If you suffer from scalp psoriasis—which affects nearly 80 percent of patients with psoriasis—reaching for a garden-variety drugstore shampoo to wash your hair won’t help improve the itching, scaling, and crusting on your scalp.
“Psoriasis presents as a build-up of skin cells which create scaly, patches that can itch, hurt, crust up and bleed,” says Dendy Engelman, MD, a board-certified dermatologist in New York City. This buildup, according to Dr. Engleman, can range from mild scalp psoriasis, which appears as fine scaling, to severe scalp psoriasis, which looks like thick, crusted plaques.
Which shampoos should you use for psoriasis?
The most effective first-line shampoo for scalp psoriasis patients, especially when the scalp is acutely itchy and red, is called clobetasol solution or topical treatment, a prescription-only treatment which can be applied as a foam, shampoo, cream, gel or lotion, says Mitchell Lewis, MD, a clinical assistant professor of dermatology at Stanford University.
But there are downsides to clobetasol's effectiveness: “It’s a very strong corticosteroid so there’s a potential for side effects,” Dr. Lewis says. Those side effects include burning, itching, and even changes in skin color, according to the US National Library of Medicine.
But it's important to remember that there's no one-size-fits-all treatment plan. "Everyone has a different kind of hair, scalp and different oil production and will have different requirements in a shampoo,” says Dr. Lewis. "It takes a lot of trial and error to find the right balance."
According to Richard Torbeck, a board-certified dermatologist with Advanced Dermatology PC in New York City, the best way to do this is to match your treatment plan to what's going on at that exact moment on your scalp: "For flake reduction, I recommend patients use Neutrogena’s T-Sal shampoo and for inflammation and flake reduction, I recommend they use Neutrogena T-Gel coal tar shampoo,” says Dr. Torbeck. “Then, for maintenance, I recommend that my patients use prescription ketoconazole shampoo, an antifungal shampoo that also has anti- inflammatory properties.”
And one more tip that has nothing to do with your shampoo: Dermatologists urge psoriasis patients to skip the long, hot showers, avoid picking or peeling the scales from your scalp, and always be gentle when you wash your hair as your psoriasis can worsen if you scrub your scalp with too much vigor.
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