An Overview of Scalp Psoriasis

Psoriasis is characterized by red, itchy, scaly lesions that can affect the skin all over the body. These lesions often develop on the elbows, knees, face, and buttocks, but around 80% of people with psoriasis develop lesions on the scalp. Scalp psoriasis can range from mild to severe and extend beyond the hairline to the forehead, neck, and ears. Though scalp psoriasis can often co-occur with other psoriatic diseases, it can also occur on its own.

The psoriatic lesions, called plaques, can also shed, resulting in dandruff-like flakes of skin. Because scalp psoriasis is often highly visible, people living with the disease can feel extreme embarrassment and emotional distress.

Although there is no cure for any type of psoriasis, there are ways to take charge of your condition and feel better.

Symptoms

Scalp psoriasis can be tricky to diagnose because it is often confused with seborrheic dermatitis (dandruff) and other skin conditions. To make the diagnosis, a skin specialist known as a dermatologist will examine the skin to look for tell-tale signs, including:

• Red, thick, inflamed plaques with a silvery-white scales
• An extremely itchy scalp that may crack and bleed
• Temporary hair loss due to constant scratching

As a chronic autoimmune disorder, psoriasis can affect more than just the skin. Psoriasis is a systemic disease that can impact the eyes (causing uveitis) and joints (psoriatic arthritis). The persistent autoimmune-induced inflammation has even been linked to heart disease and type 2 diabetes.

Causes

Currently, the cause of psoriasis is unknown. Researchers believe that the disease is caused by a combination of genetic and environmental factors.

In order for psoriasis to present in the human body, the psoriasis gene must be "switched on" by certain external factors known as triggers. These include infections, stress, allergies, medications, skin trauma, and extremely cold/dry weather, among other things.

Diagnosis

There are no lab tests or imaging studies that can definitively diagnose psoriasis. The diagnosis is based on an examination of your symptoms along with a review of your medical history. The medical history will help the doctor identify your risk factors for the disease (including family history, obesity, and other autoimmune conditions), as well as other possible explanations for the symptoms.

If your condition is especially severe and/or resistant to treatment, the dermatologist may perform an in-office skin biopsy to obtain a tissue sample. Under the microscope, the cells will appear dense and compacted (acanthotic) unlike other skin conditions, such as eczema.

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Treatment

Because there is no cure for psoriasis, treatments are designed to alleviate symptoms or prevent a recurrence. Tracking your psoriasis triggers is the first step in reducing flares. It allows you to identify the substances or events that instigate symptoms so that you can avoid them.

Clearly, some triggers are easier to avoid than others. If stress is a trigger, you may need to employ mind-body therapies (like meditation, guided imagery, or progressive muscle relaxation) to rein in your emotions or seek professional help from a therapist or psychiatrist.

In addition to avoiding triggers, your dermatologist may prescribe treatments depending on the severity of your condition.

Hair can also get in the way of treatment and, as such, may require thicker ointments or creams that can be massaged into the scalp.

Research has indicated that certain shampoos may be helpful in the treatment of scalp psoriasis. Some of the more common treatments for scalp psoriasis include:

• Anti-itch remedies: These include shampoos containing menthol or salicylic acid, over-the-counter or prescription steroid creams, and even ice packs to help numb the skin and prevent scratching.
• Salicylic acid: Also used to treat acne and dandruff, salicylic acid can soften lesions and peel away the layers of dead skin. Your dermatologist may recommend a shampoo containing salicylic acid or prescribe a salicylic acid-based liquid that can be dabbed onto lesions.  
• Coal tar: Approved by the U.S. Food and Drug Administration (FDA) for the treatment of mild to moderate psoriasis, coal tar can be found in a variety of ointments, gels, and shampoos.   
• Topical steroids: Topical steroids help reduce the inflammation associated with psoriasis and come in a variety of strengths and preparations. Injectable steroids may be used if psoriasis is especially severe.
• Light therapy: Also known as phototherapy, light therapy involves the controlled administration of ultraviolet (UV) light to soothe the symptoms of psoriasis. Performed in a doctor's office (not in a tanning booth), it can be difficult to administer in people with especially thick hair.

Generally speaking, systemic therapies like pills or injections are not used to treat scalp psoriasis unless there are lesions elsewhere on the body.

Coping

If you are feeling self-conscious about your scalp psoriasis, a hat, haircut, or hair accessories can help conceal lesions and flaking. When choosing headgear, avoid any options that are tight or cause friction, as this may worsen your symptoms. If you are getting a haircut, let your stylist know about your condition so that milder shampoos and hair products can be used.

Even though psoriasis manifests with physical symptoms, it is important to take care of your emotional health as well. Depression is common in people with chronic psoriasis and can end up adding to the stress you are already feeling. Try not to ignore these feelings, and seek professional help if you are losing sleep or are unable to cope.

There are also numerous online communities and support groups dedicated to people living with psoriasis. Friends and family should also be a part of the solution if you help them better understand the condition and the symptoms you are experiencing.

Most importantly, seek appropriate treatment for not only your psoriasis but any other medical condition you have. By better managing things like weight, blood pressure, diabetes, and cholesterol, many of the triggers associated with psoriasis can be mitigated, reducing the risk of flares and recurrence.