Scalp Psoriasis Treatment: Options and Recommendations

Medically Reviewed by Jabeen Begum, MD on July 09, 2024
Written by Frances Gatta
10 min read

At least half of people with psoriasis have it on their scalp. The skin cells on your scalp grow too quickly and make powdery or thick scales called plaques. The areas around them can be red and itchy.

Scalp psoriasis can cause everything from mild scaling to crusting on the entire scalp – sometimes extending onto the forehead, around the nose, in the beard area, or behind or inside the ears.

If you have mild scaling, it may get better on its own. Sometimes, though, you'll need treatment. It can take a couple of months or longer to get more severe dandruff under control. Once you do, you may be able to keep it from flaring with special shampoos or moisturizers.

There's no cure for psoriasis, but you can take a number of steps to manage it.

Your treatment will depend on:

  • How severe it is
  • How it has responded to treatment before
  • Whether you have psoriasis elsewhere on your body
  • How much hair you have

Scalp psoriasis is a common issue that can be difficult to treat, because getting the medicine to the affected area can be tricky.

The most common treatments for mild cases are medications you put directly on your scalp. If you have a more severe case or have psoriasis elsewhere on your body, you may need a medication that treats your whole body. You can take these medications by mouth or as a shot.

If your psoriasis doesn't respond well after repeated use of one medication, your doctor may replace it or combine it with another type of treatment.

One of the first steps is to soften and remove scales. This makes it easier for medications to do their job.

  • Apply over-the-counter (OTC) products to your scalp to help soften scales and make it easier for them to peel off. Look for products with the active ingredients salicylic acid, lactic acid, urea, zinc pyrithione, or selenium sulfide.
  • Gently loosen the scales with a brush or fine-toothed comb.
  • Shampoo your scalp to remove the scales using a salicylic acid shampoo or soap.
  • Apply thick creams to your scalp while it's still damp to hold in the moisture.

To apply medication:

  • Put petroleum jelly on cotton balls and put them into your ears to keep the medications for your scalp out of your ears. Don't use cotton balls to treat psoriasis in your ear canals. 
  • Use medications sparingly. They may cause skin irritation and weaken hair shafts, causing temporary hair loss.
  • With an oil or lotion, part your hair and drip the medication onto your scalp.
  • With a cream or ointment, rub it right into your scalp.
  • Covering your scalp with a shower cap for a short period may help some medications work better, but check with your doctor first.

Your doctor will help you find the treatment plan that's right for you, depending on the type of psoriasis you have and how severe it is.

Your doctor may recommend these:

Coal tar products are available as over-the-counter (OTC) 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 it on for 5 to 10 minutes before rinsing it out. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can help ease the odor of tar shampoo.

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

Medicated shampoos are available in coal tar and non-coal tar varieties. You can use these daily for scalp plaques, but follow the directions.

Intralesional steroid shots can reduce inflammation. A doctor uses a small needle to inject medication into scalp plaques. You can have this procedure at the doctor’s office.

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.
  • Try OTC tar shampoos or ones with menthol or phenol creams. You can also check with your doctor about taking OTC antihistamine pills.

Your doctor may prescribe steroids, lotions, solutions, sprays, or foams to treat moderate to severe scalp psoriasis. Some topical treatments are applied directly to the skin, then shampooed and rinsed out, including:

Anthralin (Psoriatec). Apply this cream once a day for 10 to 30 minutes.

Calcipotriene (Dovonex). This is a prescription form of vitamin D. Apply it at night and cover your scalp with a shower cap. Leave it on overnight. Don't get it in your eyes.

Calcipotriene and betamethasone dipropionate (Taclonex Scalp, Enstilar Foam). This is a combination of a type of vitamin D and a strong steroid in a suspension or ointment. You use it once a day. Don't get it in your eyes.

Tazarotene (Tazorac). This vitamin A treatment comes in a cream, foam, or gel form. If using it at night, put it on clean, dry skin, and let the medication dry before you go to sleep. Applying a moisturizer after the medication may help prevent drying.

Follow your doctor's directions for all medications. Don't use stronger steroids for more than a 2-week cycle without your doctor giving you the OK.

Systemic treatment involves taking medicines that affect the immune system to help manage psoriasis. These medications work on your body entirely. About 10% to 20% of people with moderate or severe psoriasis take these medicines.

Your doctor will recommend systemic treatment for scalp psoriasis only if you have moderate or severe scalp psoriasis and you can’t tolerate other types of treatment or they don’t work for you. 

Systemic medicines for treating psoriasis include:

Biologics. These medicines are made from living cells. They target specific parts of the immune system that are overactive in psoriasis.

Small molecules. These are drugs that work on immune cells involved in psoriasis. They include apremilast and tofacitinib.

Non-biologic medicines. These medicines are not made from living cells, and they include: 

  • Methotrexate, which slows an enzyme involved in the rapid growth of skin cells
  • Ciclosporin, which lowers the immune system function and, therefore, helps to reduce inflammation from psoriasis
  • Oral retinoids, which help control the growth of cells

Talk with your doctor about the potential side effects of these treatments.

Phototherapy may be recommended as a second option for treating psoriasis. It uses light to: 

  • Slow down skin cells that are growing too quickly
  • Control an overactive immune system
  • Reduce inflammation 
  • Reduce or stop the itch
  • Help the skin heal

Phototherapy is safe and works well for most people with scalp psoriasis, including children, pregnant or breastfeeding people, and people with a weakened immune system or an infection.

Your doctor will not recommend phototherapy if you have:

  • Had skin cancer like melanoma
  • A condition that makes you more likely to have skin cancer, like Gorlin syndrome
  • A condition that causes you to be sensitive to UV light, like lupus or porphyria
  • To take medicine that makes you more sensitive to UV light, like antibiotics, diuretics, and antifungals 

You may get phototherapy two to three times a week and sometimes five times a week. 

UVB therapy

Ultraviolet light B, or UVB, is a type of light found in sunlight. UVB therapy involves exposing affected skin to artificial UVB light. It works well for treating psoriasis by slowing down excessively growing skin cells. You may get broad-band or narrow-band UVB therapy. Narrow-band UVB light bulbs emit a smaller range of UV light than broad-band UVB therapy, but they work faster and may produce longer-lasting results.

You’ll get this therapy at the doctor’s office, at a clinic, or at home with a phototherapy unit setup.

PUVA therapy

Most of the sun’s rays that get to the skin are ultraviolet light A (UVA). Alone, it can’t work to treat psoriasis. But using it with light-sensitizing agents called psoralens can help reduce skin cell growth and improve psoriasis symptoms. This therapy is called PUVA, which stands for psoralens and ultraviolet light A.

Laser treatment

Your doctor will use a laser to target affected areas of your skin with high-intensity light to improve your psoriasis symptoms and slow down the rapidly growing skin cells. Because the light dose you’ll be getting is high, you’ll only need a few sessions.

Other phototherapy

Depending on your case, your doctor may also recommend other phototherapy options, like:

  • Photodynamic therapy, which involves using a light-sensitizing drug activated by light to treat psoriasis.
  • Grenz rays, which involves using low-voltage radiation that goes only about 2 millimeters into the skin.

Biologics are drugs that work on the immune system to reduce your symptoms. You’ll likely get this drug as a shot. Your doctor will likely only recommend it if you have moderate to severe psoriasis and other treatments haven’t improved your condition. 

Drugs approved for treating moderate to severe psoriasis include:

Etanercept (Enbrel)

This drug belongs to a class of medications called anti-TNFs or TNF blockers. These medicines work against a chemical messenger in your immune system called TNF-alpha, which you have too much of when you have psoriasis and contributes to your symptoms. You’ll get it as a shot once or twice a week. 

Infliximab (Remicade)

This is another anti-TNF drug for treating severe psoriasis that doesn’t respond to other treatments. You’ll get this medicine through your vein with an IV (intravenous) drip. After you first get this treatment, you'll get it again after 2 weeks, at 6 weeks after, and then every 8 weeks.

Adalimumab (Humira)

Like other anti-TNF biologic medicines, adalimumab blocks TNF to reduce your symptoms. It is recommended in people with moderate to severe psoriasis. You’ll get this medicine as a shot that you have to take every other week after your first dose. Your doctor might also recommend this medicine with methotrexate. 

Ustekinumab (Stelara)

Ustekinumab treats psoriasis symptoms by targeting immune signals interleukin-12 (IL-12) and interleukin-23 (IL-23), which may worsen your symptoms. It treats moderate to severe plaque psoriasis in people ages 6 or older who might benefit from light or systemic therapy. You’ll get it as a shot or through your vein with an IV drip every 4 weeks for the first two doses and then every 12 weeks as long as you’re taking this treatment. 

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

You can manage your scalp psoriasis symptoms at home by:

  • Bathing daily, gently washing your scalp with mild soap and lukewarm water. You can also add bath oil, oatmeal, or Epsom salts to your water and soak in it for at least 15 minutes.
  • Moisturizing your dry scalp with oils or thick ointments
  • Spending some time under the sun, only exposing areas with scalp psoriasis to sunlight. Talk to your doctor about using sunlight to improve your psoriasis first, as too much sun can trigger or worsen your symptoms and make you more likely to have skin cancer.
  • Using a medicated shampoo with coal tar and an anti-itch cream with hydrocortisone or salicylic acid to reduce itching
  • Keeping your body and environment cool. When it's hot, try using an air conditioner or placing cold packs on itchy spots for a few minutes.
  • Taking up healthy lifestyle habits like staying active and eating a healthy, balanced diet to manage your symptoms

Many people with psoriasis have it on their scalp, causing areas of their scalp to have plaques and to be red and itchy. Treatment can be challenging, but there are several options to explore with your doctor. If over-the-counter or prescribed medicines such as creams, steroids, lotions, solutions, sprays, or foams don’t work well, your doctor may suggest light therapy or systemic therapy. You can also manage your symptoms at home by regularly bathing and moisturizing, staying in a cool environment, using anti-itch shampoo and moisturizer, and maintaining healthy lifestyle habits.

What causes psoriasis of the scalp?

Psoriasis of the scalp happens when your immune system doesn’t work as it should, causing your skin cells to grow too quickly. 

Is it OK to remove scalp psoriasis?

It’s not OK to remove scalp psoriasis, as doing so may worsen your symptoms unless you’re using OTC products with salicylic acid, lactic acid, urea, zinc pyrithione, or selenium sulfide to make it easier to remove.

What deficiency causes scalp psoriasis?

Vitamin D deficiency has been linked to scalp psoriasis, although researchers are still trying to find out how it contributes to psoriasis.