What is Scalp Psoriasis?

Between seven and eight million Americans suffer with psoriasis. According to the National Psoriasis Foundation, about 50 percent of people with psoriasis have scalp psoriasis. Scalp psoriasis can affect your scalp, hairline, forehead, back of your neck, and the skin around your ears, which makes it difficult to hide. Besides being uncomfortable, it can also be embarrassing leading to anxiety and depression for some people.

What Causes Scalp Psoriasis?

Psoriasis is not contagious. All psoriasis is an autoimmune disease, which means your body’s defense system – your immune system – mistakenly attacks normal cells of your body causing inflammation. With psoriasis, your immune system attacks skin cells making them grow and shed more rapidly than normal. Normally skin cells get replaced over about one month, but with psoriasis, the process can take only three to four days.

There may be abnormal genes passed down through families that cause psoriasis, and some people will have a family history of the disease. On the other hand, many people have a family history of psoriasis and never develop psoriasis and many others develop psoriasis without having a family history. The cause may be genes that need a trigger to become active. Possible triggers for psoriasis to start include:

• Injury to the skin
• Sunburns
• Physical or emotional stress
• Medication reactions
• Smoking
• Drinking alcohol
• Obesity

Scalp Psoriasis Symptoms

Psoriasis plaques will look powdery, silvery, and shiny. Plaques are dry. ©szefei | Getty Images

Like dandruff, scalp psoriasis causes flaking and itching of your scalp, but scalp psoriasis also causes raised and thickened areas of the scalp and skin around the hairline called plaques. Plaques are covered with crusts of flaking skin that is powdery, silvery, and shiny. The plaques may have unusual colors like red, brown, gray, or purple. Seborrheic dermatitis is another condition that may be confused with scalp psoriasis, but this condition causes yellow crusts that are moist, not dry and flaky like psoriasis.

Symptoms of scalp psoriasis may come and go. When they get better it is called remission. When they get worse it is called a flare. These flares and remissions are unpredictable, which adds to the stress of living with psoriasis. Finally, people with scalp psoriasis are more likely to have two other autoimmune diseases, alopecia and psoriatic arthritis. Alopecia causes hair loss, and psoriatic arthritis causes joint swelling and pain. These symptoms may be added to the burden of scalp psoriasis.

Scalp Psoriasis Treatment

Scalp psoriasis can be diagnosed by the signs and symptoms. Although there is no cure for scalp psoriasis, and it is likely to be a lifelong problem, there are many treatment options. Treatments work differently for different people, so you need to work with a dermatologist to find the treatment that works best. Most people will have some relief with some combination of these treatments:

• Over-the-counter scalp psoriasis shampoos and creams are available. There are many products, but according to the National Psoriasis Foundation, there are only two over-the-counter ingredients you should look for that actually work. They are salicylic acid and coal tar.
• For more severe scalp psoriasis, there are prescription strength shampoos and skin creams.
• Prescription drugs that block the immune system may be used.
• For the most difficult cases, injection into the scalp with new drugs called biologics may be helpful when other treatments have been ineffective.
• A medical treatment that may help is regular timed exposure to ultraviolet light, called phototherapy.

Scalp Psoriasis Treatment at Home

Some home treatments that may help include moisturizing the scalp with aloe vera, coconut oil, or olive oil. Plaque inflammation may respond to a paste made of baking soda and water. An anti-inflammatory diet that may help can include fish with healthy omega-3 oils, like mackerel, salmon, and sardines. Other anti-inflammatory foods are olive oil and leafy green vegetables.

Preventing or reducing flares of scalp psoriasis may be possible. For some people foods cause flares, so you can keep a food journal to see if there are foods you can avoid. Basic home care tips from the Cleveland Clinic include:

• Avoid hot water showers. Hot water may irritate your scalp.
• Always use a conditioner or moisturizer after washing your hair.
• Brush or comb your hair gently.
• Don’t wear a hat if you don’t need to. Scalp psoriasis does better when it can breathe.
• Try avoiding common triggers like alcohol, smoking, citrus fruits, gluten, and nightshade vegetables (tomato, potato, and peppers).

Let your doctor know if your treatment plan is not working. Ask for help if you feel anxious, depressed, or hopeless. There are many good options for treating this frustrating and unpredictable condition, so keep working with your doctor to find the best options for you.

For more on skin health, purchase the UCLA School of Medicine Skin Care report. 

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