What Is Scalp Psoriasis?

Psoriasis typically appears on the arms, back, neck, and legs, but it can affect skin anywhere on the body. “And that includes the scalp,” says Dina D. Strachan, MD, a dermatologist and clinical assistant professor of dermatology at NYU Grossman School of Medicine in New York City.

Scalp psoriasis involves patches of thick, raised skin. On fair-skinned people, these areas are typically red and scaly, while psoriasis on skin of color can appear violet or dark brown.

“While some people only have psoriasis on the scalp, most people with scalp psoriasis have it on other parts of their body as well,” Dr. Strachan says.

Symptoms of scalp psoriasis can vary depending on whether it's mild, moderate, or severe.

• Thick, inflamed patches (plaques) on the scalp
• Dry scalp, that may crack and bleed
• Itchy scalp, which can be intense for some people; can lead to scratching, which can cause bleeding and worsen the plaques
• A burning or sore feeling on your scalp
• Temporary hair loss, which can be caused by removing the scale can cause hair loss, though hair will likely regrow once the flare clears

While the symptoms of scalp psoriasis may seem to come and go, psoriasis is a chronic condition that will need to be treated and managed over time.

If you're not sure whether you actually have scalp psoriasis, consult your doctor as soon as you can for an accurate diagnosis and to develop a psoriasis treatment strategy that works for you.

“Dandruff tends to itch more, and it has a greasy-appearing yellow scale. In contrast, psoriasis — whether it's on your scalp or any other body part — tends to have a thick, silvery scale,” Strachan explains.

Jody Alpert Levine, MD, a dermatologist in New York City, adds: “Scalp psoriasis may itch and become easily irritated during a flare, and it also may affect your hairline or creep down onto your forehead, nape of your neck, or your ears.”

• Remove a small skin sample from the area, which is sent to a lab.
• Perform an allergy test.
• Run blood tests to see if there could be another cause of a rash.

There's no cure for scalp psoriasis, but there are ways to manage its symptoms. “I always remind my patients that they'll need to continue treating it to keep it under control,” says dermatologist Steve Daveluy, MD, an associate professor at Wayne State University School of Medicine in Detroit.

And, according to Strachan, treating your psoriasis promptly is the best way to reduce its impact on your appearance.

Treatments for scalp psoriasis may involve a combination of therapies, including the following:

Topical Treatments

The first step in treating scalp psoriasis effectively involves removing or lifting thick scales, which helps medication penetrate the plaques and clear them up.

Scale Softeners These are products “which contain active ingredients, such as salicylic acid, urea, lactic acid, or phenol, that are designed to dissolve skin flakes or scales,” says Strachan. “Another way to soften and loosen scalp scales is to apply oils, lotions, creams, or ointments to a damp scalp,” she adds.

Once the medication softens the psoriasis scale, you can carefully remove it with a fine-tooth comb or brush.

“Gently comb the scalp in a light circular motion, holding the comb almost flat against the scalp,” advises Strachan. “Once the scale is loosened, shampooing is a good way to get the scale away from your scalp and out of your hair. But be gentle. Brushing or combing too vigorously can break the skin and lead to an infection. It can also break hair off at the scalp, causing temporary hair loss.”

Shampoos — both with and without coal tar medication — are available to treat scalp lesions. “We actually don't know exactly how coal tar works, but it's one of the oldest treatments for psoriasis,” Dr. Daveluy says. “In mild scalp psoriasis, it may be the only treatment necessary to keep it under control.”

• tapinarof (Vtama)
• calcipotriene (Dovonex)
• calcipotriene and betamethasone (Taclonex)
• tazarotene (Tazorac)
• topical corticosteroid solutions, oils, and foams
• roflumilast (Zoryve)

“Liquid or foam topical medication [like steroids and calcipotriene] are easy to apply to the scalp,” says Strachan. But for anyone who may have thicker, curlier hair, applying these topical treatments may be particularly challenging.

Before starting any topical scalp treatment, Strachan suggests applying a test patch of the medication to an inconspicuous spot on your head.

“In some cases, treatments may cause irritation or temporary hair loss,” she says. “Your hair should grow back. But if hair loss persists after you've treated the psoriasis, you should consult a dermatologist.”

Severe flares may require the use of oral medication in conjunction with such topical treatments.

Systemic Treatments

Systemic treatments, which work throughout the whole body, are often an important part of scalp psoriasis therapy. Biologics are targeted medications for psoriasis and are often prescribed if older therapies like methotrexate (Trexall), oral retinoids, and cyclosporine are not recommended by your physician.

Phototherapy

Ultraviolet light or phototherapy may be used if psoriasis is also on other parts of the body.

Steroid Injections

Injections of corticosteroid medication can target persistent, itchy plaques on the scalp. Because these shots can be uncomfortable, a dermatologist may recommend injecting only a few areas until other treatments help.

In addition to medical treatment, making certain lifestyle modifications can help you manage living with scalp psoriasis and potentially improve your symptoms.

• Change your hairstyle. While your scalp is clearing up, talk with your hairstylist about alternative hairstyles that can help conceal affected areas.
• Wear light-colored clothing to hide flakes. This can help to disguise the falling silvery plaque scales that are easily mistaken for dandruff.
• Only wear a hat or scarf when necessary. You may be tempted to cover up but you should let the affected areas “breathe.”

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• Practice a stress-reduction routine to bolster your overall hair health. Psoriasis itself does not cause hair loss, but your hair can enter a resting stage known as telogen when you are under stress.

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  When too much of your hair goes into telogen at once, fewer hair follicles are available to grow new hair. Stress can trigger psoriasis flares and flares can worsen stress. It's important to try to break the cycle.
• Try not to scratch. Psoriasis can develop in unaffected surrounding areas that have been scratched and traumatized. Scratching can also cause the scalp to bleed, raising the risk of infection, and it can also cause hair loss.

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• Follow a healthy diet. While there's no specific diet for psoriasis, consuming foods with anti-inflammatory omega-3 fatty acids (in oily fish, nuts, and seeds) and antioxidants in fruits and vegetables, may help improve symptoms.

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   Likewise, try to avoid alcohol and inflammatory foods high in saturated fat, like red meat and processed foods.

Psoriasis can have a different appearance on darker and lighter skin tones. In darker skin, psoriasis can look purple or grayish, rather than red and scaly. While treatment options are essentially the same no matter your skin tone (though phototherapy can be an exception), a lack of awareness and research can lead to delays in psoriasis diagnosis in people of color.

• Scalp psoriasis manifests as thick, raised skin on the surface of the head.
• While no cure exists for scalp psoriasis, there are many treatments that can help mitigate its effects.
• Treatments range from topical products and phototherapies to steroid injections and oral medications.
• Consult with your doctor to determine the best treatment option for your condition.