Scalp psoriasis

Scalp psoriasis: When psoriasis forms on the scalp, it can creep beyond the scalp.

Scalp psoriasis: Overview

Psoriasis (sore-EYE-ah-sis) can appear anywhere on the skin. When it forms on the scalp, it is often called scalp psoriasis.

Scalp psoriasis can extend beyond the scalp. It can appear on the forehead as shown in the picture on this page. Sometimes, it extends to the back of the neck or appears behind the ears.

On the scalp, psoriasis may need different treatment. The skin on the scalp is thicker. Hair can get in the way.

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Scalp psoriasis: It can appear behind the ear as shown on the left. It can cause a silvery-white scale and temporary hair loss as shown on the right.

Scalp psoriasis: Signs and symptoms

Psoriasis can appear anywhere on the scalp. Sometimes a small patch develops, which can be easy to hide with hair. Scalp psoriasis also can cover the entire scalp. When psoriasis appears on the scalp, you may notice:

• Reddish patches on the scalp. Some patches are barely noticeable. Patches also can be very noticeable, thick, and inflamed.
• Dandruff-like flaking and silvery-white scale. Scalp psoriasis can look a lot like dandruff. Many people who have scalp psoriasis see flaking. But there are differences between scalp psoriasis and dandruff. Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp.
• Dry scalp. The scalp may be so dry that the skin cracks and bleeds.
• Itching. This is one of the most common symptoms. For some the itch is mild; others have intense itching that can interfere with everyday life and cause sleepless nights.
• Bleeding. Because scalp psoriasis can be very itchy, almost everyone scratches. Scratching can make the scalp bleed. Scratching also tends to worsen the psoriasis. Scratching can make the patches larger and thicker. This is why dermatologists tell their patients, “Try not to scratch your scalp.”
• Burning sensation or soreness. The scalp can burn. It can feel extremely sore.
• Temporary hair loss. Scratching the scalp or using force to remove the scale can cause hair loss. Once the scalp psoriasis clears, hair usually regrows.

These signs and symptoms can come and go. Some people have only one mild flare on their scalps. Others have many flare-ups, which can range from mild to serious. Many things can trigger a flare-up, including stress, cold, and dry air.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Scalp psoriasis: Who gives and causes

Who gets scalp psoriasis?

Psoriasis is common on the scalp. Researchers estimate that at least half (50 percent) of the people who have plaque (plak) psoriasis will have at least one flare-up on the scalp.

What causes scalp psoriasis?

Regardless of where psoriasis forms, the cause is the same. Psoriasis develops when a person’s immune system has faulty signals that tell skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not shed these excess skin cells. The skin cells pile up on the surface of the skin, causing patches of psoriasis to appear.

Scalp psoriasis: Diagnosis and treatment

How do dermatologists diagnose scalp psoriasis?

To diagnose scalp psoriasis, a dermatologist looks at the scalp.

Sometimes a dermatologist also needs to remove a bit of skin. This skin is sent to a lab. The lab report will tell the dermatologist whether the patient has scalp psoriasis.

How do dermatologists treat scalp psoriasis?

Scalp psoriasis causes many people discomfort. Some people feel embarrassed. Treatment can ease these problems. There are many safe and effective treatments. Some people get relief from a medicated shampoo or solution. A few of these can be purchased without a prescription.

But scalp psoriasis can be stubborn. Many people see a dermatologist for treatment. A dermatologist can tell you what can help. The following types of treatment can help scalp psoriasis:

• Medicine applied to the scalp.
• Medicated shampoos.
• Scale softeners.
• Injections.
• Light treatments.
• Biologics and other medicines that work throughout the body.

Outcome

When a person sees a dermatologist, it is rare to suffer from scalp psoriasis for long. Of course, it helps to follow the treatment plan.

Scalp psoriasis: Tips for management

To help their patients get maximum benefit from treatment for scalp psoriasis, dermatologists often share the following tips with their patients:

1. Try not to scratch your scalp. Dermatologists realize that scalp psoriasis can be extremely itchy. Scratching, however, can make the psoriasis worse. Scratching can cause the scalp to bleed. It also can cause hair loss, which can become noticeable.
2. Relieve the itch by treating the psoriasis. When the psoriasis clears, the itch will stop. If that’s too long to wait, tell your dermatologist that the itch is unbearable.
3. Shampoo gently. Rubbing a shampoo into the scalp may seem best, but it’s not. Rubbing, scrubbing, and scratching your scalp tend to make scalp psoriasis worse.
4. Remove scale with care. To treat scalp psoriasis, you need to loosen and remove the scale on your scalp. You must do this gently. Picking can cause psoriasis to flare. Picking also can cause hair loss.
5. Dermatologists recommend using a scale softener. A scale softener that contains salicylic acid can soften the thick, stubborn patches of psoriasis. Softening these patches also allows medicine that you apply to the psoriasis to work better. When applying medicine to your scalp, be sure to lift your hair out of the way. This helps ensure that you apply the medicine to your scalp and not your hair.
6. Try not to stress out. A psoriasis flare-up can be stressful. Feeling stressed, however, can make matters worse. Stress can worsen psoriasis. Stress can cause the hair on your head to fall out. Finding ways to unwind can do wonders.

© 2019 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission. Use of these materials is subject to the legal notice and terms of use located at https://www.aad.org/about/legal