Scalp psoriasis is a chronic autoimmune condition that affects the skin on the scalp. Active flare-ups alternate with periods of remission. During a flare-up, the immune system activates, causes swelling in the affected area, and induces skin cells to grow too quickly. This produces one or more patches of dry, swollen, red, and scaly skin called plaques. They usually appear on the hairline, forehead, around the ears, or on the back of the neck, but they can affect any area on the entire scalp. Other signs include skin cracking, bleeding, and temporary hair loss.
Psoriasis can affect any area of the skin, but scalp psoriasis is the most common. About half of people diagnosed with psoriasis have scalp psoriasis, though other areas of the skin may be affected. Most people with scalp psoriasis have plaque psoriasis that causes raised white lesions on the skin during a flare-up. Psoriasis can also affect the eyes or joints (psoriatic arthritis). By itself, scalp psoriasis can be effectively treated with over-the-counter (OTC) or prescription topical ointments, gels, creams, lotions, or shampoos.
Scalp psoriasis is a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity.
Scalp psoriasis is caused by genetics and environmental triggers.
Risk factors for scalp psoriasis include a family history of psoriasis. Lifestyles that contribute to the risk of developing psoriasis include smoking, obesity, and drinking.
Symptoms of scalp psoriasis include swollen patches of skin that are red, scaly, itchy, and sometimes painful. These patches could have nodules or plaques.
Scalp psoriasis usually requires a medical diagnosis.
Scalp psoriasis generally requires treatment. A flare-up typically improves and may resolve within eight weeks or longer of treatment.
Treatment of scalp psoriasis may include topical corticosteroids, topical vitamin D3 analogues, topical scale softeners, topical retinoids, coal tar, oral medications, or monoclonal antibodies (biologic drugs). Read more about psoriasis treatments here.
Scalp psoriasis flare-ups are preventable by avoiding triggers, adopting a healthy lifestyle, and protecting the scalp.
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The cause of scalp psoriasis is genetic, though science is unsure of the precise genes involved. In addition to genetics, environmental factors can trigger the initial and later flare-ups. Not everyone will be triggered by the environmental variables. Some people may not be able to identify anything that triggers their episodes.
The most common scalp psoriasis triggers include:
Skin injury (including shaving cuts)
Stress
Infections, such as ear infections, strep throat, or bronchitis
Medication side effects
Smoking
Drinking
Cold temperatures
Hot temperatures
Sun exposure
Dry air
None of these triggers are scalp psoriasis causes, but they have the potential to provoke the immune system and start the inflammatory response that leads to psoriasis flare-up a few weeks later.
As an autoimmune condition, scalp psoriasis can be due to genetics. The most obvious risk factor is being related to someone with psoriasis, as 1 out of 3 people with psoriasis have an immediate family member who also has it.
Genetics are often not enough to cause psoriasis. Some environmental trigger usually provokes a flare-up. Stress, skin injuries, and infections are the most common triggers. For reasons we don’t understand, some people are more likely to get psoriasis than others. These include:
Smokers
People who drink frequently or too much
People with excess weight
Psoriasis is a serious medical condition. It can worsen and affect other areas of the body, including the eyes and joints. Additionally, standard treatments are very effective, especially for mild scalp psoriasis. If there’s any question about a scalp problem, see your primary care provider for an initial evaluation.
RELATED: What are the early signs of psoriasis?
Most people will first visit their family physician for a diagnosis, but the final diagnosis and the treatment plan may be made by a dermatologist.
At the initial visit, the clinician will get a medical history, perform a physical examination, and closely examine the affected area. In its symptoms and appearance, scalp psoriasis is very similar to other common skin conditions, such as seborrheic dermatitis and eczema. The symptoms and appearance may be enough for a diagnosis, but the clinician may take a skin sample for a biopsy.
Other tests may include:
Allergy tests
Blood tests for rheumatoid factor or to measure erythrocyte sedimentation rate (ESR)
Urine tests
Pregnancy test
RELATED: Is it just dry skin, or could it be eczema or psoriasis?
Scalp psoriasis is not contagious. Instead, it is an autoimmune disease in which the immune system causes inflammation in otherwise healthy skin.
As an autoimmune condition, scalp psoriasis is not curable. However, flare-ups can be successfully managed with topical medications, including medicated creams, ointments, lotions, and shampoos. Oral medications, such as immune suppressants, retinoids, or injected biologics, are less commonly used. They’re a last-resort option for severe scalp psoriasis or if other parts of the body are affected. Phototherapy, either UVB light therapy or laser treatment, is not commonly used to treat scalp psoriasis because of the density of the hair.
Topical treatment options for scalp psoriasis include:
Over-the-counter (OTC) or prescription topical corticosteroids, considered to be the first-line and most effective treatment, block the immune system and reduce swelling in the affected area. People should see results in two to three weeks.
Prescription topical vitamin D3 analogues, such as calcipotriene cream, that slow down skin growth are also highly effective at improving symptoms and inducing remission. Optimal results occur in about eight weeks.
Combination topical corticosteroid-vitamin D3 analogue creams, available by prescription only, combine the two most effective treatments in one cream.
Coal tar slows down skin growth and relieves itching. It’s available in OTC coal tar shampoos or ointments. Coal tar can produce complete remission and lengthen the time between flare-ups.
Scale softeners (keratolytics), such as salicylic acid shampoo, remove thick scales on the scalp and increase the effectiveness of other treatments.
Tazarotene is a prescription topical vitamin A derivative (retinoid) that can be used to slow down skin growth and decrease scaling. It’s commonly used to treat other forms of psoriasis.
Topical Zithranol (anthralin) is another possible prescription treatment, but it’s usually not used because one of its side effects is staining of the skin and hair.
RELATED: Everything you need to know about biologics for psoriasis
Scalp psoriasis is not preventable. Once it begins happening, flare-ups are unpredictable and often unpreventable. People with scalp psoriasis only have limited resources to prevent flare-ups. These include:
Following the treatment plan
Identifying triggers and then avoiding them
Protecting the scalp from sunlight, excessive heat, and cold
Protecting the scalp from drying out by using mild hair conditioners that help moisturize the skin
Protecting the scalp from irritation by brushing or combing the hair gently
Allowing the scalp to breathe by avoiding hats unless you need them to keep the head warm
Eating a healthy anti-inflammatory diet consisting of unprocessed foods, healthy oils, and antioxidants
Maintaining a healthy weight
Being physically active
It’s easy to mistake scalp psoriasis for other conditions that are less serious, such as dandruff. There may be telltale signs. Scalp psoriasis tends to happen around the edges but can occur anywhere on the scalp. Flakes are white and silvery. Itchiness, soreness, and burning pain are often worse than other scalp conditions. If there’s any doubt, talk to your primary care physician or another healthcare provider. Treatment is effective and can improve symptoms or produce total remission. Only a healthcare provider can properly identify the condition and start the most effective treatment.
While psoriasis is not caused by any dietary deficiency, it is often associated with low levels of vitamin D. This vitamin is manufactured by skin cells when they’re exposed to ultraviolet light. Vitamin D performs many vital roles in the skin, including regulating skin growth and the immune system. Vitamin D topical treatments are one of the most successful treatments for scalp psoriasis, especially when combined with topical steroids. Topical vitamin D both slows down skin growth and dials back immunity-induced swelling. Despite the success of topical vitamin D analogues, research has not shown that vitamin D supplementation helps with psoriasis.
The most common triggers of psoriasis are stress, infection, skin injury, and dry skin. Other common triggers include heat, cold, sun exposure, smoking, and drinking. Smoking triggers psoriatic episodes, and flare-ups are often more severe in smokers.
Psoriasis is considered to be a distinct autoimmune disease. The immune system causes inflammation in otherwise healthy skin tissues, causing redness, swelling, and rapid growth of skin cells. The disease attacks the joints in 1 out of 10 people with psoriasis, causing psoriatic arthritis, which looks and feels like rheumatoid arthritis. These two conditions are called psoriatic disease, a distinct type of autoimmune disorder.
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What are the early signs of psoriasis?, SingleCare
Managing scalp psoriasis, The Dermatologist
Psoriasis treatments and medications, SingleCare
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Treatment of psoriasis: An algorithm-based approach for primary care physicians, American Family Physician
Scalp psoriasis: shampoos, scale softeners, and other treatments, American Academy of Dermatology (AAD)
Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures, Journal of the American Academy of Dermatology
Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist, Reviews in Endocrine & Metabolic Disorders
Dry scalp treatments and medications, SingleCare
Eczema treatments and medications, SingleCare
Seborrheic dermatitis treatments and medications, SingleCare
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