Plaque psoriasis is a chronic inflammatory autoimmune condition that affects the skin, causing patches of raised, red, inflamed, thickened skin called plaques to develop. Plaques are often covered in silvery scales and can cause itchiness and other types of discomfort. The scalp is one of the most common places on the body to be affected by plaque psoriasis. In fact, around half of people with the condition have symptoms located on the scalp1. As with psoriasis located in other areas, symptoms may come and go over time.
The symptoms of plaque psoriasis on the scalp
Psoriasis symptoms can occur anywhere on a person’s scalp, and the back of the head is a common place for plaques to develop. There may be just one patch on the scalp or multiple patches in different places. In some people, plaques might extend outside the area of the scalp that is covered in hair. For example, they might occur on the forehead at the edge of the person’s hairline, around the ear area, or on the back of the neck at the bottom of the hairline2.
Just like other areas affected by psoriasis, symptoms on the scalp can be mild, moderate, or severe. For people with mild symptoms, psoriasis on the scalp can be relatively thin with light scales, covering only a small part of the head. For people with more severe symptoms, the plaques may become much thicker and cover a larger area of the head.3
Can plaque psoriasis on the scalp cause me to lose my hair?
Some people with scalp psoriasis might worry that the plaques will cause them to lose their hair.2 Hair loss is not very common for people with mild or moderate psoriasis on the scalp. In some cases, people with severe scalp psoriasis may temporarily lose some hair in areas of the scalp affected by severe plaques. For example, small areas of hair might fall out due to combing or scratching off scaly areas of plaque. However, for most people, that hair will tend to grow back fully over time.
How is plaque psoriasis on the scalp treated?
For some people, having scalp psoriasis may cause self-consciousness or embarrassment at times. The good news is that there are various treatment options available for people to try, and many people find that they are able to manage the condition effectively.
However, treating psoriasis on the scalp can be more challenging than treating it on other parts of the body because the hair can make it difficult for treatments to reach the affected area on the scalp.1
In many cases, your healthcare provider will recommend that you combine treatments or cycle through several different types of treatment.2 This is because a person’s psoriasis can change over time, and a treatment that worked well at the beginning may gradually stop working if it is used for a long period of time.
Treatment options for mild plaque psoriasis on the scalp
Most people with scalp psoriasis have a mild form of the condition. For some people, it may cause very little discomfort at all. For others, even very small patches of plaque can be very itchy and uncomfortable.
For many people with very mild scalp psoriasis, over-the-counter topical medicines can be helpful.2 Topical medicines are applied directly to the affected areas on the skin. Coal tar is a non-prescription treatment that can help to reduce the growth of skin cells that cause the plaques. Another option is salicylic acid, which can help to lift the scales on psoriasis plaques off of the affected skin. Consult a healthcare provider before starting either of these treatments, because both can cause side effects for some people.3
Medicated shampoos are another option for treating scalp psoriasis. Some of them contain coal tar, while others contain different kinds of active ingredients.4 These types of shampoos are generally rubbed into the scalp and left to sit for a period of time so that the treatment can penetrate the scalp through the hair.
Treatment options for moderate or severe plaque psoriasis on the scalp
For people with moderate or severe plaques on the scalp, over-the-counter topical treatments, and medicated shampoos may not be effective enough to treat their symptoms.2 These patients will need to work with their healthcare providers to figure out the best treatment plan for their condition. Treatment might include stronger topical treatments that require a prescription. Generally, these topical treatments work by decreasing the growth of the excess skin cells that cause psoriasis plaques. Some of them also help to flatten thickened skin and reduce the amount of scale on plaques. Topical prescription medicines that may be used to treat scalp psoriasis include:
Corticosteroids are a type of topical medication that are available as a scalp oil or foam to treat symptoms of plaque psoriasis. Typically, these products are applied with occlusion using a scalp covering such as a shower cap.
People with very severe scalp psoriasis may be advised to try a systemic medicine if their symptoms are not controlled well enough by topical medicines.3 Unlike topical medicines that are directly applied to affected areas, systemic medicines work by changing the way that the entire body functions. These types of drugs can be taken orally (by mouth) in a tablet, capsule, or liquid. They can also be injected through a shot or in an IV. Some of the systemic medicines that healthcare providers might suggest for treating scalp psoriasis include:
- Methotrexate
- Oral retinoids
- Cyclosporine
- Biologic therapies
Ultraviolet light therapies can also be used to treat scalp psoriasis, but the hair on the head can prevent the light from getting down to the scalp so that it can work most effectively. However, there are special light therapy wands designed specifically for areas that are hard to reach with traditional phototherapy.4 Laser treatments may be effective in treating scalp symptoms for some patients.
Tips for living with scalp psoriasis
Having short hair or a shaved head can help the effectiveness of ultraviolet light therapies and topical treatments (although this may not be a good option for some people). Itching on the scalp can be particularly bothersome and painful for many people.2 Your healthcare provider can advise you about strategies for dealing with scalp itching. Some people find it helpful to use an over-the-counter antihistamine and/or to use shampoo or conditioner containing menthol.3Flare-ups of scalp psoriasis and dandruff-like flaking can have different causes for different people, but some common triggers are cold weather, dry air, and experiencing stress. Also, getting your hair cut or styled may cause further irritation to your scalp if the barber or hairdresser is not familiar with psoriasis. If your barber or hairdresser is not familiar with the condition (although many are), then it may help to explain that it is not contagious and it is not a fungal infection.
