Written by Dr. Pradeep

Scalp Psoriasis

Scalp psoriasis is an autoimmune condition. It causes raised, discolored plaques on your scalp or on the skin around your scalp that may be dry, itchy and irritating. Prescription and over-the-counter medications can alleviate your symptoms.

What is scalp psoriasis?

Scalp psoriasis (sore-eye-uh-sis) is a long-lasting (chronic) autoimmune disease (caused by your own immune system) that causes your skin cells to reproduce too quickly. It creates thick, discolored patches of skin (plaques) on your scalp and other areas around your scalp. These areas may include

• Your hairline.
• Your forehead.
• The back of your neck.
• The skin around your ears.

Who does scalp psoriasis affect?

Scalp psoriasis can affect anyone. But you may be more likely to have scalp psoriasis if you

• Drink alcohol.
• Have stress or depression.
• Have obesity.
• Smoke or use tobacco products.
• Take your medications infrequently.
• Have other autoimmune diseases.

How common is scalp psoriasis?

Psoriasis affects about 7.5 million people in the United States. About half of those have scalp psoriasis at any given time; though most people with psoriasis have at least one flare of scalp psoriasis, and 80% to 90% of people with psoriasis have plaque psoriasis.

How does scalp psoriasis affect my body?

Scalp psoriasis causes thick, rough, scaly, dry, discolored plaques to develop on your scalp and the skin around your scalp. The plaques can be itchy or painful. Scalp psoriasis can cause hair loss (alopecia), and scratching your plaques may worsen that hair loss.

Scalp psoriasis can make you worry about how others look at you. It can also affect your behavior and how you think about yourself. You may become self-conscious or experience stress, anxiety and depression.

What are the symptoms of scalp psoriasis?

Symptoms of scalp psoriasis vary.

Mild scalp psoriasis symptoms may involve only small, thin scales or flaking that looks like dandruff.

Moderate or severe scalp psoriasis symptoms include

• Raised, discolored (red, brown, gray or purple) plaques with a white or silvery surface of dead skin cells.
• Plaques on most of your scalp or your entire scalp.
• Plaques along your hairline, forehead, the back of your neck or on the skin around your ears.
• Dryness.
• Skin flakes.
• Itching.
• Cracks (fissures).
• Bleeding.
• Irritation or pain.

What causes scalp psoriasis?

Scalp psoriasis is an immune system disease. Your immune system overreacts, causing inflammation, which leads to new skin cells growing too fast.

Typically, new skin cells grow every 28 to 30 days. But in people with scalp psoriasis, new skin cells grow and move to the skin surface every three to four days. The buildup of new cells replacing old cells creates thick patches of skin.

Scalp psoriasis can runs in families, but the actual triggers are complex. Parents may pass it down to their children, and environmental exposures can include skin trauma, sunburn, medications, stress and other inflammatory or autoimmune health conditions.

Is scalp psoriasis contagious?

No, scalp psoriasis isn’t contagious. You can’t spread scalp psoriasis to another person through skin-to-skin contact.

DIAGNOSIS AND TESTS

How is scalp psoriasis diagnosed?

Your healthcare provider will examine your scalp and the remainder of your skin to look for signs of psoriasis. They’ll also ask about your symptoms, your family history and if you’ve recently started or stopped using a medication or hair product just before your flare-up.

What tests will be done to diagnose scalp psoriasis?

Your healthcare provider may perform several tests to rule out other conditions that could cause your symptoms, such as scalp fungal infection, eczema or seborrheic dermatitis (dandruff). The tests may include

• Allergy test.
• Biopsy.
• Blood tests to check for causes of a rash unrelated to scalp psoriasis.

MANAGEMENT AND TREATMENT

Is there a cure for scalp psoriasis?

There isn’t a cure for scalp psoriasis. You may have flare-ups and times where the plaques go away (remission). Treatment can provide relief for your symptoms and can include UV light or medications that can be directly applied to the lesions, injected into the lesions or taken by mouth.

Should I avoid any foods or drinks if I have scalp psoriasis?

Certain foods or drinks may contribute to scalp psoriasis flare-ups. If you have scalp psoriasis, it’s a good idea to keep track of what you eat and drink in a food journal. Keeping track of what you eat and drink can help you and your healthcare provider determine any causes of your flare-ups.

An anti-inflammatory diet may limit your scalp psoriasis flare-ups. Foods that have anti-inflammatory properties include

• Oily fish, such as mackerel, salmon or sardines.
• Leafy greens, such as spinach and kale.
• Olive oil.

Foods and drinks that may cause flare-ups include

• Alcohol.
• Dairy, including cow’s milk, and eggs.
• Citrus fruits, including lemons, limes and oranges.
• Gluten (a protein found in many foods, especially wheat).
• Nightshade vegetables, including peppers, potatoes and tomatoes.

What medications or treatments are used to treat scalp psoriasis?

Your healthcare provider may prescribe the following as a cream, lotion or gel to treat mild cases of scalp psoriasis

• Corticosteroids.
• Coal tar.
• Salicylic acid lotion or shampoo.
• Anthralin.

In more severe or widespread cases of scalp psoriasis, your healthcare provider may prescribe:

• Medicine injections. Your healthcare provider will use a thin needle to inject medicine into your skin, a vein in your arm or directly into your plaques. These medicines may include adalimumab, etanercept or ustekinumab.
• Oral medicines. Oral medicines are pills or tablets you swallow with water. These medicines may include acitretin, cyclosporine or methotrexate.
• Phototherapy. Phototherapy uses ultraviolet light (UV), usually ultraviolet B (UVB), from special lamps. The ultraviolet light waves in sunlight can help certain skin disorders, including scalp psoriasis.

Treating scalp psoriasis may be difficult. Your body is unique, and it might not respond to certain treatments. Talk to your healthcare provider about the best treatment for you.

Are there any home remedies for scalp psoriasis?

While home remedies are safe for most people, it’s a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.

• Aloe vera. Aloe vera is a wound care gel. It can keep your skin hydrated while treating itchiness and irritation. Gently apply aloe vera to your plaques two to three times per day.
• Baking soda. Mix 2 teaspoons of baking soda with a small amount of warm water to make a paste. Gently apply the paste to your plaques and leave it on for up to 10 minutes to treat itchiness and irritation. Baking soda’s gritty texture also helps remove dead skin cells (exfoliates). Gently rub it on your affected areas to soften your plaques.
• Coconut oil. Coconut oil moisturizes your skin. It also contains anti-inflammatory and antibacterial properties that help reduce inflammation.
• Olive oil. Olive oil helps moisturize your dry skin and minimize irritation and itching.

How do I manage my symptoms?

• Take any OTC or prescription medications and products as recommended by your healthcare provider, including antihistamines for severe itching.
• Bathe or shower in lukewarm — not hot — water. Limit the amount of time you spend in the water to under 15 minutes and apply moisturizers or emollients immediately after lightly toweling dry.
• Use conditioner every time you wash your hair to keep your scalp and hair moisturized.
• Gently comb your hair to avoid causing irritation.
• Moisturize your scalp or affected areas several times a day using a cream or ointment, including after your bath or shower.
• Avoid wearing hats or other headwear unless necessary – you generally don’t want to cover your plaques so your scalp can breathe.

How soon after treatment will I feel better?

It may take up to eight weeks or longer for your symptoms to start going away. It’s important to use any medications or treatments as directed by your healthcare provider, even if your plaques go away.

PREVENTION

How can I prevent scalp psoriasis?

If you have scalp psoriasis, it may come and go throughout your life and there isn’t any way to completely prevent it. Following a healthy anti-inflammatory lifestyle can help make it less severe or less frequent, though. Treatments can reduce symptoms, even in people with severe scalp psoriasis.