Your Essential Guide to Scalp Psoriasis
In this video, we'll dive into the differences between dry scalp, dandruff, seborrheic dermatitis, and scalp psoriasis, helping you understand their unique causes and treatments. Whether you're dealing with flakiness, itchiness, or redness, we'll provide clear insights to help you identify and manage these common scalp conditions effectively.
Different Types of Scalp Psoriasis
What is Scalp Psoriasis?
Scalp psoriasis can occur as a standalone condition but more commonly appears alongside psoriasis in other areas of the body. It is a chronic inflammatory condition that speeds up the growth cycle of skin cells (commonly on the scalp, elbows, knees, and back. This results in the formation of thick, silvery scales and itchy, dry, red patches. It most commonly occurs on the back of the scalp, though it can also extend beyond the scalp to the forehead, back of the neck, or behind the ears. Treatment consists of two separate steps: reducing scale + reducing inflammation.
50% of people with psoriasis also have scalp psoriasis!
Photos of Scalp Psoriasis
Photos of scalp psoriasis can help you recognize this condition, which often shows up as red patches on the scalp covered with white or silvery scales. The patches can be small or cover large parts of the scalp, and sometimes they spread to areas like the forehead, neck, or behind the ears. In severe cases, you might also see hair loss in the affected areas. While photos can give you an idea of what scalp psoriasis looks like, they can’t give you a diagnosis. If you think you might have scalp psoriasis, it’s important to see a dermatologist for proper advice and treatment.
Scalp Psoriasis Treatment
Effectively treating scalp psoriasis involves a two-step process: descaling and reducing inflammation. The first step, descaling, focuses on softening and removing the thick, scaly patches on the scalp. This can be achieved using medicated shampoos containing ingredients like coal tar or salicylic acid, which help break down and lift scales. Gentle removal of these scales with a soft brush or comb can enhance the effectiveness of subsequent treatments. The second step is reducing inflammation. Over-the-counter options such as hydrocortisone creams or anti-dandruff shampoos with anti-inflammatory properties like zinc pyrithione can help alleviate redness and swelling.
Scalp Psoriasis Treatment: Reduce Scale
To reduce scaling in scalp psoriasis, start by using medicated shampoos containing ingredients like coal tar or salicylic acid, which help soften and remove scales. Regularly applying topical treatments such as corticosteroids or vitamin D analogs can also be effective. Gentle removal of scales with a soft brush or comb after the treatment can help improve effectiveness. Additionally, keeping the scalp moisturized with oils or ointments can prevent dryness and scaling. Consistent treatment and gentle care are key to managing and reducing scalp psoriasis symptoms effectively.
Nizoral Psoriasis Shampoo
Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.
MG217 Psoriasis Shampoo
Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.
Neutrogena T/Sal
Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Neutrogena has two popular shampoos: T-Sal (with salicylic acid) and T-Gel (with coal tar).
Dermarest Psoriasis Shampoo
Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.
Scalp Psoriasis Treatment: Reduce Inflammation
After descaling, the next step in managing scalp psoriasis is to reduce inflammation. Non-prescription topical treatments containing hydrocortisone can help alleviate redness and swelling. Products with zinc pyrithione also have anti-inflammatory properties that can soothe the scalp. Coal tar shampoos not only help with scaling but can also reduce inflammation when used regularly. Incorporating natural anti-inflammatory options, such as tea tree oil shampoos, may provide additional relief. Consistent use of these OTC products, combined with gentle scalp care, can effectively manage inflammation in scalp psoriasis.
Scalpicin Itch Treatment
Active Ingredient: 1% Hydrocortisone
Note: Topical steroid. Do not overuse. Much stronger steroids are available by prescription (clobetasol, betamethasone, fluocinonide, etc.)
Nizoral
Active: 1% Ketoconazole
Note: Anti-fungal. Anti-inflammatory. Prescription version is 2% ketoconazole.
Head & Shoulders
Active Ingredient: 1% Zinc Pyrithione
Note: Anti-fungal. Anti-bacterial. Anti-inflammatory.
Nizoral Scalp Itch Relief
Active Ingredient: 1% Hydrocortisone
Note: Topical steroid. Do not overuse. Much stronger steroids are available by prescription (clobetasol, betamethasone, fluocinonide, etc.)
Scalp Psoriasis Treatment: Reduce Scale + Inflammation
Coal tar is a common treatment for scalp psoriasis and other skin conditions due to its ability to reduce scale AND inflammation. Available in various forms, including shampoos, creams, and ointments, coal tar works by slowing the rapid growth of skin cells and helping to shed dead skin cells from the scalp. Its anti-inflammatory and antiseptic as well, making it effective in managing itchy symptoms! Coal tar does not smell great 😔 but it works very well!
MG217 Coal Tar Shampoo
Active Ingredient: 3% coal tar
Note: Coal tar works well for scale and itch, but it can be smelly/messy!
DHS Tar Shampoo
Active Ingredient: 0.5% coal tar
Neutrogena T/Gel
Active Ingredient: 0.5% coal tar
Note: Neutrogena has two popular shampoos: T-Sal (with salicylic acid) and T-Gel (with coal tar).
Tarsum Scalp Treatment
Active Ingredient: 2% coal tar
Note: Can leave on scalp and wash off.
Scalp Psoriasis Tips
Proper Shampoo Usage: Following the recommended directions for all psoriasis treatments, including shampoos, is important. Even effective products can cause side effects like irritation, itching, and redness if not used correctly. Make sure to stick to the instructions to avoid worsening your symptoms.
Psoriasis Shampoos Are for the Scalp, Not the Hair: Medicated shampoos for psoriasis are meant to treat the scalp, not the hair itself. To get the best results, part your hair in sections and apply the shampoo directly to the roots. This helps the active ingredients target the affected areas without overexposing your hair to the medication.
Moisturizing Hair: After using medicated shampoos, it's a good idea to apply a moisturizing conditioner. This helps reduce dryness and irritation while nourishing both your scalp and hair. By balancing treatment with moisture, you can manage your psoriasis while keeping your hair healthy and looking good.
Best Prescriptions for Scalp Psoriasis
Sometimes, over-the-counter creams and lotions aren't enough to handle psoriasis. When that happens, doctors often prescribe stronger medicines that you can only get with a prescription. These prescription topicals are usually more powerful and can help manage the symptoms better. If over-the-counter options aren't working, it's important to talk to your doctor about getting a prescription. The most common prescriptions we use for psoriasis include:
Topical Steroids
- Reduces inflammation and itching
- Available in various strengths
- Prolonged use can thin the skin (we try not to use steroids for too long!)
- Ex: Clobetasol, Betamethasone, Fluocinonide, Bettamousse
Vitamin D
- Slows skin cell growth
- Often combined with topical steroids
- Few side effects
- Ex: Calcipotriene, Sorilux
Sotyktu
- Daily Pill
- Used if topicals are not an option
- Few side effects
- Requires monitoring
Prednisone
- Oral steroids are sometimes used for severe flares
- Short-term use only
- Not our favorite treatment: you can flare after you stop the prednisone!
Biologics
- Injections at home (it's easy!)
- Reduces skin inflammation
- Requires regular monitoring
- May have systemic side effects
- Ex: Humira, Stelara, Cosentyx, Skyrizi
Otezla
- Twice Daily Pill
- Reduces inflammation
- Common side effect: diarrhea
- Doesn’t work as well as biologics
Best Procedures for Scalp Psoriasis
Sometimes, even prescription treatments aren’t enough to manage psoriasis effectively. In such cases, doctors may recommend phototherapy, a more advanced treatment. Phototherapy involves exposing the skin to controlled amounts of ultraviolet (UV) light to reduce inflammation and slow down skin cell growth. This treatment is usually performed in a medical setting but can also involve home devices. If topical treatments aren't providing relief, discussing phototherapy with your doctor could be a beneficial next step. Common types of phototherapy for psoriasis include:
Over-the-Counter Phototherapy
- Can be purchased online
- Typically used a few times a week to affected areas
- Can be effective for mild to moderate psoriasis
Office Phototherapy
- Uses UVB light or Excimer laser to reduce inflammation and itching
- Effective for moderate to severe eczema
- Administered in a clinical setting or at home with a unit
Home Phototherapy
- Prescription phototherapy, but at home!
- Similar to an office-based device
- Check your insurance coverage for “Durable Medical Equipment (DME)”
- Most popular companies: National Biologic + SolRx!
Scalp Psoriasis FAQs
Can castor oil help scalp psoriasis?
Yes, castor oil can help moisturize the scalp, which may reduce itching and flaking. It’s not a cure, but it can be a soothing part of your treatment routine.
How do you use castor oil for scalp psoriasis?
To use castor oil, apply a small amount to your scalp and gently massage it in. Leave it on for a few hours or overnight before washing it out with a gentle shampoo. Repeat this process as needed.
Is short hair better for scalp psoriasis?
Short hair can make it easier to manage scalp psoriasis because it's simpler to apply treatments and maintain a healthy scalp. However, hair length is a personal choice, and you should choose what works best for you.
What is scalp inflammation, and how can it be treated?
Scalp inflammation in psoriasis is caused by an overactive immune response. Treatment options include medicated shampoos, topical steroids, and natural oils like castor oil to reduce redness and itching.
What is scalp scaling?
Scalp scaling refers to the buildup of thick, flaky skin on the scalp, which is a common symptom of psoriasis. Regular gentle exfoliation and medicated shampoos can help manage scaling.
Is castor oil good for psoriasis of the scalp?
Yes, castor oil is often used to soothe and moisturize the scalp, which can help alleviate some symptoms of psoriasis. However, it’s best used alongside other treatments recommended by your dermatologist.
What is the best shampoo for scalp inflammation?
Look for shampoos that are designed for sensitive skin and contain ingredients like coal tar, salicylic acid, or zinc pyrithione. These can help reduce inflammation and flaking. Always consult with your dermatologist for recommendations specific to your needs.
Are there specific scalp brushes for psoriasis?
Yes, there are scalp brushes with soft bristles designed to gently exfoliate without irritating the skin. These can help remove scales while massaging the scalp.
How do you get rid of scalp inflammation?
To reduce scalp inflammation, you can use medicated shampoos, topical steroids, and natural oils like castor or olive oil. Reducing stress and maintaining a balanced diet can also help.
What is PSO psoriasis?
PSO stands for psoriasis, a chronic autoimmune condition that causes red, scaly patches on the skin, including the scalp.
How long do you leave Enstilar on your scalp?
Enstilar foam is usually left on the scalp for around 12 hours before washing it off. However, always follow your doctor's instructions for specific usage.
Will olive oil help scalp psoriasis?
Yes, olive oil can help moisturize the scalp and soften scales, making them easier to remove. It’s best used in conjunction with other treatments.
Does rosemary oil help scalp psoriasis?
Rosemary oil may have anti-inflammatory properties that can soothe the scalp, but it should be used with caution as it may irritate some people. Consult your dermatologist before use.
Can psoriatic arthritis cause hair loss?
Yes, psoriatic arthritis can sometimes lead to hair loss, particularly if inflammation affects the scalp. Managing the underlying inflammation can help reduce hair loss.
How do you treat scalp inflammation?
Scalp inflammation can be treated with medicated shampoos, topical treatments, and natural oils like castor or olive oil. Reducing triggers like stress and diet can also help.
What is the suspected cause of eczema and psoriasis?
Both eczema and psoriasis are believed to be caused by an overactive immune system, but the exact triggers can vary from person to person, including genetics, environmental factors, and stress.
Is there a dr for hair?
Yes, there are doctors who specialize in hair, known as trichologists and dermatologists. Here’s a breakdown:
Trichologists: These specialists focus specifically on the health of the scalp and hair. They deal with issues like hair loss, scalp conditions, and hair disorders. Trichologists are often not medical doctors but are trained to diagnose and manage hair-related problems.
Dermatologists: Dermatologists are medical doctors who specialize in the skin, hair, and nails. They can treat many hair-related issues, including hair loss (like alopecia), scalp conditions (like psoriasis or seborrheic dermatitis), and other hair disorders. For more complex or medically-involved hair problems, dermatologists are usually the specialists to consult.
A dermatologist would be the best option if you're experiencing significant hair issues, especially those related to medical conditions. For non-medical hair and scalp concerns, a trichologist could also be helpful.
Should I Use a Hydrocortisone Shampoo?
While we recommend hydrocortisone for scalp psoriasis, it’s more effective to use a hydrocortisone leave-on serum to soak into the skin. If hydrocortisone is in a shampoo, you’ll rinse off the steroid!