Scalp Psoriasis

About 3% of American adults (7.5 million people) have psoriasis. Of them, nearly half have it on their scalp.

This condition is the same as psoriasis anywhere else on the body. However, scalp psoriasis is harder to treat since it's under the hair.

This article discusses the symptoms, causes, and treatment of scalp psoriasis.

Scalp Psoriasis Pictures

Scalp psoriasis has a distinctive appearance, including white or silver crusty patches and skin discoloration. It may extend beyond the hairline and down onto the forehead, neck, or ears.

Scalp Psoriasis Symptoms and Risks

Scalp psoriasis may affect only small patches of your scalp or cover the entire thing. Symptoms include:

• Discolored, thick, and inflamed patches (plaques)
• Silvery-white scales that flake off like dandruff
• Dry scalp (severe enough to cause cracking and bleeding)
• Itchiness (mild to severe and may disrupt your sleep and daily life)
• Easy bleeding when you scratch it
• Pain (burning sensation)

Psoriasis can also cause non-skin symptoms such as: 

• Joint pain (psoriatic arthritis)
• Nail pitting and other abnormalities
• Impaired vision
  

Risks

Scalp psoriasis, as with all psoriasis, causes chronic inflammation that’s not confined to the skin, which is believed to put you at risk for other inflammatory health conditions. These may include:

• Heart disease
• Metabolic syndrome (a combination of conditions that can lead to stroke, heart disease, or diabetes)
• Having obesity
• Hypertension (high blood pressure)
• High cholesterol
• Insulin resistance (prediabetes)
• Inflammatory bowel disease
• Cancer
• Chronic kidney disease
• Sleep apnea
• Chronic obstructive pulmonary disease (COPD)
• Uveitis (eye inflammation)
• Nonalcoholic fatty liver disease

If you’re diagnosed with scalp psoriasis, it’s important to keep an eye out for other conditions. Talk with a healthcare provider if you develop new symptoms that don’t seem related to psoriasis.

Eczema vs. Scalp Psoriasis

Although psoriasis and eczema can look similar, they’re different conditions. Eczema (atopic dermatitis) causes dry, bumpy skin, while some people develop small blisters that ooze or crust over.

It’s most common for eczema to start in childhood, while psoriasis is more likely to start in adulthood.

Dandruff vs. Scalp Psoriasis

The flakes of scalp psoriasis are sometimes mistaken for dandruff since both involve flaking skin.

Dandruff causes flakes, itchiness, and mild discoloration. It doesn’t involve inflammation and is much less severe than psoriasis. It’s also confined to the scalp.

What Causes Scalp Psoriasis?

Psoriasis is an autoimmune disease, which means your immune system mistakes healthy tissue for a threat, like a virus or parasite, and tries to destroy it. This causes inflammation and other symptoms.

In psoriasis, that immune activity causes new skin cells to grow faster than you need them. Typically, new cells form as the old ones are ready to slough off. 

When that process is sped up, cells end up stacked on each other, and the dead ones can't be shed. That's what forms the scales of scalp psoriasis.

What Deficiencies Cause Scalp Psoriasis?

While their role as possible causes of scalp psoriasis is unclear, deficiencies in the following have been linked to scalp psoriasis: 

• Vitamin D 
• Selenium
• Copper

These deficiencies may contribute to the development and severity of psoriasis.

Complications of Scalp Psoriasis

Scalp psoriasis can lead to complications, especially if it’s not well managed. These include:

• Sleep problems due to itching
• Skin infections from breaks in the skin or scratching
• Reduced self-esteem
• Temporary hair loss due to plaques and scratching
• In rare cases, patches of permanent hair loss due to scarring

Talk to a healthcare provider if you have any of these complications. They may be able to help.

Treatment for Scalp Psoriasis

Your hair makes treating scalp psoriasis more challenging than treating psoriasis elsewhere on your body. But you still have several options, including topical treatments, systemic drugs, phototherapy, diet, and self-care.

Topical Treatments

Topical (on the skin) treatments are typically the first line of defense for scalp psoriasis. Topical products include over-the-counter (OTC) and prescription products such as:

• Medicated shampoos, foams, or gels containing corticosteroids
• Vitamin D products like calcipotriol
• Combined corticosteroid and vitamin D preparations
• Keratolytic (anti-scaling) products (salicylic acid, urea)
• Coal tar shampoos
• Coconut oil ointments
• Antifungal shampoos

A healthcare provider will ask about your typical hair care routine and help you decide on topical treatments.

Systemic and Biologic Treatments

If you don’t respond well to topical treatments or your psoriasis is widespread, you may have better luck with oral (by mouth) medications. Some drugs for this condition include:

• Immunosuppressants
• Soriatane (acitretin), derived from vitamin A
• Otezla (apremilast), a phosphodiesterase-4 (PDE4) inhibitor
• Biologics like Enbrel (etanercept) and Humira (adalimumab)

Phototherapy

Phototherapy (light therapy) involves UV light, which can slow down the growth of new cells. To get around the problem of hair covering the plaques, you can get phototherapy units with built-in combs.

Diet

Your diet doesn’t cause psoriasis, but avoiding inflammatory foods and eating more anti-inflammatory foods may help you control the condition.

Foods to avoid include:

• Alcohol
• Dairy
• Processed foods (white bread, pasta, baked goods, breakfast cereals)
• Those with saturated or trans fats (red meat, cheese, fried food, margarine, snack foods)
• Those high in added sugar (soda, candy, baked goods, fruit juices)

People with psoriasis are more likely than others to have celiac disease, which is an autoimmune reaction triggered by gluten. Foods to increase include:

• Fish
• Lean protein
• Plant-based proteins (tofu, tempeh, soy products)
• Fruits
• Vegetables
• Beans and lentils
• Nuts and seeds
• Olive oil
• Whole grains
• Low-fat dairy (in small amounts)

If you’re struggling with dietary changes, ask your healthcare provider for a referral to a nutritionist.

Self-Care

You can also take steps on your own to help manage scalp psoriasis. You may want to try:

• Scalp oils or other scalp moisturizers/emollients
• Washing your hair gently
• Using a scale softener containing salicylic acid and removing scales carefully
• Reaching and maintaining a healthy weight
• Limiting alcohol consumption
• Not smoking

It’s also important to avoid scratching or picking at your plaques. It can damage your skin and make psoriasis worse.

Does Scalp Psoriasis Go Away?

Scalp psoriasis is chronic, meaning it won’t go away. However, it is possible to manage it successfully so symptoms are gone or kept to a low level. A big part of managing the condition is preventing symptom flares.

Preventing Scalp Psoriasis Flares

You can help prevent flares of your scalp psoriasis by:

• Taking care of your scalp
• Sticking to your treatment regimen
• Managing stress
• Avoiding things that trigger or worsen your psoriasis

When to Seek Care

If you have symptoms that suggest psoriasis, make an appointment with a healthcare provider. They may be able to diagnose and treat you, or they may refer you to a dermatologist (a doctor who specializes in conditions of the skin, hair, and nails).

It’s especially important to seek medical care from a dermatologist if:

• Your symptoms are getting worse.
• Your healthcare provider hasn’t found successful treatments.
• You want to try treatments like biologics or phototherapy, and your provider isn’t familiar with them.

Summary 

Scalp psoriasis is psoriasis that develops on the scalp. It may also cause joint, nail, or eye problems. Psoriasis may also disrupt your sleep and harm your self-esteem. Treatment options include topical products, oral medications, phototherapy, an anti-inflammatory diet, and self-care. You may benefit from seeing a dermatologist experienced in treating scalp psoriasis.