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Scalp psoriasis: causes, symptoms and treatments

Woman with brown hair scratching her head
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Have you noticed changes to the skin on your scalp? You might be experiencing a skin condition known as scalp psoriasis. In this article, we will examine the underlying causes of scalp psoriasis, identify common symptoms, and highlight the various shampoos and treatments that can help manage the condition.

What is scalp psoriasis?

Scalp psoriasis is a specific type of psoriasis, a condition that causes patches of red, dry, flaky and scaly skin to develop on the body. In scalp psoriasis these patches develop on the head, underneath the hair.

Scalp psoriasis is similar to another condition, called seborrhoeic dermatitis. This is a form of eczema that affects the scalp, face and chest. To make sure you’re correctly diagnosed you should visit a doctor before you begin using treatment.

What causes scalp psoriasis?

Psoriasis is caused by an underlying problem with the way skin cells in your body are created. In people with psoriasis, the skin cells are replaced too quickly – new cells, which aren’t fully matured, start to build up rapidly on the surface of the skin, causing red, flaky, scaly patches to develop.

It’s thought that a problem with the immune system causes psoriasis, and that genetic and environmental factors may also play a role. You are more likely to develop psoriasis if other people in your family have it.

Psoriasis flare-ups are usually brought on by exposure to certain triggers.

Common psoriasis triggers include:

  • Injuries to the skin
  • Smoking and drinking too much alcohol
  • Stress
  • Hormonal changes
  • Certain prescription medicines e.g. lithium
  • Throat infections
  • Conditions affecting the immune system e.g. HIV

Psoriasis is not contagious, which means you can’t pick it up or pass it on to anyone else.

Scalp psoriasis symptoms

The symptoms of scalp psoriasis vary depending on the severity of your condition. The key characteristic is patches of skin under the hair that are dry, raised, red and covered in silvery scales. These are known as “plaques”.

People with scalp psoriasis might also experience:

  • Skin shedding similar to dandruff
  • Soreness or burning
  • Itching
  • A tight feeling on the scalp

The patches may be small and develop in one or two areas, or may cover your entire scalp. Sometimes, scalp psoriasis can spread to the forehead, the neck and behind the ears. Because the plaques are developing underneath hair, which prevents the skin from shedding, they may become quite thick.

Sometimes scalp psoriasis can lead to hair loss. This can happen if the plaques are very thick, if you scratch or pick at the affected skin on your scalp, or if you use very harsh treatments on it. The good news is that this hair loss is usually temporary.

Treatment for scalp psoriasis

Because scalp psoriasis occurs beneath the hair it can be slightly more difficult to treat than other types of psoriasis. The hair can make it more difficult to apply treatment efficiently, and can prevent plaques from shedding as quickly. Having said that, there are plenty of treatments available for this condition.

Treatments for scalp psoriasis tend to be topical – in other words, they are applied directly to the affected skin. Topical treatments for scalp psoriasis typically work by reducing inflammation and itching, and slowing down the production of skin cells.

Commonly used topical treatments include:

  • Corticosteroids
  • Vitamin D analogues
  • Dithranol
  • Coal tar

These products come in the form of shampoos, lotions, solutions, foams, gels and ointments.

Topical treatments for mild scalp psoriasis

If your symptoms are mild, you should be able to pick up some treatments over the counter in a pharmacy. Two popular products to try are medicated shampoos, such as Neutrogena T/Gel Therapeutic Shampoo and Dermalex Scalp Psoriasis Gel.

Topical treatments for moderate to severe scalp psoriasis

If your symptoms are more severe and the plaques on your scalp are thick, you will probably need prescription treatment. Your GP can recommend a topical treatment containing corticosteroids, vitamin D analogues, or dithranol. Prescription products containing these ingredients include Dermovate scalp application, Locoid scalp lotion, Dithrocream and Dovobet gel.

You should use these treatment exactly as directed by your doctor. Make sure that you apply the medicated product directly to the scalp, and not to the hair.

In addition to these medicated treatments, you might also try using emollients on your scalp, as these can help to soften thick plaques. An emollient is a rich moisturiser which can prevent itching and inflammation, and create a protective barrier on the skin, sealing in moisture.

If you are going to use an emollient on your scalp, you should try the following method:

  • Massage the emollient into the scalp, section by section
  • Wrap your head in a towel, shower cap or cling film and leave for at least one hour
  • Wash the hair with coal tar or normal shampoo
  • Use a comb to gently massage the scalp and remove skin scales, taking care not to damage the skin
  • Comb scales out of hair and wash again

  • Other treatments for scalp psoriasis

    If your scalp psoriasis is severe, and not responding to the kinds of treatments described above, you might require a referral to a dermatologist.

    Advanced techniques for treating scalp psoriasis include:

    • Phototherapy using ultraviolet light
    • Systemic treatments in the form of tablets, capsules or injections
    • Combination treatments e.g. phototherapy with coal tar or dithranol

    Before you start using any treatment for scalp psoriasis, make sure you speak to a pharmacist or a doctor. This way, you can ensure that you are using the right treatment for your specific needs and that it won't interact with any other medications you may be taking.