Psoriatic lesions can affect different parts of the body, including the scalp. Up to 56% of people diagnosed with psoriasis will develop scalp psoriasis. These lesions cover parts of the scalp, hairline, the skin around the ears, and the back of the neck.
There are different types of psoriasis. Plaque psoriasis is the most commonly diagnosed. Scalp psoriasis is plaque psoriasis, and other parts of the body are also covered by plaques. Some individuals will experience mild forms, while others have moderate or severe psoriasis.
Doctors may classify psoriasis depending on its extent. A mild psoriasis is a form that affects less than 3% of the body surface. We identify moderate forms of psoriasis as having psoriatic lesions that affect 3% to 10% of the body. Severe psoriasis is the form of psoriasis that affects more than 10% of body surface skin.
Signs and Symptoms of Scalp Psoriasis
Scalp psoriasis manifests as thick, crusty psoriatic plaques covered by fine scales. It can affect just some areas or the entire scalp. Scalp psoriasis can mimic another condition affecting the scalp called seborrheic dermatitis. However, seborrheic dermatitis is more likely associated with yellowish, greasy skin patches. Scalp psoriasis looks more like dandruff, with powdery, silvery scales.
Scalp psoriasis often causes hair loss in the affected areas. However, the hair grows back when the skin lesions resolve.
Scalp Psoriasis Treatment
It’s harder to treat scalp psoriasis compared to other parts of the body. Since hair covers the scalp, the skin is more sensitive. However, there are a few treatment options.
Doctors will tend to change treatments over time. Sometimes they’ll combine or rotate treatment therapies to avoid side effects. Another reason is that certain drugs stop working when used for a long period of time.
Over the Counter Products
Over-the-counter (OTC) products are the first-line therapy used in mild psoriasis cases. Most of them have a salicylic acid-base, which helps soften the plaque and remove scales. Wood tar-based products reduce inflammation and itchiness while slowing down the abnormal growth of skin cells.
A pharmacist can help you find the right formula for scalp psoriasis.
There are a variety of topical treatments for scalp psoriasis. They come in the form of shampoos, steroid creams, and ointments.
Topical tars are available over the counter or with a prescription.
Phototherapy or Light Therapy
Phototherapy uses ultraviolet B light to slow down skin cell growth. It also promotes skin repair. The process of phototherapy involves controlled exposure to sunlight. You could also use special devices that contain narrowband or broadband UV radiation. Laser therapy is also approved by the FDA for treating scalp psoriasis.
Oral or Injectable Medication
Doctors recommend oral or injectable medication for severe forms of psoriasis. Oral steroids, methotrexate, and injectables like adalimumab and etanercept are often used. These are alternative treatments when phototherapy or topical treatments don’t work.
Scalp Psoriasis Home Remedies
There are also home remedies for scalp psoriasis you can try. You can use these in addition to standard treatments and can help you better manage symptoms.
Using warm water before applying medicated shampoos help soften the plaques. Some people find it helpful to comb the hair in a circular motion after washing it. Some of the most popular remedies include aloe vera cream which you can apply directly on the scalp. Coconut, sesame oil, or olive oil are great natural moisturizers too.
Diluted apple cider vinegar (1:1 ratio with water) helps reduce the itch and inflammation. Avoid using apple cider vinegar if the skin is sensitive or cracked. Also, avoid hot baths and limit showers to 5-10 minutes.
Creams and ointments based on camphor or menthol tend to work best if the skin is extremely itchy. Cool compresses and moisturizers also help reduce itch and irritation.
Oatmeal or Epsom salt baths can also help reduce inflammation and redness. Research has also found that supplements like Vitamin D, omega-3 fatty acids, and tea tree oil improve scalp psoriasis.
One randomized controlled study found turmeric tonic decreased redness and scaling of the scalp. It also decreased the induration of scalp lesions and improved quality of life.
Living with Scalp Psoriasis
Psoriasis is a chronic condition, with periods of flare-ups and remissions. There are certain triggers for flare-ups including stress, skin injuries, sunburn, smoking, obesity, viral and bacterial infections. Vitamin D deficiency, alcohol consumption, and certain medication are also risk factors. Avoiding these triggers can help prevent a flare-up.
As this is a long-term condition, adjusting treatment from time to time is important. Therefore you will need to consult your family physician and specialists on a regular basis.
According to the National Psoriasis Foundation, scalp psoriasis may be an indicator of psoriatic arthritis, because many individuals have both. In this case, a dermatologist will recommend skin treatments. A rheumatologist will screen for arthritis and provide necessary treatments.