What is Scalp Psoriasis?
Scalp psoriasis is a chronic autoimmune condition that causes raised, red, scaly patches to appear on the scalp. It is a form of plaque psoriasis, the most common type, that develops in areas with more rapid skin turnover like the scalp, elbows, and knees.
With scalp psoriasis, skin cells grow too quickly and pile up on the surface of the skin before they have a chance to mature. This causes psoriatic plaques to form which are areas of thick, red skin covered with silvery-white scales. The plaques are often itchy or sore and can crack and bleed if scratched.
Scalp psoriasis is not contagious and while symptoms can range from mild to severe, it is not life-threatening. However, it can significantly impact quality of life. Around half of people with plaque psoriasis have it on their scalp.
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.
Symptoms and Causes
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.
Symptoms of Scalp Psoriasis
Scalp psoriasis commonly causes red, inflamed patches covered with silvery-white scale. These patches will often feel itchy or sore, and can crack and bleed if scratched excessively. The most common symptoms of scalp psoriasis include:
Red Patches: Psoriasis causes areas of thick, red skin that is inflamed and irritated. These patches often have sharply defined borders and tend to appear on the scalp, behind the ears, on the hairline, and at the back of the neck.
Silvery Flakes: The inflamed patches are usually covered with a layer of off-white or silvery scale. These loose flakes are dead skin cells that build up due to the increased skin cell turnover caused by psoriasis. The scale is often mistaken for severe dandruff.
Itching and Burning: Scalp psoriasis commonly causes itching, soreness, and burning sensations. The itching may range from mild to severe, and can be extremely frustrating for sufferers. Scratching usually makes the itching and inflammation worse.
Dryness and Flaking: The accelerated skin cell growth of psoriasis causes dry, flaky areas as dead cells accumulate. Gentle removal of the loose flakes, along with moisturizing, can provide some relief. Excessive scratching can remove flakes and cause bleeding.
Hair Loss: In some cases, the inflammation can lead to hair thinning or temporary hair loss in the affected area. The hair loss is usually reversible once the psoriasis is successfully treated.
Seeking treatment is important, as scalp psoriasis rarely resolves on its own. Without treatment, the symptoms may persist indefinitely and can significantly impact one’s quality of life.
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.
Causes and Risk Factors
Scalp psoriasis is not contagious and does not directly result from poor hygiene. The exact cause is unknown, but certain factors can trigger or worsen the condition:
Genetics and Family History – Having a family member with psoriasis significantly increases your risk. Around 30% of people with psoriasis have a close relative with the condition. Certain genes are associated with psoriasis.
Immune System Malfunction – Psoriasis is an autoimmune disorder. For unclear reasons, the immune system mistakes healthy skin cells for foreign substances and attacks them. This causes inflammation and a rapid buildup of skin cells.
Stress – While stress does not cause psoriasis, it can worsen symptoms. Any type of stress, whether physical, emotional, or mental, may trigger a flare-up. Reducing stress is an important part of managing scalp psoriasis.
Infections – Certain bacterial and viral infections, including strep throat and upper respiratory infections, can trigger psoriasis outbreaks. The reason is unclear but may involve interactions between the infection, immune system, and genetics.
Medications – Some medications are associated with psoriasis flares, especially lithium, antimalarial drugs, and beta blockers. Always consult a doctor before stopping any medication.
Understanding the factors that provoke scalp psoriasis outbreaks can help you take preventive steps and manage flare-ups. While the condition is incurable, many effective treatments are available to relieve symptoms and improve quality of life.
Diagnosis
Diagnosing scalp psoriasis usually begins with a physical exam of the scalp by a dermatologist. The doctor will look for key signs of psoriasis such as silvery-white scales, red plaques, bleeding when scales are scraped off, and a thick crust on the scalp. Sometimes a skin biopsy is needed to confirm psoriasis and rule out other conditions. A skin biopsy involves taking a small sample of skin to examine under a microscope. This helps differentiate psoriasis from other possible causes like seborrheic dermatitis.
Seborrheic dermatitis can appear similar to psoriasis with red, itchy, and scaly patches, but it lacks the thick plaque buildup characteristic of psoriasis. Dandruff shampoos are usually effective for seborrheic dermatitis while medicated shampoos, topical treatments, and systemic medications may be needed for scalp psoriasis. Dermatologists are experts in diagnosing and treating scalp psoriasis as well as determining the best treatment approach.
Treatment Options
There are several treatment options available for scalp psoriasis:
Topical Corticosteroids
Corticosteroids reduce inflammation and slow the rapid growth of skin cells. They come in various strengths and are applied directly to the affected areas in lotion, foam, gel, spray, or ointment form. Mild corticosteroids like hydrocortisone are used for mild cases, while stronger ones like betamethasone are used for more severe psoriasis.
Salicylic Acid
This helps remove scales and ease itching and discomfort. It is often combined with topical corticosteroids. Salicylic acid comes as an ointment, gel, foam, shampoo, soap or lotion.
Vitamin D Analogues
These slow the growth of skin cells and are commonly used along with topical corticosteroids. Examples are calcipotriene and calcitriol.
Biologics
For moderate to severe scalp psoriasis, biologics may be prescribed. These are injectable or intravenous drugs that target specific parts of the immune system. Examples are etanercept, adalimumab, infliximab, ustekinumab. They are usually used if other treatments fail.
Natural and Home Remedies
There are several natural and home remedies that may help relieve scalp psoriasis symptoms. While not scientifically proven, many people find them effective as part of an overall treatment plan.
Apple Cider Vinegar
Apple cider vinegar is naturally acidic and can help gently exfoliate dead skin cells when applied topically. It may also have antibacterial and anti-inflammatory properties to soothe irritation. Dilute apple cider vinegar with equal parts water and apply directly to affected areas of the scalp. Rinse after 15-30 minutes.
Tea Tree Oil
Tea tree oil has natural antifungal and antibacterial properties. When diluted and applied to the scalp, it may help reduce scaling and inflammation associated with scalp psoriasis. Mix a few drops of tea tree oil with a carrier oil like coconut oil and massage into the scalp.
Aloe Vera
The soothing gel from aloe vera plants can help moisturize and calm areas of the scalp affected by psoriasis. Apply pure aloe vera gel directly to the scalp and allow it to fully absorb. You can also find shampoos and conditioners containing aloe vera.
Oregon Grape
Oregon grape contains the active compound berberine which may reduce inflammation and overproduction of skin cells. The roots and bark can be boiled into a tea and applied to the scalp once cooled. Oregon grape ointments and creams are also available.
Evening Primrose Oil
Evening primrose oil is rich in gamma-linolenic acid (GLA) which has anti-inflammatory effects. Taking evening primrose oil supplements may help reduce scalp itching and scaling. Applying evening primrose oil directly to the scalp may also be beneficial.
These natural remedies can be used in combination with medications, light therapy, and other treatments recommended by your doctor. Be sure to consult your dermatologist before using any new products on sensitive skin prone to psoriasis flares. With some trial and error, natural remedies may help control symptoms.
Psoriasis Shampoos and Solid Shampoo Bars
There are several medicated shampoos that can help treat scalp psoriasis:
Coal Tar Shampoos
Coal tar is derived from coal and is known to slow down the growth of skin cells and have an anti-inflammatory effect. Coal tar shampoos like Neutrogena T/Gel help to reduce scaling, itching, and inflammation caused by psoriasis. They are usually used several times a week.
Salicylic Acid Shampoos
Salicylic acid helps exfoliate the buildup of dead skin cells on the scalp. It softens and lifts off the scales caused by psoriasis. Salicylic acid shampoos need to be massaged thoroughly into the scalp and left for some time before rinsing off. Some examples are Ionil-T and Sebulex.
Handmade Shampoo Bars
Handmade shampoo bars are a great natural alternative to treat scalp psoriasis. They are free of harsh detergents and chemicals that can worsen skin irritation. Some beneficial ingredients include:
Coconut Oil – Has antimicrobial and anti-inflammatory properties. Moisturizes the scalp.
Shea Butter – Deeply moisturizing. Soothes irritation and inflammation.
Olive Oil – Rich in antioxidants and hydrates the scalp.
Tea Tree Oil – Has antifungal and antimicrobial properties. Reduces itching and scaling.
The gentle cleansing action of shampoo bars can help clear plaques without disrupting the skin barrier. They are also convenient to use and travel-friendly.
Scalp Psoriasis Diet and Lifestyle
Making certain lifestyle adjustments can help reduce flare-ups and manage scalp psoriasis symptoms. Here are some tips:
Avoid triggers like stress, smoking, and alcohol consumption which can worsen psoriasis. Practice stress management through yoga, meditation, or therapy. Quit smoking and limit alcohol.
Follow an anti-inflammatory diet high in fruits, vegetables, fish, nuts and seeds. Avoid inflammatory foods like refined carbs, processed meat, and dairy. An anti-inflammatory diet provides nutrients that improve skin health.
Keep scalp moisturized to prevent dryness and itching. Apply moisturizers and oils like coconut, olive, jojoba or argan oil. Oils also help loosen scales. Use humidifiers to add moisture to indoor air.
Expose scalp to small amounts of sunlight for short periods. Sun exposure can help improve psoriasis. Always use sunscreen to prevent sunburn.
Avoid scratching or picking at scales as it can worsen symptoms and cause infection. Use soft brushes and massage shampoos to gently remove scales.
Wear hats or scarves to protect scalp from harsh weather elements like cold, wind or sun exposure.
Manage stress through relaxation techniques, sufficient sleep, and saying no to overwhelming demands. Stress is a common psoriasis trigger.
Making lifestyle changes along with medical treatment is key to managing scalp psoriasis flare-ups. Work closely with your dermatologist for a holistic treatment plan.
Coping and Support
Living with scalp psoriasis can take an emotional toll. The itching, scaling, bleeding, and embarrassment associated with the condition can negatively impact mental health and self-esteem. Managing stress and finding support is crucial for people living with scalp psoriasis.
Manage stress and anxiety
Stress is a common trigger for scalp psoriasis flares. Finding healthy ways to manage stress can help control symptoms. Relaxation techniques like meditation, yoga, deep breathing, and mindfulness have been shown to reduce stress and anxiety. Make time for hobbies and activities you enjoy. Get regular exercise, which can improve mood and relieve tension. Consider therapy or counseling if you are struggling with stress, anxiety, or depression.
Join a support group
You are not alone in dealing with scalp psoriasis. Connecting with others who understand your experience can provide comfort and advice. Local and online support groups allow you to share tips and encouragement. Hearing how others cope with scalp psoriasis challenges can inspire your own self-care and treatment. Support groups reduce isolation and remind you that many people live full lives despite psoriasis.
See a therapist or counselor if needed
Some people find that living with scalp psoriasis significantly worsens their mental health over time. If you are experiencing ongoing depression, social isolation, or low self-esteem, seeking professional counseling can help. A therapist can provide tools to improve your emotional wellbeing and outlook. Working through the psychological impact of scalp psoriasis will allow you to focus your energy on effectively managing your symptoms. With support, many people find healthy ways to view themselves and their skin condition.
Outlook and Prevention
While there is no cure for scalp psoriasis, the condition can be managed with proper treatment and care. The key is to control flare-ups and keep symptoms under control. Here are some tips:
There is no way to prevent psoriasis altogether, but avoiding triggers can help reduce flare-ups. Triggers may include stress, skin injuries, certain medications, smoking, excessive alcohol use, and throat infections like strep throat. Take steps to reduce stress, stop smoking, limit alcohol, and treat infections promptly.
Take care of your overall physical and mental health. Eat a healthy diet, exercise regularly, get enough sleep, and make time to relax. A healthy lifestyle can help manage psoriasis symptoms.
See your dermatologist regularly, even when symptoms improve. Stick with your treatment plan and report any flare-ups. Your doctor may need to adjust therapies over time.
Don’t lose hope. With continued care and the right treatment, many people find their psoriasis symptoms and flare-ups become more manageable over time. Work closely with your healthcare providers.
Join a support group to connect with others managing psoriasis. Learning from their experiences can be helpful.
The key is diligent management of symptoms and consistent care. While psoriasis cannot be cured, it can often be controlled with lifestyle changes, avoiding triggers, and working closely with your dermatologist. Consistency is important in keeping flare-ups at bay.
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