Scalp Psoriasis and Natural Hair

Medically Reviewed by Stephanie S. Gardner, MD on March 15, 2022
4 min read

The beautiful curls of your natural hair can make psoriasis of the scalp more challenging to treat. But whether your condition is mild or severe, there are options to help you ease itching and flakes while preserving your locks.

Around half of people living with psoriasis have the condition on their scalp. This form of psoriasis is common in Black people and can also show up on the hairline, forehead, back of the neck, and around the ears.

Doctors diagnose psoriasis less often in African Americans because they may overlook signs and symptoms of the condition. While lesions appear red on lighter skin, they look purple, grayish, or dark brown on skin of color. Discoloration along the hairline may be more noticeable on darker skin tones because of the contrast with lighter-colored scaliness.

Scalp psoriasis is often hard to treat in Black people due to the texture of their hair. Many people of African descent have tightly coiled hair, which is more fragile than loose curls or straight textures. It also tends to be drier because sebum, a natural moisturizer made in your oil glands, has trouble moving down the hair shaft.

Certain hairstyles and styling techniques like weaves and chemical hair relaxers can also sometimes leave hair weaker and prone to breakage.

Although it’s more challenging to treat scalp psoriasis in natural hair, the good news is that you have a range of prescription and over-the-counter options. There are medicated ointments, creams, foams, and other formulations.

“There’s a lot of flexibility,” says Morgan McCarty, DO, a board-certified dermatologist at Austin Regional Clinic in Round Rock, TX. “Treatment depends on the type of hairstyle you have and how often you wash your hair.”

People with afro-textured hair usually avoid washing it too often so it doesn’t dry out. If you decide to use a medicated psoriasis shampoo, keep in mind you’ll need to wash your hair at least once every 2 weeks for it to work well.

Your doctor may instead suggest an oil or moisturizing foam treatment, which may be a similar consistency to products you already use to style your hair. You’ll treat your hair until flaking and itching are under control, then scale back to a couple of times a week for long-term maintenance.

It’s possible you’ll have to try different treatments before you find one that works. And it can take a couple of months before you see a difference in your skin. If your skin doesn’t start to get better after 4 weeks, contact your dermatologist.

You switch up your hairstyle to express yourself and protect your natural hair from styling damage and elements like humidity. Unfortunately, psoriasis dries out and irritates your scalp, and some styles can make the condition worse.

Talk to your dermatologist about ways to avoid a psoriasis flare while maintaining your hairstyle. “I always take into consideration people's styling preferences,” says Chynna Steele Johnson, MD, a board-certified dermatologist at Steele Dermatology in Atlanta. “If they tend to wear their hair in a naturally curly state, get their hair blown out straight, or wear braids, we always want to make sure that treatments are doable and mesh with someone's lifestyle.”

In general, until you have scalp psoriasis under control, it’s best to avoid:

  • Too much heat. This includes curling irons, flat irons, and hot rollers. The heat from these tools can irritate your scalp. Cut back on how often you use them, and try not to let the heat touch your scalp.
  • Tight hairstyles. Braids, ponytails, buns, and other styles that pull the hair too tightly may cause a psoriasis flare. If you decide to wear braids, only keep them in for a few weeks at a time to avoid putting stress on your hair. Also, wear larger braids for easier access to the scalp.
  • Weaves. This style can cover the scalp, making it hard to cleanse and treat psoriasis properly. Wigs are OK since you can take them off to care for your scalp.
  • Hair coloring and relaxers. The chemicals in these products can also trigger a scalp psoriasis flare.
  • Too much brushing or combing. They help tame your hair but can spread psoriasis lesions and worsen the condition. Be sure to use gentle motions when you brush or comb your hair.
  • Alcohol-based products. They tend to be drying in general and can cause more flaking when you have psoriasis.
  • Moisturizers. You may be tempted to use moisturizers, oils, or ointments to try to treat what looks like dryness. In reality, it’s flaking from psoriasis, and these products only mask the condition.

The bottom line is you’ll want to avoid changing or manipulating your hair as much as possible until your psoriasis clears up. In the meantime, scarves and other headwraps are stylish and help protect your sensitive scalp.