Psoriasis Australia

Scalp Psoriasis

Scalp psoriasis is a common form of psoriasis, a chronic autoimmune skin condition characterized by the rapid turnover of skin cells, leading to the formation of thick, scaly plaques.

Overview

Scalp psoriasis is a common form of psoriasis, a chronic autoimmune skin condition characterized by the rapid turnover of skin cells, leading to the formation of thick, scaly plaques. When psoriasis affects the scalp, it can range from mild scaling to severe crusting, potentially extending beyond the hairline to the forehead, back of the neck, and around the ears.

Symptoms

The symptoms of scalp psoriasis can vary in severity and may include:

  • Red patches: These patches of skin are often covered with thick, silvery-white scales.
  • Itching: Itching can be intense and may lead to scratching, which can cause bleeding, infection, and temporary hair loss.
  • Dry scalp: Scalp psoriasis often results in a dry, flaky scalp, similar to dandruff but more severe.
  • Burning or soreness: Some patients experience a burning sensation or soreness on the scalp.
  • Temporary hair loss: Although psoriasis does not directly cause hair loss, excessive scratching, stress, and certain treatments can lead to temporary hair loss.

Causes

Scalp psoriasis shares the same underlying causes as psoriasis in other parts of the body. The exact cause is unknown, but it is believed to involve a combination of genetic predisposition and environmental factors. The immune system mistakenly attacks healthy skin cells, leading to an accelerated production cycle of skin cells that accumulate and form plaques.

Triggers

Common triggers for scalp psoriasis include:

  • Stress: Emotional or physical stress can trigger or worsen scalp psoriasis.
  • Injury to the scalp: Cuts, scrapes, or severe sunburn on the scalp can lead to the development of new psoriatic lesions, a phenomenon known as the Koebner effect.
  • Infections: Certain infections, particularly streptococcal throat infections, can trigger flare-ups.
  • Medications: Certain medications, including lithium, beta-blockers, and antimalarial drugs, can worsen psoriasis.
  • Weather: Cold, dry weather can exacerbate symptoms, while sunlight may improve them in some cases.

Diagnosis

Scalp psoriasis is typically diagnosed based on a clinical examination of the affected area. A dermatologist may identify the condition by its appearance. In some cases, a biopsy may be performed to confirm the diagnosis and rule out other conditions like seborrheic dermatitis, which can have similar symptoms.

Treatment Options

Treatment for scalp psoriasis aims to reduce inflammation, remove scales, and prevent flare-ups. Options include:

  1. Topical Treatments

    • Corticosteroids: These are often the first line of treatment for mild to moderate scalp psoriasis. They help reduce inflammation and itching. Available in various forms, including shampoos, creams, and ointments.
    • Vitamin D Analogues: Calcipotriol is a synthetic form of vitamin D that helps to slow down skin cell growth. It is often used in combination with corticosteroids.
    • Coal Tar: An old but effective treatment, coal tar can reduce scaling, itching, and inflammation. It is available in shampoos and other topical formulations.
    • Salicylic Acid: This keratolytic agent helps soften and remove scales, making it easier for other medications to penetrate the skin.
    • Calcineurin Inhibitors: Although not specifically approved for psoriasis, medications like tacrolimus and pimecrolimus can be used off-label for sensitive areas such as around the hairline.

  2. Phototherapy

    • UVB Light Therapy: This involves exposing the scalp to ultraviolet B (UVB) light, which can slow down the rapid production of skin cells. This treatment is often administered in a clinical setting.
    • Excimer Laser: A form of targeted phototherapy that delivers a high dose of UVB light directly to the affected areas, reducing the risk of damage to surrounding healthy skin.

  3. Systemic Treatments

    • Oral Medications: For severe cases, oral medications such as methotrexate, cyclosporine, or acitretin may be prescribed to reduce the immune system’s activity.
    • Biologic Agents: Biologics target specific parts of the immune system. They are used in moderate to severe cases of psoriasis and can be very effective in reducing symptoms.

  4. Home Remedies

    • Moisturizers: Regular use of moisturizers can help keep the scalp hydrated, reduce itching, and prevent scaling.
    • Medicated Shampoos: Over-the-counter shampoos containing ingredients like coal tar, salicylic acid, or zinc pyrithione can be effective in managing mild scalp psoriasis.

Living with Scalp Psoriasis

Scalp psoriasis can be challenging due to its visibility and the discomfort it causes. Patients are encouraged to manage stress, follow a regular treatment routine, and seek support from healthcare providers or support groups. It’s also important to avoid scratching the scalp, as this can worsen symptoms and lead to complications like infection.

Prognosis

While scalp psoriasis is a chronic condition with no cure, most people can manage their symptoms effectively with treatment. Flare-ups can be controlled, and many patients experience periods of remission.