What is Psoriasis of the Scalp?
Scalp Psoriasis of the scalp, also known as scalp psoriasis, is a common skin condition that causes red, itchy, flaky patches on the scalp. It occurs when skin cells multiply faster than normal, leading to a buildup of scales and inflammation.
Psoriasis can occur on any part of the body, but the scalp is one of the most common sites. Up to 80% of people with psoriasis have it on their scalp.
The main symptoms of scalp psoriasis include:
Red, inflamed areas with silvery-white scales that peel off easily. These patches often extend beyond the hairline onto the forehead, back of neck, or around the ears.
Dryness, itching, burning, soreness, and tenderness. Itching is common and scratching can make symptoms worse.
Flaking and shedding of dead skin cells (dandruff). Scalp psoriasis causes thicker scales that sometimes need to be removed by hand.
Hair loss. Psoriasis does not cause permanent baldness, but repeated inflammation and scratching can damage hair follicles and lead to temporary hair loss.
Bleeding points on the scalp if the affected skin cracks due to dryness and irritation.
The severity of scalp psoriasis can range from a few scattered plaques to involvement of the entire scalp. Symptoms may come and go in cycles known as flares and remissions. Triggers like stress, illness, weather changes, and skin injuries can worsen flares.
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.
Causes and Risk Factors
Psoriasis of the scalp is not contagious. While the exact cause is unknown, research suggests it’s an immune system disorder with a genetic component that can be triggered by environmental factors.
Genetics
Having a family history of psoriasis significantly increases your risk. Around 40% of people with psoriasis have a family member with the condition. Certain genes are associated with psoriasis and can be inherited. However, the condition requires a combination of genetic and environmental triggers to develop.
Stress
Stress is a common trigger for psoriasis flares. Stress causes inflammation and can prompt the overproduction of skin cells. Managing stress levels through relaxation techniques may help prevent flare-ups.
Infections
Infections, especially strep throat, can trigger psoriasis outbreaks. The immune system responds to infections by increasing inflammation, which can worsen psoriasis.
Weather
Cold, dry weather can worsen psoriasis symptoms. Winter flares are common. The cold air dries out the skin, allowing plaques to form. Humid summer weather may provide some relief.
Other Factors
Skin injuries, smoking, obesity, and heavy alcohol consumption have been associated with psoriasis flares. However, more research is needed to confirm these as definite triggers.
Diagnosis
Diagnosing psoriasis of the scalp typically involves a physical exam and review of your medical history by a dermatologist. The doctor will look for key signs of psoriasis, including red, scaly patches and silvery-white scales.
During the physical exam, the dermatologist will examine the entire scalp. They may gently scrape off some of the scale and look at it under a microscope to rule out other conditions like seborrheic dermatitis or ringworm.
Your medical history can provide clues, especially if you have psoriasis in other areas of your body. About half of people with plaque psoriasis have it on their scalp.
Sometimes a biopsy is needed to confirm the diagnosis. This involves numbing the area, taking a small sample of the affected skin, and examining it under a microscope. A biopsy can help rule out other potential causes like skin cancer.
Overall, a combination of a thorough physical exam, medical history review, and possibly a biopsy allows the dermatologist to diagnose psoriasis of the scalp.
Treatment Options
Scalp Psoriasis of the scalp can often be difficult to treat due to the hair covering the affected skin. However, there are several effective treatment options available:
Topical Creams and Ointments
Topical corticosteroid creams and ointments are commonly prescribed to reduce inflammation and itching associated with scalp psoriasis. They come in varying strengths depending on severity. These medications work by reducing the overproduction of skin cells. Examples include betamethasone, clobetasol, and triamcinolone.
Calcipotriene is a topical vitamin D-based cream that helps slow skin cell growth. It is often used along with topical corticosteroids.
Coal tar is another topical treatment derived from coal that helps slow skin cell growth and reduce scaling, inflammation, and itching. It comes in various forms including shampoos, solutions, and ointments.
Shampoos
Medicated shampoos containing ingredients like salicylic acid, coal tar, or corticosteroids can help treat scalp psoriasis by reducing scaling and itching. These shampoos are massaged into the scalp and left on for several minutes before rinsing out.
Light Therapy
Exposing the affected areas of the scalp to ultraviolet light under medical supervision can help treat psoriasis. Phototherapy helps slow skin cell growth. Types of light therapy include UVB phototherapy and excimer laser.
Oral Medications
For moderate to severe psoriasis that has not responded to other treatments, oral systemic medications may be prescribed. This includes drugs like methotrexate, cyclosporine, acitretin, and biologics like adalimumab or etanercept. They work by targeting overactive immune responses underlying psoriasis. Side effects need to be closely monitored.
Home Remedies
Some natural remedies may help relieve scalp psoriasis symptoms, often with fewer side effects than prescription medications. However, always check with your doctor before trying new treatments. Home remedies to consider include:
Apple Cider Vinegar
The acetic acid in apple cider vinegar has antibacterial and anti-inflammatory properties that may help treat scalp psoriasis. Dilute apple cider vinegar with an equal amount of water. Apply it to the scalp with a cotton ball, leave it on for a few minutes, then rinse. Repeat 1-2 times per day. The vinegar smell fades quickly.
Tea Tree Oil
Tea tree oil has antifungal, antibacterial and anti-inflammatory effects. Dilute a few drops with a carrier oil like coconut or jojoba oil. Use a cotton swab to apply to psoriasis lesions. Rinse after 10-15 minutes. Use once a day. Tea tree oil can cause irritation in some people.
Aloe Vera
The soothing gel from aloe vera plants can help reduce redness, scaling, itching and inflammation. Break open a leaf and apply the gel directly to psoriasis patches. Rinse after 30 minutes. Aloe vera gel is safe to use 1-2 times per day. Look for products containing at least 50% aloe.
While these remedies may help, talk to your dermatologist before relying solely on natural treatments. More effective medical options are often available. Home remedies can provide supplemental relief and are very gentle on the scalp.
Complications
Psoriasis of the scalp can sometimes lead to complications, including:
Temporary Hair Loss
The inflammation and rapid skin turnover caused by scalp psoriasis can result in temporary hair loss in the affected areas. The hair usually grows back once the flare-up is treated and resolves. However, the hair loss can be distressing cosmetically during the flare.
Eye Problems
If psoriasis occurs on the forehead, ears or back of the neck, the inflammation can spread to the eyelids and cause conjunctivitis. This is called blepharitis and causes red, itchy, irritated eyes. Treating the scalp psoriasis can help resolve the eye inflammation.
Psoriatic Arthritis
Some people with scalp psoriasis develop psoriatic arthritis, which causes pain, stiffness and swelling in the joints. Psoriatic arthritis may affect any part of the body, such as hands, knees or spine. Getting psoriatic arthritis under control is crucial to prevent joint damage.
Living with Psoriasis
Living with psoriasis of the scalp can be challenging, but there are ways to cope and find support.
Coping Strategies
Identify and avoid triggers that may worsen symptoms. Common triggers include stress, skin injuries, certain medications, and excessive alcohol consumption.
Use relaxation techniques such as meditation, yoga, or deep breathing exercises to help manage stress. Stress can exacerbate psoriasis.
Try not to scratch, pick or rub affected areas. This can worsen inflammation and cause skin injuries.
Apply moisturizer after washing to avoid dryness and itching. Choose gentle, fragrance-free moisturizers.
Wear loose, breathable clothing and avoid wool which can irritate skin.
Use a humidifier to add moisture to overly dry indoor air.
Protect scalp from sun exposure which can worsen symptoms for some people.
Educate yourself about the condition and treatment options.
Support Groups
Joining a support group can help people share experiences and tips for coping with psoriasis. Both in-person and online support groups exist.
Talking with others who understand the challenges of living with psoriasis can provide emotional support.
Talk to Your Doctor
Inform your doctor about any lifestyle changes or alternative remedies you want to try. They can provide guidance on safety and effectiveness.
Discuss any concerns about treatment plans and options. Do not stop prescribed treatments without consulting your doctor.
Report any significant changes in symptoms. New or worsening symptoms may require evaluation.
Ask your doctor to connect you with counseling services or a support group if needed.
Outlook and Prognosis
Psoriasis of the scalp is a chronic condition that causes red, itchy, and scaly patches on the scalp. There is no cure for psoriasis, but it can go through cycles where symptoms flare up for a period of time and then subside. With proper treatment, most people with scalp psoriasis can keep their symptoms under control.
Treatments such as medicated shampoos, topical creams, light therapy, and oral medications can provide relief from scalp psoriasis symptoms. While symptoms may come and go, these treatments need to be used on an ongoing basis to manage the condition. Some trial and error with different treatments may be needed to find the most effective approach.
People with scalp psoriasis are at increased risk for developing psoriatic arthritis, which causes joint pain and swelling. There is also an association between scalp psoriasis and an increased risk of cardiovascular disease. With proper management of scalp psoriasis and attention to overall health, the outlook can be positive. It’s important for people with this condition to see their doctor regularly.
Prevention
There is no known way to prevent psoriasis. However, you may be able to manage potential triggers that can cause flare-ups or worsen symptoms.
Stress
Stress is one of the most common triggers for psoriasis flare-ups. Finding healthy ways to manage stress through exercise, meditation, therapy, or other stress-reducing practices may help prevent flare-ups.
Infections
Infections, especially strep throat, can trigger psoriasis flare-ups. Seeking prompt treatment for infections and practicing good hygiene may help prevent flare-ups.
Weather
Cold, dry weather can worsen psoriasis symptoms. Keeping the skin moisturized and protected with creams, lotions, or protective clothing may help minimize flare-ups during colder months.
Skin Injuries
Cuts, scrapes, sunburns, and other skin injuries can trigger psoriatic flare-ups. Taking care to avoid skin damage and keeping scrapes and cuts clean and protected can potentially prevent flare-ups.
Alcohol
Drinking alcohol, especially in excess, is a common psoriasis trigger. Limiting alcohol intake may help some people reduce flare-ups.
While psoriasis cannot be prevented, being aware of your personal triggers and taking steps to avoid or minimize them can go a long way in managing flare-ups. Working closely with your doctor can help identify and reduce potential triggers.
When to See a Doctor
Psoriasis of the scalp is typically mild and can often be managed with over-the-counter treatments. However, you should see your doctor if your scalp psoriasis:
Is not improving with over-the-counter treatments after 2-4 weeks of consistent use. Prescription medications may be required for more stubborn cases of scalp psoriasis.
Causes joint pain. Some people with psoriasis can develop psoriatic arthritis, which causes joint pain and swelling. Let your doctor know if you experience any joint symptoms.
Shows signs of infection, such as pus, fever, increased swelling, warmth and redness. Scalp psoriasis can open the skin and allow bacteria to enter, leading to infection. See your doctor right away if you notice signs of infection.
Getting prompt medical care is important if your scalp psoriasis is worsening or not responding to treatment. Your doctor can help get your symptoms under control.
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