Skip to Accessibility Menu Skip to Login Skip to Content Skip to Footer

What Is Scalp Psoriasis?

Editorial Team's avatar image

By Editorial Team

4 min read

Reviewed by: HU Medical Review Board | Last reviewed: August 2024 | Last updated: August 2024

Most people with psoriasis develop thick, scaly patches on their skin called plaques. These patches are the result of an overactive immune system that causes rapid skin cell growth. These skin cells are unable to shed, so they pile up and form plaques.1

In people with scalp psoriasis, plaques generally occur on the scalp. They can also occur on other areas of the head, such as the forehead, ears, and neck.1-3

Up to 80 percent of people with psoriasis have scalp psoriasis. This equals about 2 percent of the general population.1-3

What causes scalp psoriasis?

In general, psoriasis is caused by the immune system attacking skin cells, and in response, the body makes new skin cells faster than normal. These excess skin cells build up and form plaques, often on or around the scalp. Experts do not know why the body does this, but studies so far have shown that genetics and a problem with the immune system play a role.4

Genetics

Psoriasis runs in families. People with a family history of it have a greater chance of developing it. Researchers have found that certain genes are linked to psoriasis. But not everyone with these genes will have psoriasis. And not everyone who develops psoriasis has these genes.4

Immune system response

Psoriasis is an autoimmune condition. This means the body mistakes healthy skin cells as something harmful and attacks them. This causes the skin to make new cells very quickly, which creates plaques on the skin surface.4

By providing your email address, you are agreeing to our Privacy Policy and Terms of Use.

Triggers

Scalp psoriasis often appears after a person is exposed to a certain trigger. Many possible triggers exist. Different people may react differently to each trigger. Common triggers for initial or recurring psoriasis flare-ups are:2,4

  • Periods of high stress
  • Infections
  • Injury or trauma to the skin
  • Hormonal changes
  • Exposure to cold, dry air
  • Heavy alcohol intake or smoking
  • Obesity
  • Low calcium levels
  • Certain drugs

What are the symptoms of scalp psoriasis?

The main symptom of scalp psoriasis is plaques behind the ears or on or around the:2,5

  • Scalp
  • Hairline
  • Forehead
  • Neck

These plaques can appear in 1 or more areas, or they may cover the whole scalp. They may cause:2,5

  • Thin, red/pink patches
  • Thick patches with silver or white scales on top
  • Powdery flakes that look like dandruff
  • A "tiled" look
  • Mild to severe itching
  • A burning feeling
  • Dry skin that bleeds or cracks

What are possible complications of scalp psoriasis?

In some cases, scalp psoriasis can lead to other health issues. These complications may include:2,3

  • Problems sleeping (because of itching)
  • Skin infections stemming from scratching
  • Hair loss that is often temporary and reversible
  • Skin scarring
  • Loss of confidence in one’s appearance
  • Other health challenges like anxiety

Scalp psoriasis may also be a sign of psoriatic arthritis (PsA). This inflammatory illness affects the joints and places where tendons and ligaments connect to bones. Around 1 in 3 people with psoriasis also have PsA. A rheumatologist can diagnose and treat PsA.6,7

How is scalp psoriasis diagnosed?

To diagnose scalp psoriasis, your doctor will look closely at your head and scalp for signs of the condition. They will also ask about your symptoms and how they affect you. Based on your answers, they may assign you a score on the Psoriasis Scalp Severity Index (PSSI). In some cases, they may remove a small piece of skin to look at under a microscope (biopsy).2

How is scalp psoriasis treated?

Psoriasis on the scalp can be harder to treat than psoriasis elsewhere on the body. One main reason is that topical treatments can be hard to apply and may negatively affect appearance. Because of this, scalp psoriasis may lower a person’s quality of life more than other kinds of psoriasis.2

But there are effective treatments for this condition. Some are topical and can be applied to the skin. Others are systemic and work inside the body to slow down the immune system. Treatment options include:2,6,8

  • Topical steroid drugs (corticosteroids) – These drugs are applied directly to the affected scalp areas to reduce inflammation. They may come in the form of a foam, gel, solution, shampoo, or spray. Topical treatments may also combine steroids with vitamin D for long-term use, which is effective at keeping the skin clear.
  • Other topicals – Other topical treatments include scale-softening keratolytics (such as salicylic acid), coal tar, and coconut oil compounds. Many of these products are available over the counter.
  • Light exposure (phototherapy) – Handheld devices like combs that deliver ultraviolet (UV) light directly to the scalp can help lessen symptoms.
  • Systemic drugs – These drugs, often given by injection, may be prescribed if you have psoriasis plaques on your scalp and elsewhere on your body. They reduce inflammation throughout the body by blocking certain immune processes. Systemic treatment options include:
    • Certain biologics
    • PDE4 blockers
    • Other drugs that suppress the immune system

Certain lifestyle changes may also help reduce flare-ups of scalp psoriasis. Try the following:2

  • Avoid known triggers whenever possible.
  • Moisturize your scalp regularly.
  • Quit smoking if you smoke.
  • Reduce your alcohol intake.
  • Cut your hair shorter.

The right treatment depends on each person’s:8

For example, a shampoo treatment may not be an effective choice for people who do not wash their hair often. Such persons might benefit more from an ointment, lotion, or non-topical treatment.8