An Overview of Scalp Psoriasis

What You Need to Know to Feel Better

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Scalp Psoriasis

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Psoriasis is an autoimmune disorder characterized by red, itchy, uncomfortable lesions that can affect the skin all over the body. Although these lesions often develop on the face, elbows, knees, and buttocks, about 50 percent of people with psoriasis will develop lesions on the scalp.

Scalp psoriasis can range from mild to severe, and although it’s called scalp psoriasis, can extend beyond the hairline, affecting the forehead, neck, and ears.

These plaques can also shed, resulting in dandruff-like flakes of skin on the clothes. Because scalp psoriasis is often highly visible—especially if it extends beyond the hairline—and flakes onto clothing, those living with the condition can feel severe mental and emotional distress.  

While there’s no cure for any type of psoriasis—scalp psoriasis included—there are ways to take charge of your condition and feel better.

Symptoms

Scalp psoriasis can be tricky to diagnose because it’s often confused with dandruff, as well as other common skin conditions. If you haven’t already been diagnosed with psoriasis sand start to develop these symptoms, head to your dermatologist’s office:

  • Red, thick, inflamed patches of skin with a silvery-white build-up of dead skin cells on the scalp, forehead, neck, or ears
  • An extremely itchy scalp that may crack and bleed
  • Temporary hair loss due to constant scratching

    Because psoriasis is a chronic, autoimmune condition, it can affect the entire body. Not only does psoriasis cause uncomfortable skin lesions, but it’s also been linked to heart disease, cancer, type 2 diabetes, and other very serious chronic conditions. That’s why it’s so important to get an accurate diagnosis and get your psoriasis under control.

    Causes

    Currently, there’s no known cause of psoriasis. Researchers believe it’s a combination of genetic and environmental factors. In order for psoriasis to present in the human body, the “psoriasis gene” must be “turned on” by certain environmental factors called triggers.

    These triggers, like trauma to the skin, stress, allergies, and extremely cold, hot, or dry weather, can cause psoriasis outbreaks.    

    Diagnosis

    There are no special tools or tests dermatologists use to diagnose psoriasis. Rather, they'll ask you a few questions about your medical history—Does anyone else in your family have psoriasis? When did your lesions start to develop? Do you have any other chronic conditions?—and examine the affected area. Your medical and family history, in conjunction with your physical exam, can help your dermatologist develop the most accurate diagnosis.

    In some circumstances, your healthcare provider may take a biopsy of the affected skin and examine it under a microscope, but this is not as common as a standard physical exam.

    Treatment

    As previously mentioned, there’s no cure for psoriasis. Accordingly, most treatments are designed to alleviate symptoms when they occur and reduce the risk of additional flare-ups.

    Tracking your psoriasis triggers is the first step in reducing uncomfortable flare-ups. Why? Knowing what contributes to your flare-ups can help you take active steps in avoiding those triggers.

    Do you have flare-ups during stressful times at work? Try to practice some simple stress management techniques. You can listen to your favorite song, meditate for 10 minutes, try a new exercise class, or call a friend—whatever will help you de-stress. Is your psoriasis irritated by a certain shampoo, soap, or laundry detergent? Stop using it. Simple lifestyle modifications can help you take charge of your condition and reduce your risk of flare-ups.

    In addition to avoiding triggers, your dermatologist may recommend prescribed treatments, depending on the severity and location of your scalp psoriasis. Generally, systemic treatments, or treatments that work through the entire body, are not used for scalp psoriasis unless you have lesions elsewhere. What's more, the skin on the scalp is thicker and your hair may get in the way of treatment, so scalp psoriasis treatments can differ from other psoriasis treatments. Some common scalp psoriasis treatments include:

    • Anti-itch treatments: Although it can be extremely itchy, scratching your scalp lesions can worsen symptoms. Treatments that help reducing itchiness, like shampoos containing menthol or salicylic acid, over-the-counter or prescription steroid creams, and even ice packs can offer some relief for mild to severe psoriasis. In more severe cases, these types of treatments will are generally used to supplement prescription medications. 
    • Salicylic acid: Also used to treat acne and dandruff, salicylic acid can soften lesions and peel away the layers of dry, dead skin. Your dermatologist may recommend shampoo containing salicylic acid or salicylic acid that can be dabbed onto lesions to help mild psoriasis.   
    • Coal tar: Approved by the FDA for treatment, coal tar is also one of the longest used treatments for psoriasis. Your healthcare provider may recommend using ointments, gels, or shampoos containing coal tar to help alleviate your scalp psoriasis. Be sure to ask how frequently you should use it and how long you should keep the treatment on your scalp.    
    • Topical steroids: Topical steroids help reduce the inflammation associated with psoriasis. In more severe cases, dermatologists may recommend an injectable steroid treatment.  
    • Light therapy: Otherwise known as photo therapy, controlled, professionally administered UV light can help soothe the symptoms of scalp psoriasis. Keep in mind: Light therapy should always be done in a clinician's office—hitting the tanning bed is not an appropriate substitute for controlled exposure.

    If you’re feeling embarrassed or self-conscious about your scalp psoriasis, a hat, hair accessories, or a new haircut can help you conceal your lesions and flaking. When choosing a hat or accessories, however, be sure to avoid hats that are tight or can cause friction, as they may worsen your symptoms. If you’re getting a haircut, be sure to let your stylist know about your condition, so he can take extra care when selecting hair products and cutting, washing, and styling your hair.  

    Even though psoriasis manifests as physical symptoms, it’s important to take care of your mental and emotional health when you have scalp psoriasis, too. Feelings of embarrassment, depression, and anxiety are common in people living with psoriasis.

    Be sure to practice self-care, like taking a colloidal oatmeal bath, grabbing coffee with a friend, or vegging out with a movie, and seek help if you’re feeling sad, angry, depressed, or embarrassed about your condition. There are tons of online communities and support groups dedicated to people living with psoriasis, or you can talk to a trusted family member or friend.  

    A Word From Verywell

    Scalp psoriasis can be extremely uncomfortable, but with the right treatments and mental and emotional support, you can better manage your condition. Work with your healthcare provider or dermatologist to determine the best treatment options for your case and lifestyle.

    View Article Sources
    • Scalp Psoriasis. The National Psoriasis Foundation website https://www.psoriasis.org/about-psoriasis/specific-locations/scalp.
    • About Psoriasis. The National Psoriasis Foundation website https://www.psoriasis.org/about-psoriasis.
    • Scalp Psoriasis. The American Academy of Dermatology website https://www.aad.org/public/diseases/hair-and-scalp-problems/scalp-psoriasis.