Scalp Psoriasis: Symptoms, Causes, and Treatment

Around 2-3 percent of the world’s population have psoriasis in one form or another. Scalp psoriasis is a type of psoriasis that appears on or around the scalp.

More than half of people with psoriasis may have it on their scalp. In this article, I’ll explore what scalp psoriasis is, its symptoms, causes, and potential treatment options.

I’ll also cover ways to manage it, possible complications, and how to know when you should see a doctor.

What is Scalp Psoriasis?

Psoriasis is a chronic inflammatory autoimmune condition. It can affect the skin, certain organs, or joints.

The scalp is a common place for psoriasis to appear. Scalp psoriasis appears as itchy, scaly plaques that may appear reddish, pink, purple, tan, or dark brown.

Scalp psoriasis can affect:

• Top of the head
• Hairline
• Forehead
• Ears
• Back of neck

Symptoms

Common symptoms of scalp psoriasis include:

• Itchiness
• Dry, flaky skin patches
• Discoloration on skin patches
• Burning sensation or other pain signals
• Hair loss in affected areas

In mild cases, it may cause little or no symptoms.

Types of psoriasis

Because psoriasis is an autoimmune disorder, it may not just affect one area of the body. A patient can have psoriasis in just one area, or in many areas.

The different types of psoriasis are classified as either pustular psoriasis or non-pustular psoriasis.

Non-pustular psoriasis is the most common and includes subtypes that affect different areas of the body, such as:

• Scalp psoriasis (head, ears, neck)
• Psoriatic arthritis (joints)
• Guttate psoriasis is (arms, legs, and chest)
• Palmoplantar psoriasis (palms of hands and soles of feet)
• Inverse psoriasis (folds of the skin)
• Erythrodermic psoriasis (whole body, the most severe type)

Scalp psoriasis vs. dandruff

Scalp psoriasis can look like dandruff, which is medically known as seborrheic dermatitis (sometimes referred to as scalp eczema). It is possible to misdiagnose scalp psoriasis as common dandruff, especially if hair blocks a complete view, or if there is an excessive buildup of dead skin cells.

The difference between the two is that psoriasis is caused by an autoimmune disease and dandruff may be caused by many different factors, such as:

• Side effects of other medical conditions
• Irritation from shampoo, condition, or hair products
• Stress
• Dietary changes or deficiencies
• Cold, dry weather
• Oily scalp
• Fungal infection
• Alcohol use disorder

Causes

Scalp psoriasis is an autoimmune disease that is triggered when the body mistakenly starts to treat skin tissue as a pathogen. The immune system directs inflammation at the scalp.

Usually, new cells take weeks to form, but with the inflammatory barrage from psoriasis, new skin cells form more rapidly. The condition also makes it hard to slough off old skin cells.

This results in the build-up of characteristic psoriasis patches. As with many autoimmune conditions, an exact cause is not clearly understood.

But researchers think that both genetics and altered immune function play a role. Scalp psoriasis may also be more common in people who have other autoimmune disorders, nutritional deficiencies, or factors that can increase the body’s inflammatory response.

These can include:

• Sedentary lifestyle
• Celiac disease
• Nutritional deficiencies
• Obesity

In some cases, psoriasis can be triggered as a side effect of certain medications, such as:

• Beta-blockers
• Antimalarial drugs like chloroquine
• Lithium
• Oral steroids
• Chemotherapy drugs
• Arthritis medications
• Antiviral medications
• Medications for skin conditions
• Monoclonal antibodies

Treatments

Scalp psoriasis may be more challenging to treat than psoriasis in other locations primarily because hair can get in the way.

While there is no cure, there are some options to help address symptoms.

Over-the-counter (OTC)

Over-the-counter (OTC) treatment options can include topical shampoos or solutions. These typically work best when they are rotated, so that they do not lose effectiveness.

OTC scalp psoriasis treatment options include one or more of the following active ingredients:

• Salicylic acid to reduce scales. However, it can also lead to hair breakage with excessive use.

• Aloe vera may help with discoloration and scale buildup. There is little potential for side effects when aloe is used topically.

• Capsaicin may be helpful for pain associated with scalp psoriasis, but it is not known whether this is safe to use long-term.

Prescription

Moderate or severe scalp psoriasis may require a prescription medication. In some cases, you can continue using OTC treatments but check with your healthcare provider first.

Typical prescriptions for scalp psoriasis include:

• Topical steroid creams/ointments, such as clobetasol, betamethasone, and halobetasol. These can reduce symptoms during a flare, but are only intended for short-term use, no longer than 4 weeks at a time. Long-term steroid use can cause thin skin and increase the risk of complications. These products should not be used on the face.

• Steroid injections may be used if topical products do not work, but this is usually only for the most severe cases.

• Prescription topicals that include nutrients like vitamin A or vitamin D may also be used to slow how quickly the skin replaces new cells, as well as to remove scales and address itchiness or inflammation. These can include tazarotene, anthralin, and calcipotriene.

Systemic and biologic treatment

When scalp psoriasis does not respond to topical treatment, or a patient shows signs that psoriasis may be active in other areas of the body, a healthcare provider may recommend systemic or biologic therapies.

These work to reduce inflammation and address underlying causes, but may take more time before they reduce symptoms.

Most often, these are given via injection or infusion. Biologic or biosimilar treatments target specific areas of the immune system.

These types of medications include:

• Secukinumab (Cosentyx)
• Adalimumab (Humira)
• Guselkumab (Tremfya)

As with other treatments for autoimmune disorders, these may come with side effects that include:

• Increased risk of infection or suppressed immune function
• Flu-like symptoms

Systemic drugs target the whole immune system and are reserved for more severe cases since they come with more risks and side effects.

These treatments include:

• Acitretin
• Cyclosporine
• Methotrexate
• Phosphodiesterase-4 inhibitors

These drugs may be given via injection or some may be available orally.

Phototherapy

Phototherapy involves exposing the scalp to a laser ultraviolet light that emits UVB rays. Treatment is available at some hospitals or clinical centers, such as a dermatology office.

Treatment courses are often 3 times per week for 6-8 weeks. This method can be effective as an alternative therapy or used in combination with other methods.

Management Tips

Whether you use OTC treatments or get prescription therapy, there are also other things you can do to manage scalp psoriasis.

• Be gentle with your scalp. Even if it itches, scratching can lead to skin breaks and infections that may take longer to heal. Use cooler water when you shower, which can reduce how dry the scalp gets, and can be gentler for fragile hair.

• Avoid things that trigger stress, which can play a role in psoriasis flare-ups.

• Be consistent with OTC or prescription treatments. Most of them only take effect if they are used regularly.

Potential Complications

Having psoriasis can increase the risk of complications with other health conditions. Since psoriasis is an autoimmune disorder, this can lead to a higher risk of developing another autoimmune disease or conditions relating to inflammation or immune problems.

Some common overlapping complications with psoriasis include:

• Type 2 diabetes
• Obesity
• Crohn’s disease
• Depression
• Heart disease or heart attack
• Eye inflammation (uveitis)
• Arthritis

When to See a Healthcare Provider

If you develop a new rash or scaly skin, see a healthcare provider. Even if you suspect that the condition is scalp psoriasis, getting a proper diagnosis can ensure that you get effective treatment.

Sometimes scalp psoriasis is confused with dandruff or other types of eczema, which may not always respond to the same treatments.

A healthcare professional will be able to diagnose the condition and recommend appropriate treatments based on symptoms and other medical conditions you may have.

How K Health Can Help

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