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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:
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Reddish plaque
on the scalp. Plaques range from barely noticeable to thick and
inflamed.
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Silvery-white
scale. This often develops on the scalp and can be mistaken for
dandruff.
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Dandruff-like
flaking. This is common due to the continual shedding of the new
skin cells.
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Dry scalp. The
scalp may be so dry that the skin cracks and bleeds.
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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.
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Burning
sensation or soreness. These may develop on the scalp.
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Temporary hair
loss. This can result from frequent or intense scratching or
forcefully removing scale. Once the scalp psoriasis clears, hair
normally re-grows.
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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. |
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This
man has scalp psoriasis that extends beyond his
hairline, appearing behind his ear.
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Scalp
psoriasis can extend beyond the scalp to the forehead. |
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(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:
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:
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Biologics. Four of these —
alefacept, efalizumab, etanercept, and infliximab — have proven
effective in some patients with scalp psoriasis.
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Corticosteroid
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Cyclosporine
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Methotrexate
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Oral retinoid
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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.

All content solely
developed by the American Academy of Dermatology

Supported by an educational donation
provided by Abbott.
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When talking about plaque
psoriasis, the word “plaque” means a raised, reddish,
patch of inflamed skin. Silvery-white scale often coats
this patch. |
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