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Psoriasis Health Center

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Scalp Psoriasis

Scalp psoriasis is a common skin disorder that produces raised, reddish, and often scaly patches. It can appear as one or multiple patches on the scalp, affect the entire scalp, and spread beyond the scalp to the forehead, back of the neck, or behind the ears.

Scalp psoriasis is not contagious. Like other types of psoriasis, its exact cause is unknown. But it's believed to result from an abnormality of the immune system that causes skin cells to grow too quickly and build up as patches. You may be more likely to develop scalp psoriasis if psoriasis runs in your family.

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About half of the estimated 7.5 million Americans with psoriasis -- which can affect any skin surface -- have scalp psoriasis. Most commonly, people with scalp psoriasis also have psoriasis on other parts of their body. But sometimes the scalp is the only affected area.

Scalp psoriasis can be mild and almost unnoticeable. But it can also be severe and long lasting, causing thick, crusted lesions that affect appearance. Intense itching can interfere with sleep and everyday life, and frequent scratching can lead to skin infections and hair loss. People with scalp psoriasis often report that it leaves them feeling embarrassed and ashamed.

Symptoms of Scalp Psoriasis

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

  • Reddish plaques
  • Silvery-white scales
  • Dandruff-like flaking
  • Dry scalp
  • Itching
  • Burning sensation or soreness
  • Hair loss

Although scalp psoriasis itself is not the cause of hair loss, frequent or intense scratching, forceful removal of scales, harsh treatments, and associated stress can cause temporary hair loss. Fortunately, hair usually grows back after the psoriasis lesions clear.

If you have any of these symptoms, see your doctor or dermatologist. He or she may diagnose scalp psoriasis by visual examination alone or perform a skin biopsy to rule out other conditions, such as seborrheic dermatitis.

Topical Treatments for Scalp Psoriasis

The first line of defense against scalp psoriasis is topical treatment: medicated shampoos, creams, gels, oils, ointments, and soaps. Although some of these products are available over the counter, stronger topical treatments require a prescription.

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

Prescription products for scalp psoriasis may contain higher concentrations of salicylic acid, coal tar, or both, as well as other FDA-approved medications, such as:

  • Anathralin, an older prescription medication
  • Antimicrobials, which are used to treat bacterial or yeast infections associated with scalp psoriasis
  • Calcipotriene, a vitamin D derivative
  • Calcipotriene and betamethasone dipropionate (a potent steroid)
  • Other topical steroids
  • Tazarotene, a vitamin A derivative

To be effective, topical treatments must be applied to the scalp instead of just to the hair. They also must be used exactly as directed until you get adequate control of your lesions, a process that can take up to eight weeks or longer. After your psoriasis has cleared, you may be able to prevent recurrences by shampooing daily or twice-weekly with a shampoo containing coal tar or other medications.

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