists wish you knew about the condition.

Scalp psoriasis is common

psoriasis on the hair, dermatological diseases, skin problemsClaudia Pylinskaya/Shutterstock
At least 50 percent of all people with psoriasis will develop some scaling on their scalp, according to the National Psoriasis Foundation (NPF). Scalp psoriasis runs the gamut from mild to severe, and psoriasis scalp can extend beyond the hairline onto the forehead, the back of the neck, and around your ears. There are some foods that can worsen it.

It may be something else

There are at least 21 reasons that your scalp may itch, and just one of them is scalp psoriasis. See your dermatologist to make sure you are treating the right scalp condition. He or she can easily tell if it is scalp psoriasis or something else.

Scalp psoriasis itches… a lot

Itching is one of the most common–and vexing–symptoms of scalp psoriasis, says Harold Farber, MD of Philadelphia. And itching begets inflammation and can cause your scalp psoriasis to spread to previously unaffected areas via the Koebner phenomenon. Scalp psoriasis tends to itch more than other body parts, and not scratching is easier said than done, Dr. Farber says. Making matters even more difficult, stress tends to travel with psoriasis and many of us cope with stress by … scratching. Scalp psoriasis treatments including OTC topical creams, gels, lotions, ointments, pads, shampoos, and sprays to help curb the itch. But “be careful applying these products to inflamed scales as they can burn or sting,” he says. Other anti-itch treatment options can include topical steroids and oral antihistamines.

Scalp psoriasis can cause temporary hair loss

Fortunately, this isn’t all that common, but it does occur, says Jerry Bagel, MD, director of the Psoriasis Treatment Center of Central New Jersey. “Some people may lose clumps of hair, but this hair does grow back in about a month with adequate scalp psoriasis treatment,” he says. “The hair loss may be from scratching and the inflammation of the disease.” This is one of the reasons why so many people with psoriasis are desperate for psoriasis remedies that can ease symptoms.

Hair care matters

Anything that stresses your scalp can aggravate your psoriasis, Dr. Bagel says. “If you blow-dry your hair, make sure you don’t use the hottest setting.” Skipping the heat-shield step before applying a hot tool to your hair is among the worst hair care mistakes anyone can make. “Gently comb your hair, and not your scalp,” Dr. Bagel suggests. “Don’t pull at your hair which tugs at skin and can be source of trauma, causing psoriasis to worsen or spread.” Always tell your hair stylist that you have scalp psoriasis and let him or her know if you are sensitive to high heats, pulling, or rough scalp massages, the NPF suggests.

Shampoo can help

ShampooSahacha Nilkumhang/Shutterstock
There are a host of OTC and prescription shampoos designed to help treat scalp psoriasis, Dr. Farber says. When you have psoriasis, your skin grows at an abnormally fast rate, resulting in the buildup of psoriasis lesions or patches. If you have scalp psoriasis, tar, zinc, or salicylic acid-based shampoos can help slow skin growth and reduce inflammation, itching, and scaling, he says. Neutrogena T/Gel Therapeutic Shampoo Original Formula and G217 Psoriasis Medicated Conditioning 3% Coal Tar Formula Shampoo are some top sellers. When shampooing your hair, don’t rub or scrub, warns the American Academy of Dermatology. “Rubbing, scrubbing, and scratching your scalp tend to make scalp psoriasis worse,” the AAD states. Instead, shampoo gently and make sure to avoid all these hair washing mistakes.

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It takes trial and error to find the best treatment

Scalp psoriasis is one of the scalp conditions that you should never ignore. “Unfortunately a lot of the topical treatments are thick, gooey ointments that need to be rubbed on the scalp, and this can be a non-starter for some,” Dr. Farber says. The main ingredients in these products are tar or salicylic acid. “I recommend that people massage the lotion or foam into their scalp at night and then put on a shower cap to sleep,” he says. “The key thing is to be using something that fits with routine and lifestyle,” he says. “The good news is that once the scalp psoriasis is under control you can decrease frequency to every other day or twice a week, Dr. Bagel adds. If OTC topical products don’t do the trick, your dermatologist may prescribe Dovonex (a form of vitamin D that slows skin cell growth and removes scales), Taclonex (vitamin D-steroid combo), Tazorac (a topical retinoid that slows skin cell growth) or Anthralin, which reduces the rapid growth of skin cells.

Scalp psoriasis causes flakes

Yes, flakes can be embarrassing and a dead giveaway of your scalp condition, but while the flaking may resemble dandruff, psoriasis is not one of the sneaky causes of dandruff. Wearing light-colored clothing (as opposed to black) can help hide the flakes. “Treating the psoriasis can put an end to the flaking and other symptoms,” Dr Bagel says.

There are many treatment options

If topicals don’t work, you have options. Excimer laser therapy can be really effective for scalp psoriasis, says Dr. Farber. The laser directs UVB light to the psoriasis plaques where it helps reduce inflammation and scaling. “Sometimes intralesional injections of low dose steroids directly on to the resistant spot on scalp works nicely,” Dr. Farber says. Add these foods to your diet for healthier hair.

Systemic therapy may be an option

Powerful biologic drugs that aim to cool the inflammation associated with a host of diseases may be effective for severe scalp psoriasis, Dr. Bagel says. Dr. Bagel conducted two studies looking at the use of biologics, Enbrel (etanercept) and Cosentyx (secukinumab), for the treatment of scalp psoriasis. Both showed impressive results in terms to minimizing itch, bleeding, and sleep disturbances related to symptoms, Dr. Bagel says. These drugs do have side effects including increase risk of infection due to their effects on the immune system. “If the topical isn’t working, we may have to bump treatment up a notch,” he says.

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