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Understanding Scalp Psoriasis

 Psoriasis is a skin condition that affects about 2 to 3 percent of people worldwide, according to the National Psoriasis Foundation.

Symptoms usually include raised and scaly patches, or plaques, on the skin that can vary in color depending on a person’s skin tone.

Psoriasis is a chronic condition with symptoms that may worsen at times and then improve. It’s an autoimmune disease caused by an overactive immune system that can cause an increase in cell growth.

There are different types of psoriasis. The most common type is chronic plaque psoriasis. This type can spread over the body, but it most often affects the:

  • elbows
  • knees
  • back
  • scalp

Other types of psoriasis may affect the whole body or specific areas like the legs and trunk, or areas where skin touches skin, like under the breasts or in the groin or armpits (called inverse psoriasis). Psoriasis can also affect the hands, fingernails, feet, and joints.

When psoriasis appears on the scalp, it’s called scalp psoriasis. Scalp psoriasis is common among people with chronic plaque psoriasis. The National Psoriasis Foundation estimates it affects the scalp in 45 to 56 percent of people with psoriasis.

Treatment can lessen symptoms and help prevent complications. Read on to learn more about scalp psoriasis.

Scalp psoriasis causes a buildup of cells on the skin, which can cause thick, scaly, itchy patches on the scalp and other areas of the body.

On lighter skin tones, psoriasis typically appears as pink or red patches with silvery white scales.

On darker skin tones, psoriasis is more likely to appear as dark brown or purple patches with gray scales.

Psoriasis on the scalp shown on dark skin toneShare on Pinterest
Psoriasis as it may appear on a darker skin tone.
Photo: Management of Psoriasis Herpeticum in Pregnancy: A Clinical Conundrum. Case reports in obstetrics and gynecology, 2016.
Psoriasis on the scalpShare on Pinterest
Scalp psoriasis on a lighter skin tone.
Christine Langer-Püschel/Getty Images

Plaque psoriasis is particularly difficult to treat on the scalp because the usual steroid creams and ointments cannot penetrate the hair.

Psoriasis on the scalpShare on Pinterest
Scalp psoriasis on a lighter skin tone.
Anatolev/Shutterstock

Symptoms can also mimic dandruff in some cases.

Psoriasis on the scalp and behind the earsShare on Pinterest
Scalp psoriasis on a lighter skin tone.
Shutterstock

Psoriasis is particularly common in areas where there’s a lot of friction, such as behind the ears for people who wear eyeglasses.

Psoriasis on the neck and back on dark skinShare on Pinterest
Psoriasis as it may appear on darker skin of the neck and back.
Medicshots/Alamy Stock Photo Photography courtesy of Masryyy/Wikimedia

Symptoms may vary from mild to severe and include:

  • dryness
  • flaking that resembles dandruff
  • itching, burning, or discomfort
  • raised reddish patches
  • silvery-like scales
  • bleeding or temporary hair loss from scratching or removing the plaques on the scalp

These symptoms usually appear evenly on both sides of the scalp, or they may affect most of the head. They may also extend to the:

  • neck
  • ears
  • forehead
  • other parts of the face

A healthcare professional, such as a dermatologist, can make a diagnosis and prescribe the right treatment for you.

The usual treatment for scalp psoriasis is topical corticosteroid medication. Sometimes multiple treatments are used together.

Topical treatments

Topical medications for scalp psoriasis include:

  • corticosteroids (either topical or locally injected)
  • vitamin D derivatives such as calcipotriene
  • retinoids
  • coal tar shampoo
  • anthralin
  • salicylates

The hair on the scalp may make usual topical medications for psoriasis difficult to use. So, your healthcare professional may prescribe lotions, liquids, gels, foams, or sprays instead of thicker creams or ointments used on other parts of the body.

Treatment may also include a combination of more than one topical medication or other medication types.

Follow all instructions for using your medication for best results. For example, you’ll need to know when to shampoo your hair so that the medication stays on for the desired amount of time.

Once you start treatment, your healthcare professional will check to see whether your symptoms are improving.

Systemic and biologic treatments

If topical treatment isn’t effective, oral systemic medications and biologic infusions or injections are available.

These treatments work to slow down the growth of skin cells or to reduce inflammation.

Biologic medications block proteins in the immune system that are related to psoriasis, such as:

  • tumor necrosis factor-alpha (TNF-alpha)
  • interleukin 17-A
  • interleukins 12 and 23

ResearchTrusted Source is continually being done to see how these biologics can help reduce symptoms, and to develop newer medications.

Phototherapy treatments

Phototherapy treatments use ultraviolet light (UV) to help heal patches of psoriasis on your scalp, especially when other treatments haven’t worked.

Your healthcare professional may use UVA or UVB rays in various settings.

Make sure to talk with them about the risks of UV light and how to protect your skin.

Self-care tips

  • Follow your doctor’s instructions. Always follow the treatment plan you develop with your doctor. If treatments stop working or you notice any joint pain, let them know.
  • Avoid scratching or picking. Scalp psoriasis is different than common dandruff. There may be large and silvery scales. The scales must be carefully removed. Don’t scratch or pick them.
  • Combing and brushing. Scalp psoriasis can also make combing or brushing difficult. Be careful combing or brushing your hair, because it can irritate your scalp. You can use a comb to gently remove scales. Clean the comb before each use to help prevent infection, and talk with your doctor about any adverse effects.

Scalp psoriasis can cause two complications:

  • Bleeding. Scalp psoriasis can cause itching and discomfort. Bleeding may occur from scratching or removing scales.
  • Hair loss. The effect on hair follicles, heavy scaling, and excessive scratching can cause noticeable hair loss. Entire clumps of hair may also come out when the scalp is damaged. Certain scalp psoriasis treatments and stress may make hair loss worse.

Talk with a healthcare professional about ways to avoid hair loss if you have scalp psoriasis. You may need to avoid hair treatments (like dyes and perms) or change your scalp psoriasis treatment. But keep in mind, your hair will grow back.

Having scalp psoriasis can be a challenge at times. Treatment is usually effective and helps reduce the visibility of your symptoms.

Ask your doctor about support groups in your area. The National Psoriasis Foundation can provide information about support groups, the condition, treatment, and current research.

JPeei Clinic