Scalp psoriasis affects between 50 and 80% of people with this skin condition, making it the most common location. The scalp is often the only area affected.
This type of psoriasis can present in a mild form, similar to dandruff, and with very fine, light scales.
However, scalp psoriasis can also be severe, causing the appearance of thick, red patches covered with silvery scales.
In these cases, the lesions are itchy (and may even be painful) and usually affect the entire hair growth area, extending beyond the hairline to the forehead, occipital region, and around the ears.
Typically, the lesions themselves do not cause psoriatic alopecia. However, temporary, localized hair loss can occur when the plaques are scratched, chronic psoriatic lesions are present, or when attempting to remove the scales without first softening them.
If so, hair usually grows back with the right treatment.
In scalp psoriasis , the plaques are usually visible through the hair or on hairless areas of skin (the forehead, ears, and even the neck), so it often affects the self-esteem, confidence, and quality of life of those who suffer from it.
It’s important to remember that, beyond the discomfort that injuries can cause, this is an area of great aesthetic importance.
Currently, no treatment for scalp psoriasis can permanently eradicate the disease.
However, there are multiple therapeutic options to control outbreaks, minimize their physical and psychological repercussions, and try to prevent relapses:
- Start a personalized treatment. The most important thing to combat scalp psoriasis is to see a dermatologist so they can prescribe an individualized treatment. To do this, various factors must be taken into account, such as its location (whether psoriasis occurs only on the scalp or also on other parts of the body), its clinical form (mild, moderate, or severe scalp psoriasis), the recurrence of outbreaks, and each person’s unique circumstances. For example, the extent to which the disease is impairing their quality of life.. The first line of treatment for scalp psoriasis is the use of topical products (shampoos, lotions, or gels) that help soften the scales, promote their removal, and reduce inflammation. These products often include ingredients such as oils or petrolatum, salicylic acid, urea, glycolic acid, and/or ichthyol. Regarding medications, topical corticosteroids are the gold standard, especially when the flare-up is more severe. These can be applied alone or in combination with vitamin D derivatives. Other topical treatment options for scalp psoriasis include calcineurin inhibitors, retinoids, and tars. Sunbathing and phototherapy (controlled exposure to ultraviolet A or B radiation) have also been shown to be effective adjuvant therapies. Systemic treatments, on the other hand, are indicated for more extensive or severe forms, when topical treatment does not adequately control the disease, or when psoriasis is causing significant emotional distress. These include methotrexate, retinoids, cyclosporine A, dimethyl fumarate, apremilast, and biological therapies. It’s important to note that scalp psoriasis is often persistent and difficult to treat. This means that rotating treatments may be necessary, as the response to a medication or therapy may diminish after repeated use.
Treating scalp psoriasis is complex, but with consistency, outbreaks can be controlled.
- Avoid scratching your scalp. Psoriasis plaques are often itchy, causing an uncontrollable urge to scratch. Even so, scratching should be avoided, whether with your hands, a comb, or a brush. First, because it causes more inflammation and irritation, and therefore more itching. This creates a vicious cycle of itching and scratching that is difficult to break. And second, because scratching the plaques can not only cause hair loss but also cause bleeding and even infection. To avoid scratching, it is essential to know how to relieve an itchy scalp. To begin with, it is essential to use gentle, rebalancing products adapted to sensitive skin. This includes shampoos and all styling products. Although tolerance to dyes varies from person to person, they tend to cause itching. Therefore, as much as possible, it is best to avoid them or use alcohol-free dyes. At the same time, specific products can be applied to relieve an itchy scalp. These are usually creams that include anti-inflammatory, moisturizing, nourishing, re-epithelializing, and refreshing active ingredients.
- Treat your scalp with care. Beyond measures to prevent scratching, there are other recommendations for washing and caring for hair in people with scalp psoriasis. Wash your hair gently, massaging in the treatment shampoo and letting it sit for the indicated amount of time. Rinse thoroughly with warm water afterwards. This psoriasis shampoo should be alternated with other shampoos with different compositions and active ingredients, as recommended by the specialist. When drying, you should also do so carefully and avoid using the hairdryer at close range. Whenever possible, clips, rubber bands, or ribbons that cause tension in the hair should not be used. Although haircuts do not affect the progression of scalp psoriasis, short hair makes it easier for treatments to reach the skin.
- Avoid triggering factors. The causes of psoriasis can be varied, but they are essentially genetic, immunological, and environmental.Stress, for example, is usually the most common and easily verifiable cause of psoriasis flare-ups. Therefore, good stress management is key to preventing relapses. Sunburns should also be avoided, as they can trigger the appearance of psoriatic lesions in the affected area. This is known as the Koebner isomorphic phenomenon, which can also occur after an injury, in the scar. At the same time, it is important to maintain a healthy weight. It is known that people with psoriasis who are overweight or obese not only have more severe lesions but also respond less well to different treatments. Another recommendation is to reduce alcohol intake and even eliminate it. Regarding diet, vitamin D deficiency is common in patients with psoriasis, and low levels have been linked to the severity of the lesions. In this sense, a deficiency of this vitamin should be avoided. Supplements of selenium, vitamin B12, and other vitamins have been shown to improve lesions in people with psoriasis. However, supplementation is not recommended unless there is a deficiency. Finally, regular exercise is highly beneficial for controlling flare-ups.
- Seek emotional support. People who suffer from chronic conditions like psoriasis tend to develop a sense of vulnerability, insecurity about bodily functioning, and a loss of self-image.In the case of scalp psoriasis, the lesions can also be very visible (they cannot be easily hidden) and are located on a part of the body that serves an important aesthetic function. This often has a very negative impact on the well-being and quality of life of those who suffer from scalp psoriasis, with consequent impact on their personal, social, and even work-related life. Therefore, psoriasis should be treated from a comprehensive perspective, focusing on how it affects the individual and not just on their morphological characteristics or the extent of the lesions. This means that treatment for scalp psoriasis should include, whenever necessary, attention to the emotional distress it entails. This can be achieved through psychological therapy or support groups.
It is important to keep in mind that treatment results are not always rapid, so you must be patient and consistent until they take effect.