Psoriasis is a skin disease that causes scaling and swelling. Psoriasis affects 2 percent to 2.6 percent of the United States population, or between 5.8 and 7.5 million people. The scalp is one common location where psoriasis can occur. In fact, over half the people with psoriasis have it on their scalp.
Anyone can get scalp psoriasis, but it occurs more often in adults. Sometimes there is a family history of psoriasis. Certain genes have also been linked to the disease. Men and women get scalp psoriasis at about the same rate. Scalp psoriasis can occur by itself or with other
types of psoriasis.
Causes of Scalp Psoriasis
Just like other types of psoriasis, scalp psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells.
People with scalp psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause scalp psoriasis to get worse include:
- Infections
- Stress
- Changes in weather that dry the skin
- Certain medicines.
(Click Psoriasis Causes for more information about the causes of scalp psoriasis.)
Symptoms of Scalp Psoriasis
Most cases of scalp
psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. Scalp
psoriasis can extend beyond the hairline, to the back of the ears, or around the neck.
In some cases of severe scalp psoriasis, temporary hair loss may occur. Scalp psoriasis does not, however, result in balding.
Besides the scalp, psoriasis is often found on the elbows, knees, other parts of the legs, lower back, face, palms, and soles of the feet. However, psoriasis can also show up on other places such as fingernails, toenails, genitals, and inside the mouth.
Diagnosing Scalp Psoriasis
A scalp psoriasis diagnosis is usually made by examining the area of skin that is affected. Scalp psoriasis can be difficult to diagnose because it can look like other skin diseases (seborrheic dermatitis). The doctor might need to look at a small skin sample under a microscope.
Treatment Options for Scalp Psoriasis
- How serious the scalp psoriasis is
- The size of the scalp psoriasis patches
- Whether the psoriasis is located on other parts of the body
- How the patient reacts to certain treatments.
Scalp psoriasis treatment is sometimes called the "1-2-3" approach.
- Step 1 uses psoriasis medication applied to the skin (topical psoriasis treatment)
- Step 2 uses light treatments (see Light Therapy for Psoriasis)
- Step 3 involves taking psoriasis medication (by mouth or injection) that treats the whole immune system (this is called systemic therapy).
Not all treatments work the same for everyone. Doctors may switch scalp psoriasis treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working.
Topical Treatments for Scalp Psoriasis
Treatments applied right on the skin (creams, ointments) may help. Topical scalp
psoriasis treatments can:
- Help reduce swelling and skin cell turnover
- Suppress the immune system
- Help the skin peel and unclog pores
- Reduce cell turnover and swelling.
For mild scalp
psoriasis treatment, topical treatment may be all that is needed.
Topical scalp psoriasis treatment options include:
- Coal Tar
- Salicylic acid
- Clobetasol propionate.
Coal Tar
Preparations containing coal tar (gels and ointments) may be applied directly to the skin, added (as a liquid) to the bath, or used on the scalp as a shampoo. Coal tar products are available in different strengths, and many are sold over the counter (not requiring a prescription).
Coal tar is less effective than corticosteroids and many other treatments and, therefore, is sometimes combined with ultraviolet B (UVB) phototherapy for a better result. The most potent form of coal tar may irritate the skin, is messy, has a strong odor, and may stain the skin or clothing. Thus, it is not popular with many patients.
Salicylic Acid
This peeling agent, which is available in many forms, such as ointments, creams, gels, and shampoos, can be applied to reduce scaling of the skin or scalp. Often, this type of scalp psoriasis treatment is more effective when combined with coal tar.
Clobetasol Propionate
This is a foam topical medication (Olux
®), which has been approved for the treatment of body and scalp psoriasis. The foam penetrates the skin very well, is easy to use, and is not as messy as many other topical
psoriasis medications.
Light Therapy
Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat scalp
psoriasis. One treatment, called PUVA, uses a combination of a
psoriasis medication that makes skin more sensitive to light and ultraviolet A light.
Systemic Therapy
Systemic treatment is not usually used for scalp psoriasis treatment unless the psoriasis is located on other parts of the body. Doctors might prescribe systemic psoriasis medications or give psoriasis medicine through a shot.
Combination Therapy
If you choose to combine all three different treatment methods (topical, light, and systemic), you can often lower the doses of each. Combination scalp psoriasis therapy can also lead to better results.
(Click Psoriasis Treatment for more information about the options for treatment of scalp psoriasis.)
Doctors are learning more about scalp psoriasis by studying:
- Genes
- New treatments that help skin not react to the immune system
- Laser light treatment on thick patches.
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