PsoriasisNet Article
What is Scalp Psoriasis?

Plaque psoriasis can develop anywhere on the skin. On most parts of the body, it is simply called plaque psoriasis. When the raised, reddish, and often scaly patches appear on the scalp, the psoriasis is called “scalp psoriasis.”

What Scalp Psoriasis Looks Like
Scalp psoriasis can appear anywhere on the scalp. It may appear in 1 spot, multiple patches, or involve the entire scalp. Sometimes, scalp psoriasis extends beyond the scalp to the forehead, back of the neck, and/or behind the ears. The signs and symptoms of scalp psoriasis are:

• Reddish plaque on the scalp. Plaques range from barely noticeable to thick and inflamed.

• Silvery-white scale. This often develops on the scalp and can be mistaken for dandruff.

• Dandruff-like flaking. This is common due to the continual shedding of the new skin cells.

• Dry scalp. The scalp may be so dry that the skin cracks and bleeds.

• Itching. Not everyone experiences itching. For some the itch is mild; others have intense itching that can interfere with everyday life and cause sleep deprivation.

• Burning sensation or soreness. These may develop on the scalp.

• Temporary hair loss. This can result from frequent or intense scratching or forcefully removing scale. Once the scalp psoriasis clears, hair normally re-grows.

Scalp psoriasis frequently develops on the back of the head, but it can develop anywhere on the scalp. Sometimes it involves the entire scalp as shown here.		This man has scalp psoriasis that extends beyond his hairline, appearing behind his ear.		Scalp psoriasis can extend beyond the scalp to the forehead.
(Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)

Who Gets Scalp Psoriasis?
About 50% of people living with plaque psoriasis will experience at least one episode of scalp psoriasis during a psoriasis flare.

Scalp Psoriasis Affects Quality of Life
A flare-up on the scalp can range from very mild and unnoticeable to severe. Sometimes scalp psoriasis is chronic, lasting for years. Sometimes only the skin on the scalp flares, but more often, plaques also develop in other areas. Unexpected flare-ups and long-lasting psoriasis can significantly reduce a person’s quality of life.

When scalp psoriasis causes flaking, spreads beyond the scalp, or is not camouflaged by the hair, the visibility often causes others to feel intensely uncomfortable. Suffers often say this causes them to feel embarrassed or ashamed.

If the scalp itches, the itch can be so intense that it interferes with everyday life and causes sleep deprivation.

How is scalp psoriasis diagnosed?
Dermatologists generally diagnose scalp psoriasis by visually examining the scalp. To rule out other conditions, a biopsy may be performed.

How is scalp psoriasis treated?
Because a cure is not available, the goals of treatment are: 1) to provide relief from the signs and symptoms and 2) control flares-ups. Topical (applied to the skin) treatments are the first line of defense against scalp psoriasis. Some topicals, including psoriasis shampoos, are available over-the-counter. A prescription is required for stronger topicals. All prescription products — and some over-the-counter products — contain one or more of the following active ingredients:

• Anathralin

• Calcipotriene (derived from vitamin D)

• Coal tar

• Corticosteroid

• Retinoid (derived from vitamin A)

• Salicylic acid

While topical treatment can be very effective for scalp psoriasis, using it can be a challenge. For the medication to work, it must be applied to the scalp — not the hair. This can be time-consuming. If treatment is not working, ask your dermatologist for tips on how to apply the medication.

If topical therapy fails to control scalp psoriasis, phototherapy — in the form of a laser or non-laser light source — may help. The excimer laser is a type of phototherapy that delivers high-intensity light to small areas of affected skin and spares unaffected skin. This can be effective for scalp psoriasis.

When psoriasis is severe, a systemic medication may be prescribed. A systemic medication circulates throughout the body and can be taken as a pill or capsule. It also may be injected or infused. Systemic medications approved by the U.S. Food and Drug Administration (FDA) for plaque psoriasis that may effectively control scalp psoriasis are:

• Biologics. Four of these — alefacept, efalizumab, etanercept, and infliximab — have proven effective in some patients with scalp psoriasis.

• Corticosteroid

• Cyclosporine

• Methotrexate

• Oral retinoid

• Oral vitamin D derivative

It is important to know that the vitamin D and vitamin A food supplements do not control psoriasis. The medications listed above are only available by prescription and are very different from food supplements. It also is important to know is that what works for one person may not be effective for another. Some people with severe scalp psoriasis can control their scalp psoriasis with topicals. Others with less severe scalp psoriasis may need stronger medication.

The Good News About Scalp Psoriasis
Dermatologists say that it is unusual for anyone to suffer from scalp psoriasis for long — even when the psoriasis is severe — when a dermatologist’s help is sought and treatment is used as prescribed.

Related Link
Understanding Scalp Psoriasis May Head Off Hair Loss

References:
Jemec JBE, Ganslandt C, Ortonne JP et al. “A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: A randomized, double-blind, controlled trial” J Am Acad Dermatol 2008;59:455-63.

Kimball AB, Gold MH, Zib B et al. “Clobetasol propionate emulsion formulation foam 0.05%: Review of phase II open-label and phase III randomized controlled trials in steroid-responsive dermatoses in adults and adolescents.” J Am Acad Dermatol 2008;59:448-54.

Krell J, Nelson C, Spencer L et al. “An open-label study evaluating the efficacy and tolerability of alefacept for the treatment of scalp psoriasis.” J Am Acad Dermatol 2008;58:609-16.

van de Kerkhof PCM and Schalkwijk J. “Psoriasis.” In: Bolognia JL, Jorizzo JL, Rapini RP et al, editors. Dermatology. Spain, Mosby Elsevier; 2008. p. 122.

Supported by an educational donation provided by Abbott.