PsoriasisNet Article - Treatment: Scalp Psoriasis

PsoriasisNet Spotlight Article
Treatment: Scalp Psoriasis

Yes, scalp psoriasis can be controlled. There are many treatments for scalp psoriasis. Some people get relief from a medicated shampoo or solution that can be purchased without a prescription. But scalp psoriasis can be stubborn. Many people see a dermatologist for treatment.

Diagnosis: The First Step in Successfully Treating Scalp Psoriasis
Before prescribing treatment for scalp psoriasis, a dermatologist will examine your scalp. Usually a dermatologist will simply look at the scalp and make the diagnosis.

Sometimes scalp psoriasis can look like another skin condition, and a dermatologist will remove a bit of skin and send the skin to a lab. The lab report will tell the dermatologist whether the condition is scalp psoriasis. Your dermatologist may refer to this process as a biopsy. A dermatologist can safely and quickly perform a biopsy in the office.

Scalp Psoriasis Treatments
The treatments that dermatologists prescribe for their patients who have scalp psoriasis can be divided into these categories:

Treatment Tip: When applying the medication, be sure to lift your hair away from the scalp so that you can apply the medication directly to your scalp.

Medicated shampoos. A shampoo may be part of your treatment plan. For people who have moderate to severe psoriasis on their scalp, a dermatologist may prescribe a psoriasis shampoo that contains clobetasol propionate. While clobetasol propionate is a strong corticosteroid, studies show that when used in a shampoo, it can provide safe and effective treatment for scalp psoriasis.

In studies, patients have been able to use a psoriasis shampoo containing clobetasol propionate daily for as long as 4 weeks. If the scalp responds, the shampoo can be used once or twice a week to maintain the results.

Treatment Tip: When shampooing, be gentle. Rubbing, scrubbing, and scratching your scalp tends to make scalp psoriasis worse.

Scale softeners. Psoriasis can be thick, which makes it difficult for topical (applied to the scalp) treatment to work. Applying a scale softener to the psoriasis can help. A product that contains salicylic acid can soften the thick, stubborn patches of psoriasis. Studies show that topical corticosteroids can produce better results when a patient also uses salicylic acid.
Injections. Some patients receive injections of corticosteroids. Your dermatologist may call this treatment an “intralesional corticosteroid” because the corticosteroid is injected into the psoriasis.
Light treatments. When scalp psoriasis does not clear with treatment that is applied to the scalp, light treatments may be an option. Your dermatologist may call this type of treatment “phototherapy.”

Until recently, light treatments were not useful for scalp psoriasis unless the person was bald or had very thin hair. Thanks to recent advances, even people with thick hair can have light treatments on their scalp. Some patients are treated with a UV comb. Others receive laser therapy.
Biologics and other medicines that work throughout the body. Scalp psoriasis can be stubborn. Sometimes it does not respond to topical (applied to the scalp) medicine or light treatments. When a patient needs aggressive treatment, a dermatologist may prescribe a medication that works on the immune system. Some of these medications come in pill form. Others require self-injections. Sometimes the medicine is given by infusion, which requires the patient to go to a hospital or psoriasis treatment center.

Scalp psoriasis can be unbearably itchy. When people have scalp psoriasis that does not respond to a mainstay treatment, they often want aggressive treatment.

This man got relief from a biologic. Considered an aggressive treatment, a biologic is generally not the first treatment a dermatologist will prescribe.

Photograph used with permission of the Journal of the American Academy of Dermatology. The photograph was published in the Journal of the American Academy of Dermatology, Vol. # 58, 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,” 609-16. Copyright Elsevier (2008). Journal of the American Academy of Dermatology.

Medication that may be prescribed for aggressive treatment of scalp psoriasis includes:

Most cases of scalp psoriasis can be effectively treated. Sometimes treatment requires using more than one treatment option. Dermatologists have the expertise required to combine these treatments and minimize side effects.

References:
Bovenschen HJ, Van de Kerkhof PC. “Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice.” Journal of the European Academy of Dermatology and Venereology; April 2010; 24: 439-44.

Chan CS, Van Voorhees AS, Lebwohl MG et al. “Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.” Journal of the American Academy of Dermatology June 2009; 60: 962-71.

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.” Journal of the American Academy of Dermatology April 2008; 58: 609-16.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis.” The Journal of Dermatological Treatment; May 2010; 21: 185-92.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of scalp psoriasis.” Cutis; January 2010; 85: 43-50.