These tips on how to treat scalp psoriasis deals with the causes of itchy scaly scalp caused by psoriasis and the most effective remedies to control it.
Scalp is commonly involved in psoriasis. Many a times psoriasis starts on the scalp and remains localized to the scalp for many years. The lesions usually spread to other parts of body following application of superpotent class of topical corticosteroids like clobetasole propionate.
Treatment with systemic steroids followed by sudden stoppage of the medication can also cause the flares in other parts of the body.
Psoriasis scalp may be associated with scattered, isolated psoriasis plaques else where on the body or generalized psoriasis.
The area behind the ears is the most common site affected in scalp psoriasis. Occiput ( back of head) is another common site of involvement.
The lesions on the scalp may be either red, raised, scaly plaques scattered at different areas of the scalp or diffusely scaly to involve the whole scalp. Itchy and scaly scalp is the usual presenting symptom of scalp psoriasis. Surprisingly, even with generalized scalp involvement, psoriasis of scalp does not usually cause hair loss.
Psoriasis of the scalp has to be differentiated from severe dandruff or seborrhoeic dermatitis. A singular feature is that psoriasis is most often localized to a few areas on the scalp while the seborrhoeic dermatitis is present throughout the scalp. The scaling in severe dandruff is also not very thick as in psoriasis and the bleeding points on scrapping (Auspitz sign) are absent in dandruff and seborrheic dermatitis.
Harsh scrapping or vigorous rubbing can cause psoriasis plaque to appear in uninvolved areas of the scalp. This is the well known koebner phenomenon in psoriasis. Hence this should be avoided.
What are the Other Causes of Itchy and Scaly Scalp?
Psoriasis of the scalp has to be differentiated from severe dandruff or seborrheic dermatitis. Seborrheic dermatitis is generalised on the scalp while psoriasis is localised to certain areas.
The other causes of itchy scaly scalp are tinea amiantacea, tinea capitis (ring worm of scalp), contact allergy to hair lotions, creams or shampoos, dry scalp, lichen planus of the scalp, folliculitis etc.
Read more about other causes of itchy scalp conditions and their management.
How to Treat Scalp Psoriasis
Remedies for the itchy, scaly scalp depend upon the severity of the scalp psoriasis and extend of involvement.
Treatment of the Mild Scalp Psoriasis.
In mild type of scalp psoriasis, these is only superficial scaling, the thick scaly plaques are absent. The first line of treatment is tar or ketaconazole shampoos followed by betamethasone valerate scalp solution. In the absence of inflammation, calcipotriene solution can replace or alternate with the steroid topical application.
Treatment of Severe Scalp Psoriasis.
In severe psoriasis of the scalp, there are thick adherent scaly plaques on the scalp. Unless the scales are removed, the antipsoriatic medication will not be able to act on the skin. Hence the first step is to remove the scales.
Removal of Thick Scales of Scalp Psoriasis. The following steps will help remove the scales: Wet the scalp thoroughly, cover the involved area of the scalp with either a 10% salicylic acid in mineral oil or a coconut oil based tar and salicylic acid pomade. This is covered with a plastic wrap overnight. 20% urea cream is an alternative. A tar and salicylic acid containing shampoo is used in the morning to remove the scales.
Topical Applications in Scalp Psoriasis. Once the scales are removed, a combination of calcipotriene and betamethasone dipropionate gives best results in controlling the scalp psoriasis. Other alternatives are tar solutions, steroid-salicylic acid combinations, anthraline, and steroid lotions like clobetasole propionate. This is combined with moisturizing lotions like the liquid paraffin when the thickness is reduced.
Along with the above measures, life style management is also important for effective control of psoriasis. We will discuss this in a subsequent article later.
Read more about other causes of Itchy Scalp:
The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.
About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.
He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.
Visit his personal website dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD