Scalp Psoriasis

You might be experiencing scalp psoriasis if you have itchy, scaly patches and a dry scalp. Psoriasis of the scalp causes inflammation and presents as raised plaques and scales that can itch, burn, and sting. There are ways to manage psoriasis on the scalp. Treatments include topical ointments, phototherapy, or oral medications.

Psoriasis is an autoimmune disorder. The immune system speeds up the growth of skin cells, which pile up instead of sloughing off. This build-up of skin cells forms the plaques you see on your scalp. A healthcare provider can rule out similar conditions like eczema and confirm scalp psoriasis. They may examine the scalp and take a skin sample for biopsy.

About 45% to 56% of people with psoriasis have scalp psoriasis. Read on to find out how to tell if you have scalp psoriasis and how to treat it.

Symptoms of Scalp Psoriasis

Psoriasis of the scalp might cause symptoms like:

• May appear powdery with a silver sheen
• Scaling that covers parts of the scalp or the entire scalp
• Scaling that may extend beyond the hairline onto the neck
• Thick, crusted plaques on the scalp

Scalp psoriasis can also occur on the hairline, forehead, neck, and around the ears. These plaques are typically itchy and painful.

What Causes Scalp Psoriasis?

Scalp psoriasis is typically caused by plaque psoriasis, an autoimmune disorder. The immune system overreacts, causing inflammation. This inflammation causes skin cells to multiply quickly and not slough off. The skin cells build up and form thick red patches and silvery scales.

Experts are not sure what triggers the immune system to overreact in people with plaque psoriasis. Some evidence suggests that the root cause is a mix of genetic and environmental factors. Plaque psoriasis often runs in families. Infections and trauma to the skin can also trigger symptoms.

Risk Factors

It's not exactly clear why some people develop psoriasis on the scalp while others don't. Risk factors might include:

• Alcohol consumption
• Anxiety or stress
• Infrequent use of medications that treat psoriasis
• Obesity
• A secondary autoimmune disorder 
• Smoking or tobacco use

Diagnosis

A dermatologist (who specializes in the skin, hair, and nails) can diagnose scalp psoriasis. They'll typically ask about your health history and symptoms. The dermatologist will also conduct a thorough examination of your scalp and the rest of your skin.

A dermatologist can also order further testing to rule out other conditions. Conditions that can resemble scalp psoriasis include eczema and seborrheic dermatitis. Eczema is a group of conditions that cause skin inflammation. Seborrheic dermatitis, commonly known as dandruff, causes red, scaly patches on the scalp.

Tests that can rule out these conditions and confirm scalp psoriasis include:

• Allergy skin test: This type of testing can determine whether skin changes are caused by an allergen. A positive result can indicate that you might be allergic to a substance that comes into contact with your scalp.
• Biopsy: A dermatologist may take a sample of skin cells from your scalp to be examined under a microscope.
• Blood tests: A blood sample can look for other causes of skin inflammation that may not be caused by psoriasis.

Scalp Psoriasis Treatment

There are several options for treating scalp psoriasis. Treatment can differ for each person. It's important to consult a dermatologist to figure out what works best for you. They may recommend one or a combination of the following.

Topicals

First-line therapy for plaque psoriasis on any part of the body is a topical anti-inflammatory. Topical treatments include:

• Medicated shampoos
• Prescription topicals
• Steroids
• Tars

Using an ointment or cream on the scalp can be difficult. Foam, liquids, or gels are sometimes better options for the scalp.

Some topical options are available over the counter (OTC). There are specific ingredients to look for. Salicylic acid is an ingredient that softens plaques and scales and removes them from the skin. Tar (made from coal or wood) slows skin cell growth and reduces inflammation, itching, and scaling.

Look for a Seal of Recognition before buying an OTC product. This program includes products that are non-irritating and safe for people with psoriasis.

Phototherapy

Phototherapy shines ultraviolet (UV) rays on the skin to slow the growth of skin cells. This therapy can also suppress an overactive immune system, reduce inflammation, and relieve itching.

A dermatologist may use a handheld device resembling a blow dryer to treat scalp psoriasis. For optimal results, phototherapy two to three times per week for several weeks is recommended.

Systemic Agents

A dermatologist may prescribe oral medications or biologics if topicals or phototherapy do not help. There are several types of oral medications that can improve psoriasis symptoms. These drugs work by slowing down the immune system. Biologics are delivered by injection of intravenous (IV) infusion. These drugs target specific parts of the immune system.

Some examples of oral medications include:

• Cyclosporine 
• Methotrexate
• Otezla (apremilast)
• Soriatane (acitretin)
• Xeljanz (tofacitinib)

There's a variety of biologics that treat scalp psoriasis, including:

• Cosentyx (secukinumab)
• Humira (adalimumab) 
• Remicade (infliximab)
• Simponi ARIA (golimumab)
• Stelara (ustekinumab)
  

Prevention

There's no cure for scalp psoriasis. Symptoms may come and go over time, but you can take steps to prevent flares. It's important to follow a treatment regimen prescribed by a healthcare provider.

Other ways to prevent scalp psoriasis flares include:

• Apply a rich moisturizer to your scalp right after showering or bathing.
• Avoid or limit foods that might cause inflammation, such as alcohol and dairy products.
• Eat an anti-inflammatory diet that's rich in fatty fish, leafy greens, and olive oil.
• Shower or bathe in lukewarm water for less than 10 minutes.
• Use a conditioner after shampooing your hair.

Complications

If untreated, scalp psoriasis may result in complications, including a dry, itchy scalp. Other complications might include:

• Alopecia: Psoriasis may lead to hair loss if it affects your scalp.
• Anxiety: Scalp psoriasis may affect your self-esteem, resulting in anxious feelings and thoughts. You may be self-conscious of your condition and how others perceive it.
• Psoriatic arthritis (PsA): People with scalp psoriasis have a higher risk of PsA. This condition causes stiff, swollen joints.
• Sleep deprivation: If psoriasis of the scalp causes severe itching, it may be hard to fall or stay asleep. This symptom can result in a lack of quality sleep.
• Skin infections: Scratching plaques on the scalp may cause breaks in the skin that bacteria can enter. Signs of a skin infection include crusting, discoloration, and warmth and tenderness of the skin. You might require antibiotics to get rid of an infection.

Living With Scalp Psoriasis

Scalp psoriasis can be an irritating condition that causes a build-up of skin cells on the scalp. These itchy patches can be bothersome, but treatments can alleviate symptoms.

Psoriasis on the scalp can sometimes cause hair loss. Even a little inflammation can cause hair loss. However, once psoriasis clears on the scalp, hair often grows back.

There are ways to help prevent further hair loss:

• Allow your hair to air dry instead of blow-drying it.
• Avoid picking off the scales.
• Gently comb and brush away the scales.
• Keep your fingernails short to prevent scratching your scalp.
• Use conditioner after shampooing your hair.
• Use medicated shampoo and alternate with normal shampoo.

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