Scalp Psoriasis

Medically Reviewed by Stephanie S. Gardner, MD on June 02, 2023
Written by Rick Ansorge
6 min read

Scalp psoriasis is a common skin disorder. It may look different on different skin tones. If you’re light- to medium-skinned, it often shows up as raised, reddish or salmon-colored patches with white scales. On darker skin, the patches may be purple and the scales gray. It can be a single patch or several, and can even affect your entire scalp. It can also spread to your forehead, the back of your neck, and behind and inside your ears.

You can’t catch scalp psoriasis from another person. As with other types, we don’t know what causes it. Doctors believe it comes from something wrong with your immune system that causes skin cells to grow too quickly and build up into patches. You may be more likely to get scalp psoriasis if it runs in your family.

 

 

About half of the estimated 7.5 million Americans with psoriasis -- which can affect any skin surface -- have it on their scalp. Sometimes the scalp is the only place they have it, but that’s uncommon.

Scalp psoriasis can be mild and almost unnoticeable. But it can also be severe, last a long time, and cause thick, crusted sores. Intense itching can affect your sleep and everyday life, and scratching a lot can lead to skin infections and hair loss.

 

 

Symptoms of mild scalp psoriasis may include only slight, fine scaling. Symptoms of moderate to severe scalp psoriasis include:

  • Red or purple bumpy patches
  • Silvery-white or gray scales
  • Dandruff-like flaking
  • Dry scalp
  • Itching
  • Burning
  • Soreness
  • Hair loss

Scalp psoriasis itself doesn’t cause hair loss. But scratching a lot or very hard picking at the scaly spots, harsh treatments, and the stress that goes along with the condition can lead to temporary hair loss. Fortunately, your hair usually grows back after your skin clears.

If you have any of these symptoms, see your doctor or dermatologist. They may simply take a look or do a skin biopsy to rule out similar conditions like seborrheic dermatiti s.

The first line of defense is treatment you use directly on your skin (topical treatments).These include medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. You can get some of these products over the counter, but stronger ones require a prescription.

Over-the-counter products often contain one of two medications approved by the FDA for psoriasis:

Salicylic acid is a peeling agent available in over-the-counter (OTC) and prescription shampoos and soaps. It can soften scales, making them easier to remove.

Coal tar products are available OTC as shampoos, creams, gels, ointments, foams, and soaps. They can help slow skin growth and reduce inflammation, itching, and scaling. To apply a coal tar shampoo, massage it into the scalp and leave on 5 to 10 minutes before rinsing out. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can help against the odor of tar shampoo.

Medicated shampoos are available in coal tar and non-coal tar varieties. Some OTC shampoos have menthol or phenol creams as an active ingredient. You can use these daily for scalp plaques, but follow the directions.

You can also check with your doctor about taking OTC antihistamine pills.

Prescription products for scalp psoriasis may have higher concentrations of either or both of these, as well as other FDA-approved medications, such as:

  • Anthralin, an older prescription medication
  • Antimicrobials, which treat bacterial or yeast infections that can come with scalp psoriasis
  • Calcipotriene, a strong derivative (different form) of vitamin D
  • Calcipotriene and betamethasone dipropionate (a vitamin D derivative combined with a strong steroid)
  • Other topical steroids
  • Tazarotene, a derivative of vitamin A
  • Tapinarof (Vtama)
  •  Roflumilast (Zoryve)

To work, these treatments must be put on your scalp, not just your hair. Follow the directions exactly until your skin heals, which can take 8 weeks or more. Once your psoriasis has cleared, you can help keep it from coming back by shampooing regularly or twice weekly with a product that has coal tar or other medications.

To ease itchiness:

  • Use a conditioner after shampooing.
  • Limit hot tools for hair styling.
  • Use wet towels, cold packs, or cold water on itchy spots.

If you have mild scalp psoriasis in a few areas, your doctor or dermatologist may consider intralesional steroid injections. They’ll use a small needle to inject medication into scalp plaques to reduce inflammation. You can have this procedure at the doctor’s office.

If your symptoms don’t respond to topical treatments, phototherapy with a laser or non-laser light source may help. For example, the excimer laser focuses high-intensity light on affected areas and avoids the surrounding healthy skin.

Ultraviolet (UV) light -- sometimes delivered with a handheld device called a UV comb -- can be used to treat the entire scalp. Hair can block the light from reaching your scalp, so if you have thick hair, it may help to part it in rows. If you have very thin hair or a shaved head, your doctor may recommend that you go out in natural sunlight for brief periods.

If you have moderate to severe scalp psoriasis, your doctor may prescribe a drug you take by mouth or one that's injected or pumped through a needle into a vein. Oral medications include:

  • Acitretin (Soriatane), a strong derivative of vitamin A
  • Apremilast (Otezla), a small molecule inhibitor taken twice daily
  • Corticosteroids
  • Cyclosporine (Sandimmune), which lowers immune system function and helps to reduce the inflammation of psoriasis
  • Deucravacitinib (Sotyktu), a tyrosine kinase inhibitor taken once daily
  • Methotrexate (Rheumatrex), which slows an enzyme involved in the rapid growth of skin cells
  • Upadacitinib (Rinvoq), a Janus kinase (JAK) inhibitor taken once daily that is FDA approved for atopic dermatitis
  • Oral tofacitinib, a JAK inhibitor that works on the immune system  

Since these medications can cause serious side effects, including liver damage, they require a doctor’s close watch. It's also important to know that oral vitamin derivatives are different from -- and more powerful than -- vitamin supplements bought over the counter. Ordinary vitamin A and D supplements do not help.

The latest class of FDA-approved medications is called biologics. These drugs, which you get by injection or IV, may keep your skin from making too many cells. According to the American Academy of Dermatology, these biologics may work:

TNF blockers

TYK2 inhibitor

IL-23 inhibitors

IL-17 inhibitors

IL-12 and IL-23 inhibitor

If your scalp psoriasis becomes infected, you may have crusting, discoloration, warmth, tenderness, and sometimes swelling of your lymph nodes. Your doctor may prescribe an antibiotic treatment for this problem.

There is no cure, but many treatments can help cut down on the number of flares you have and ease symptoms when they do happen. People who follow their treatment plan rarely have to endure severe scalp psoriasis for long.

Psoriasis support groups can also offer valuable tips to help medical treatments work better and ease the stress and sadness that this common condition can cause.