Scalp psoriasis is one of the most common areas affected by psoriasis. In a large study of 730 psoriasis patients, 91.3% had scalp involvement (1). This makes scalp involvement almost universal among people with the condition.

What Is Scalp Psoriasis?

Scalp psoriasis occurs when your immune system causes skin cells on your scalp to grow too quickly. This leads to thick, scaly patches that can be itchy and uncomfortable. Like other types of psoriasis, it’s caused by problems with your immune system rather than poor hygiene or infection.

When doctors examine scalp psoriasis closely with special magnifying tools, they see red dots and twisted red loops (2).

Common Symptoms of Scalp Psoriasis

People with scalp psoriasis often experience several symptoms that can affect their daily life.

The most common physical symptoms include:

  • Thick, scaly patches on the scalp
  • Red or inflamed areas
  • Itching that can range from mild to severe
  • Flaking that may look like severe dandruff
  • Dry scalp that may crack and bleed

Doctors measure scalp psoriasis using a special scale called the Psoriasis Scalp Severity Index (PSSI). This helps them track how well treatments are working (1).

Who Gets Scalp Psoriasis?

Scalp psoriasis is extremely common among people with psoriasis. It affects people of all ages and backgrounds.

In a large study of 730 psoriasis patients, 91.3% had scalp involvement (1).

Fact
Over 9 out of 10 people with psoriasis will experience scalp involvement. This makes the scalp one of the most commonly affected areas in psoriasis.

Diagnosing Scalp Psoriasis

Doctors can usually diagnose scalp psoriasis by looking at your scalp. However, special tools can help them see the condition more clearly.

Dermoscopy is a tool that magnifies the skin. When doctors use this tool on scalp psoriasis, they can see:

  • Red dots that are regularly distributed across affected areas
  • Twisted red loops that represent blood vessels
  • White or yellow scales on a red background

These features help doctors confirm the diagnosis and tell scalp psoriasis apart from other scalp conditions (2).

Impact on Quality of Life

Scalp psoriasis can significantly affect how people feel about themselves and their daily activities. The visible flaking and scaling can be embarrassing, especially when flakes fall onto clothing.

Many people with scalp psoriasis adjust their lifestyle to cope with the condition. They may:

  • Avoid dark clothing to hide flakes
  • Change their hairstyle to cover affected areas
  • Limit social activities due to embarrassment

Understanding these impacts is important for both patients and healthcare providers.

Treatment Options for Scalp Psoriasis

Several treatments have been proven effective for scalp psoriasis. The choice of treatment depends on how severe your condition is and how you respond to different therapies.

Topical Treatments for Scalp Psoriasis

The first line of treatment for scalp psoriasis usually involves medications applied directly to the scalp.

Corticosteroids

Strong corticosteroids are the most effective topical treatments for scalp psoriasis (3). These medications reduce inflammation and slow down the rapid growth of skin cells.

Combination Treatments

Combining corticosteroids with vitamin D preparations can be especially effective. These combination treatments work in two ways:

  • The corticosteroid reduces inflammation
  • The vitamin D helps normalize skin cell growth

Studies show these combinations are among the top treatments for scalp psoriasis (3).

Tip
When using topical treatments on your scalp, part your hair in sections to ensure the medication reaches your skin, not just your hair. Apply treatments before bed to give them time to work overnight.

Systemic and Biologic Treatments

For people with moderate to severe scalp psoriasis, treatments that work throughout the body may be necessary.

Adalimumab

Adalimumab is a biologic medication that has shown excellent results for scalp psoriasis. In the BELIEVE study, patients with scalp psoriasis who took adalimumab experienced dramatic improvements. Half of the patients had complete clearing of their scalp psoriasis, with an average improvement of 77.2% after 16 weeks (1).

Response Rates with Biologics

Patients with scalp psoriasis respond similarly to adalimumab treatment as those without scalp involvement. About 68.2% of patients with scalp psoriasis achieved a PASI 75 response (75% improvement in psoriasis) at week 16 (1).

Managing Scalp Psoriasis Long-Term

Successfully managing scalp psoriasis often requires a combination of treatments and lifestyle adjustments.

Treatment Considerations

Different treatments work better for different people. What helps one person might not work as well for another. This is why doctors often try several approaches to find what works best for each individual patient.

Some people find that certain vitamins and minerals or supplements help support their overall treatment plan. Others explore herbal remedies as complementary approaches.

Lifestyle Factors

Many people with scalp psoriasis find that stress, diet, and other lifestyle factors can affect their symptoms. Following a psoriasis-friendly diet may help some people manage their overall condition better. Some also find relief with gentle home remedies between medical treatments.

Warning
Never stop prescribed treatments without talking to your doctor first. Even if your scalp psoriasis improves, stopping treatment suddenly can cause symptoms to return worse than before.

Special Considerations for Hair Care

Having scalp psoriasis requires special attention to hair care routines.

People with scalp psoriasis should:

  • Use lukewarm water instead of hot water when washing hair
  • Choose gentle, fragrance-free shampoos
  • Avoid harsh hair treatments like perms or color treatments during flares
  • Be gentle when brushing or combing to avoid injuring the scalp
  • Consider shorter hairstyles that make treatment application easier

When to Seek Medical Help

While mild scalp psoriasis can sometimes be managed with over-the-counter treatments, you should see a doctor if:

  • Your scalp psoriasis covers a large area
  • The itching interferes with sleep or daily activities
  • You notice hair loss in affected areas
  • Over-the-counter treatments aren’t helping after several weeks
  • You develop signs of infection like increased redness, warmth, or pus

Future Treatment Directions

Research into scalp psoriasis treatments continues to advance. Scientists are studying new ways to deliver medications to the scalp more effectively and developing new biologic treatments that target specific parts of the immune system.

The high prevalence of scalp involvement in psoriasis means that improving scalp treatments remains a priority for researchers. As our understanding of psoriasis grows, new and better treatments for scalp psoriasis are likely to become available.

Conclusion

Scalp psoriasis affects more than 9 out of 10 people with psoriasis, making it one of the most common manifestations of the disease. While it can be challenging to treat due to the presence of hair, effective options are available.

From topical corticosteroids and vitamin D combinations to biologic medications like adalimumab, treatments can significantly improve scalp psoriasis. The key is working with your healthcare provider to find the right approach for your specific situation.

Remember that scalp psoriasis is a medical condition, not a result of poor hygiene. With proper treatment and care, most people can achieve good control of their scalp symptoms and maintain their quality of life. If you’re struggling with scalp psoriasis, don’t hesitate to seek help from a dermatologist who can create a personalized treatment plan for you.

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