Treat Scalp Psoriasis with The Right Shampoo

Scalp psoriasis is very common. In fact, according to the National Psoriasis Foundation, at least half of the 7.5 million Americans who have psoriasis have it on their head.

As with psoriasis on other parts of your body, the condition is triggered by an autoimmune response that causes rapid growth of skin cells and red, scaly lesions.

The resulting flakes look like dandruff, or seborrheic dermatitis, but they’re actually very distinct.

Scalp psoriasis scales, for one thing, are silver and powdery; dandruff is yellow and greasy. Moreover, though psoriasis can be treated with shampoo, regular old dandruff products may not cut it.

To help guard against exacerbating the condition, Junko Takeshita, MD, PhD, MSCE, assistant professor of dermatology and epidemiology at the University of Pennsylvania’s Perelman School of Medicine, in Philadelphia, advises people not to pick, peel or brush the thick scales from the scalp and to choose a shampoo wisely.

“I encourage patients not to physically remove the scales themselves because aggressive removal can irritate the scalp and make the psoriasis worse,” Dr. Takeshita says. “People also need to be careful about hair dye as the chemicals in hair dyes can sometimes irritate and worsen the scalp psoriasis or even cause an allergic reaction on top of the psoriasis.”

Types of Psoriasis Shampoos

Psoriasis shampoo contains special ingredients designed to soften and loosen the scales of psoriasis on your scalp so that they can be washed away.

There are two types of psoriasis shampoo:

• Coal tar shampoo. As its name implies, the active ingredient in this psoriasis shampoo is coal tar, which is a byproduct of coal that is thick, black, and odorous. Coal tar shampoo is usually includes additional ingredients, such as salicylic acid, coconut oil, or sulphur. Some coal tar shampoos have a strong odor.
• Medicated shampoo. The active ingredients in these shampoos for scalp psoriasis include clobetasol propionate (a topical steroid), salicylic acid, ketoconazole (antifungal medication), Blue Lagoon algae, and zinc pyrithione.

There are various brands of each type of psoriasis shampoo on the market, and some contain more concentrated formulations of the active ingredients than others.

Ask your doctor which type and formulation of shampoo you should try. You may have to try more than one before you find the brand and strength that works for you.

Tips for Better Results With Psoriasis Shampoos

To use psoriasis shampoo, massage the product into your scalp, leave it on for a minimum of 5 to 10 minutes unless otherwise instructed, and then rinse it out. Before using the shampoo, you may want to coat two cotton balls with petroleum jelly and place them in your ears to keep out the shampoo.

When you have active psoriasis lesions on your scalp, you may need to use psoriasis shampoo repeatedly to get the lesions under control. Often, this means using the shampoo daily for several weeks. While most psoriasis shampoos are safe to use every day, this may lead to scalp irritation over time. So once you have your lesions under control, you can help avoid irritation by cutting back on your use of the psoriasis shampoo to just twice a week.

Remember that psoriasis shampoo is designed to treat your scalp, not your hair. So you can follow a psoriasis treatment with your favorite cosmetic shampoo and conditioner for general hair care and reduce the smell that some psoriasis shampoos have. Recent advances have actually made some medicated psoriasis shampoos more cosmetically pleasing, so you may be pleasantly surprised.

Choosing a Psoriasis Shampoo at the Drugstore

Many brands of psoriasis shampoo are available over the counter at your local drugstore, or your doctor can prescribe a stronger, prescription psoriasis shampoo for you.

In some cases, you may need a shampoo with a special mixture of ingredients to be effective for your scalp psoriasis. If the right preparation isn't available as an over-the-counter or prescription psoriasis shampoo, don't attempt to mix different preparations, since this can be dangerous. Your doctor can write a special prescription, and a pharmacist will mix, or compound, your customized psoriasis shampoo for you.

When You Need Treatments in Addition to Psoriasis Shampoo

When your scalp psoriasis is more severe, psoriasis shampoo alone may not be enough to treat it. It's also possible that even if the shampoo works for you initially, your psoriasis may eventually become resistant to its effects. In these cases, your doctor may recommend other treatments, such as topical scalp medications, a course of steroid medication, or ultraviolet light treatments.

In extreme cases, Takeshita recommends that people use oil-based topical steroids to help with softening and gentle removal of the scales. “Salicylic acid in shampoos is helpful, but in very severe cases a person needs more than topical treatments; such as, oral systemics or biologics,” Takeshita says. “Phototherapy can sometimes be helpful for severe cases as well, but usually this approach is reserved for those who have extremely short hair, or are bald, since the hair gets in the way of treatment.”

Although it can be challenging — and even frustrating at times — to deal with scalp psoriasis, you can bring it under control once you get on the right treatment plan.

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