Scalp psoriasis is one of the many forms of Psoriasis. It is distributed as a single or multiple patches of lesions on the scalp. The lesions may cover a portion or the whole of the scalp and may extend to the forehead, the back of the ears, and the neck.
Like the other forms of Psoriasis, scalp psoriasis is not contagious and theories on its development are attributed to genetics and autoimmune etiology.
Scalp psoriasis may lead to problems related to self-esteem, decreased socialization, and depression due to the unwanted nature of its appearance. Understanding the disorder and the management of its signs and symptoms is imperative in controlling the lesions and prevent further complications.
Signs and Symptoms of Scalp Psoriasis
The signs and symptoms of scalp psoriasis vary according to the severity of the condition. This includes a combination of the following:
- Dandruff-like flaking
- White scaly plaques
- Red lesions (erythematous)
- Burning sensation and soreness
- Alopecia (hair loss)
The hair loss is not directly associated to scalp psoriasis itself. It is the frequent intense scratching, forceful removal of the scales, rigid treatment, and the associated stress of having the condition that would lead to the hair loss. This state of alopecia is temporary and hair growth will return to normal after the lesions fully heal.
The severity is classified as mild, moderate and severe. Psoriasis is graded as mild (affecting less than 3% of the body, moderate (affecting 3-10% of the body), and severe (3% and above).
Treatment for Scalp Psoriasis
It is highly recommended to see a physician or dermatologist before using any medications. The dermatologist will conduct some tests and identify if it is actually psoriasis and not some other skin disease or disorder.
Once diagnosis has been formulated, the treatment regimen can begin. The treatment regimen for scalp psoriasis depends upon its severity. Treatment for scalp psoriasis is also slightly different from that of the other forms of psoriasis.
Mild Scalp Psoriasis Treatment
As a first line of defense, topical agents such as creams, shampoo, gels, ointments, oils, and soaps are used to manage mild scalp psoriasis. These medications are mostly available over-the-counter. Stronger forms of topical medications may require prescription.
Over-the-counter medications may contain either of these FDA approved substances:
- Salicylic Acid
- Coal Tar
Stronger prescription medications may contain higher concentrations of coal tar and salicylic acid or a combination of both; as well as other FDA-approved medications such as:
- Anathralin (older prescription medication)
- Calcipotreine (A vitamin D derivative)
- Calcipotreine and bethametasone (potent steroid)
- Tazarotene (vitamin A derivative)
- Antimicrobial (for yeast and bacteria associated with scalp psoriasis)
- Other steroids
In using topical medications, keep in mind that they must be used as directed. For better results, it should be applied to the scalp and not just on the hair. After the lesions are controlled, daily or bi-weekly usage of the coal tar-containing shampoo medications will prevent recurrence of the attacks.
If the extent of the lesion is limited to small areas, the physician may consider injecting steroid to the affected areas.
For cases that are non-responsive to topical therapy, phototherapy from a laser or non-laser light source may be helpful. This may be delivered using a hand-held device called the Ultraviolet Comb. The UV comb can be used to treat the entire scalp. A brief exposure to sunlight may also be recommended.
Moderate and Severe Psoriasis Treatment
For moderate to severe cases of scalp psoriasis, a systemic treatment regimen will be considered. This would include oral, subcutaneous, and intravenous modes of administration. These medications may include one or a combination of these substances:
- Oral vitamin A derivative
- Oral vitamin D derivative
It should also be advised to use caution when using these systemic medications. The liver, which is the major organ that metabolizes the drugs, and chemical that are inside the body; can be affected and liver functions must be monitored.
The vitamin A and vitamin D derivatives are entirely different from those over-the-counter vitamin A and vitamin D supplements. It is important to know the difference between them. The supplements are not useful in the treatment of psoriasis.
Biologics are newer FDA medications used in the treatment of psoriasis. These medications are delivered through injection or infusion. Biologics modify some components the immune system that would help in preventing the production excessive build-up of skin cells (keratocytes).
Home Remedies and Tips
- Early morning sunshine – The skin needs sunlight to activate and metabolize vitamin D. Sunlight keeps the skin healthy and it is beneficial in the management of psoriasis.
- Keep a short haircut- Keeping the hair short would make it easier to clean the scalp, apply medications, and prevent the retention of dead and excessive skin.
- Avoid skin irritants- Identify which food or topical products which may lead to skin irritation to be able to avoid attacks and decrease the severity of the condition.
- Avoid stress- Stress may lead to a compromised immune system and increases the susceptibility to diseases and auto-immune attacks.