What is Scalp Psoriasis?
Psoriasis typically appears on the arms, back, neck, and legs, but it can affect skin anywhere on the body.
â€œAnd that includes the scalp,â€ says Dina D. Strachan, MD, a dermatologist and clinical assistant professor of dermatology at NYU Grossman School of Medicine in New York City.
Scalp psoriasis involves patches of thick, raised skin. On fair-skinned people these areas are typically red and scaly, while psoriasis on skin of color can appear violet or dark brown.
According to the American Academy of Dermatology, scalp psoriasis can extend beyond the scalp. It can appear on the forehead, the back of the neck, or in and around the ears. (1)
â€œWhile some people only have psoriasis on the scalp, most people with scalp psoriasis have it on other parts of their body as well,â€ Dr. Strachan adds.
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Is It Scalp Psoriasis or Dandruff?
At the onset, scalp psoriasis often is confused with seborrheic dermatitis (aka dandruff). Dandruff is a flaky, itchy scalp without signs of inflammation (such as discoloration or swelling). (2)
Researchers arenâ€™t entirely sure why some people develop dandruff. It may be due to hormone levels, a weakened immune system, types of yeast, a lack of certain nutrients, or nervous system problems. (3)
You are more likely to have dandruff if you have certain conditions, such as HIV, Parkinsonâ€™s disease, or depression. In some cases, dandruff could be the sign of an underlying issue, like a vitamin deficiency or problem with the immune system, according to the Mayo Clinic. (4) Certain medications, such as lithium and interferon, can also raise the risk of developing dandruff.
â€œDandruff tends to itch more, and it has a greasy-appearing yellow scale. In contrast, psoriasis â€” whether it's on your scalp or any other body part â€” tends to have a thick, silvery scale,â€ Strachan explains.
Jody Alpert Levine, MD, dermatologist and cofounder of Plastic Surgery & Dermatology of NYC in New York City, adds, â€œScalp psoriasis may itch and become easily irritated during a flare, and it also may affect your hairline or creep down onto your forehead, nape of your neck, or your ears.â€
According to the National Psoriasis Foundation, around half of those with psoriasis have it on their scalp.
How Do You Treat Scalp Psoriasis?
Thereâ€™s no cure for scalp psoriasis, but there are ways to manage its symptoms. â€œI always remind my patients that theyâ€™ll need to continue treating it to keep it under control,â€ says the dermatologist Steve Daveluy, MD, an assistant professor at Wayne State University School of Medicine in Detroit.
Treatments for scalp psoriasis may include the following:
Methotrexate, oral retinoids, cyclosporine, biologics, and ultraviolet light may be used if psoriasis is also on other parts of the body.
â€œPhototherapy works by reducing the inflammation,â€ says Dr. Daveluy, but he cautions that itâ€™s less effective with scalp psoriasis than with psoriasis elsewhere on your body. Thatâ€™s because the scalp doesnâ€™t respond the same way. Hair blocks some or all of the light, but you may achieve better results if you part your hair in many rows.
Injections of corticosteroid medication can target persistent, itchy plaques on the scalp. Because these shots can be uncomfortable, a dermatologist may recommend injecting only a few areas until other treatments help.
These are often used in conjunction with other treatments.
The first step in treating scalp psoriasis effectively involves removing or lifting thick scales, which helps medication penetrate the plaques and clear them up.
â€œOne common way to do this is by using keratolytics treatments, which contain active ingredients, such as salicylic acid, urea, lactic acid, or phenol, that are designed to dissolve skin flakes or scales,â€ says Strachan.
â€œAnother way to soften and loosen scalp scales is to apply oils, lotions, creams, or ointments to a damp scalp,â€ she adds.
For people of color, who may have thicker, curlier hair, applying these topical treatments may be particularly challenging.
Once the medication softens the psoriasis scale, you can carefully remove it with a fine-tooth comb or brush.
â€œGently comb the scalp in a light circular motion, holding the comb almost flat against the scalp,â€ advises Strachan.
â€œOnce the scale is loosened, shampooing is a good way to get the scale away from your scalp and out of your hair. But be gentle. Brushing or combing too vigorously can break the skin and lead to an infection. It can also break hair off at the scalp, causing temporary hair loss.â€
Shampoos with ingredients such as tar and salicylic acid also may be helpful. (6) "Liquid or foam topical medication [like steroids and calcipotriene] are easy to apply to the scalp,â€ says Strachan.
Shampoo â€” both with and without coal tar medication â€” are available to treat scalp lesions. â€œWe actually donâ€™t know exactly how coal tar works, but itâ€™s one of the oldest treatments for psoriasis,â€ Daveluy says. â€œIn mild scalp psoriasis, it may be the only treatment necessary to keep it under control.â€
But severe flares may require the use of oral medication in conjunction with such topical treatments.
Topical treatments for scalp psoriasis include:
- Dovonex (calcipotriene)
- Taclonex (calcipotriene and betamethasone)
- Tazorac (tazarotene)
- Topical corticosteroid solutions, oils, and foams
Before starting any topical scalp treatment, Strachan suggests applying a test patch of the medication to an inconspicuous spot on your head.
â€œIn some cases, treatments may cause irritation or temporary hair loss,â€ she says. â€œYour hair should grow back. But if hair loss persists after youâ€™ve treated the psoriasis, you should consult a dermatologist.â€
How Can You Mask Scalp Psoriasis Symptoms?
While your scalp is clearing up, talk with your hairstylist about alternative hairstyles that can help conceal affected areas.
Psoriasis itself does not cause hair loss, but your hair can enter a resting stage known as telogen when you are under stress. When too much of your hair goes into telogen at once, fewer hair follicles are available to grow new hair.
Consider wearing light-colored tops or shirts to help to disguise the falling silvery plaque scales that are easily mistaken for dandruff.
While the symptoms of scalp psoriasis may seem to come and go, psoriasis is a chronic condition that will need to be treated and managed over time.
And, according to Strachan, treating your psoriasis promptly is the best way to reduce its impact on your appearance. Itâ€™s also important to leave it alone: Psoriasis can develop in unaffected surrounding areas that have been scratched and traumatized.
If youâ€™re not sure whether you actually have scalp psoriasis, consult your doctor as soon as you can for an accurate diagnosis and to develop a psoriasis treatment strategy that works for you.
Additional reporting by George Vernadakis
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