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Scalp Psoriasis

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Updated June 10, 2014

USA, New Jersey, Jersey City, Rear view of woman with hand in her hair
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Scalp psoriasis is a bothersome condition to many. In fact, about 50% of patients with psoriasis have it. The severity of flaking can range from fine dandruff-like flakes to plaques with thick, adherent scales. Scalp psoriasis can often extend beyond the hairline down the forehead onto the face, and the backs of the ears are often involved.

The Impact of Scalp Psoriasis

The severe scaling and flaking can make wearing dark clothing impossible. Many become so bothered by the condition that they, at times, experience embarrassment and emotional distress.

Some patients worry that scalp psoriasis will cause them to lose their hair. While excessive scratching may lead to hair loss in unusual cases, hair loss is not a hallmark of the condition.

Diagnosing Scalp Psoriasis

Differentiating scalp psoriasis from other causes of scalp flaking can be done by physical exam. A doctor will look for nail pits and psoriasis elsewhere on the body, though he may also conduct testing (such as skin biopsy) to come to a final diagnosis.

Treating Scalp Psoriasis

Medications
The medications used to treat scalp psoriasis have the same ingredients as those used to treat body psoriasis, but the vehicles used differ. Heavy creams and ointments are usually too difficult and messy for scalp application, so liquids, foams, shampoos, or oils are recommended.

Drugs that are useful for scalp psoriasis, and that your doctor may recommend, include:

Biologics and other systemic drugs, those taken within the body instead of applied topically, are also useful for the treatment of scalp psoriasis.

A 10-day course of the antifungal pill ketoconazole can be surprisingly effective at temporarily clearing up stubborn scalp psoriasis, although use of this drug for this condition is considered off-label.

Light Therapy
There are phototherapy devices with comb-like attachments designed for scalp treatment, too. However, I personally don't like to use them in my practice because monitoring the scalp for skin cancer that can occur as result of the devices' ultraviolet radiation is difficult.

Scalp psoriasis usually responds to the same treatments used for psoriasis elsewhere on the body. It may be expensive to buy the same drug in two different formulations (Dovonex cream for the body and Dovonex liquid for the scalp, for example), but this is a reality that many patients with these conditions face when working to treat them effectively. Patients who have been prescribed corticosteroid gels or foams may be able to use the same medication for both body and scalp.

Source:

Camisa C. Handbook of Psoriasis, 2nd Ed. Blackwell Publishing, USA 2004.

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  5. Psoriasis by Body Region
  6. Treatment Options for Scalp Psoriasis

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