The First Line Of Therapy
Mild to moderate psoriasis is initially treated with a low to mid-potency corticosteroid cream, lotion, spray or ointment – such as:
Lower potency products, such as fluocinolone can be use on the face or other sensitive areas.
Lotions or foams are best for the scalp, creams are best for oozing lesions, and ointments can treat dry, raised, or scaly lesions.
Higher potency topicals are reserved for thicker, tough-to-treat areas like elbows or knees. Topical treatments work best on mild and smaller areas of psoriasis.
- betamethasone topical is a higher potency spray used in mild to moderate psoriasis.
- halobetasol propionate lotion 0.01% from Ortho Dermatologics is also a high-potency topical corticosteroid formulation.
Scalp Psoriasis Fact Sheet
It can be tough to manage scalp psoriasis. Psoriasis plaques on your scalp may be itchy, flaky and awkward to treat. When scalp psoriasis is blocked by the hair, finding a safe and effective treatment that doesnât mess with your mane can get even trickier.
But living with scalp psoriasis doesnât mean you canât enjoy your hair and manage scale build up. There are ways to make living with scalp psoriasis easier.
Request a scalp psoriasis quick guide from our Patient Navigation Center with tips on dealing with itch and info on what treatments might be right for you.
Heal Flaky Red Skin With These Topical Treatments
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Psoriasis is a skin condition that most commonly causes red, scaly patches in areas along the body like the knees, scalp, and elbows. The long-term chronic condition has no cure, with people typically experiencing flare ups for a few weeks to a few months before it dies down.
Although there is no cure to the condition, products on the market help to relieve dryness, itchiness, irritation, and discomfort. Not all lotions are created equal, with some using fragrances, dyes, and chemicals that can further irritate your psoriasis instead of relieving symptoms.
Mark Lebwohl, M.D., a New York board-certified dermatologist and member of American Academy of Dermatology, told Verywell Health that people should seek an expert opinion if over-the-counter topicals dont relieve their psoriasis symptoms, as a prescription topical could provide better results.
If you’re looking for some OTC products to help soothe a last minute flare up, here are some of the best on the market.
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Best Coal Tar Shampoo
“Coal tar is a mainstay in the treatment of psoriasis,” says Dr. Mauricio, adding that coal tar shampoos, such as Neutrogena T/Gel Therapeutic Shampoo, can be very effective. This popular shampoo received the National Psoriasis Foundation Seal of Recognition, meaning it’s intended to be non-irritating and safe for people with psoriasis. It helps treat itching and reduces scalp buildup, but there are some limitations to the benefits of coal tar. Kids canât use the ingredient, for one, and you have to be careful with sun exposure when using coal tar. It can also temporarily discolor light-colored hair, and also runs the risk of staining your skin or clothing.
Note that Dr. Mauricio has her patients with scalp psoriasis rotate between this, Selsun Blue, Nizoral, and a shampoo with salicylic acid â all featured below â for best results.
What Does Psoriasis Look Like
Psoriasis can occur on any area of the body, including hands, feet, elbows, scalp or genitals.
- In plaque psoriasis, the most common form of psoriasis, the skin tends to be dry, flaky, itchy, red and covered with white scales.
- Psoriasis can affect small areas of the body or be very widespread.
- For many people, psoriasis can lead to embarrassment, self-consciousness, or stress some people may require treatment for depression or anxiety.
- Family doctors, dermatologists, or rheumatologists may treat your psoriasis depending upon site and severity.
- See more pictures of psoriasis.
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Neutrogena T/sal Therapeutic Shampoo
Dr. Chimento recommends Neutrogena T/Sal Therapeutic Shampoo for people with psoriasis visible on their scalp. For scalp psoriasis, shampoos that contain salicylate acid and/or tar work wonders, she says. Used regularly, they help to gently exfoliate the skin and break up the scaliness and flakiness.
Natural And Home Remedies
The National Psoriasis Foundation recommends several natural remedies in conjunction with medical treatments, to soothe the pain, itch, and plaque of scalp psoriasis:
- Aloe vera juice, gels, or creams
- An apple cider vinegar rinse
- Tea tree oil shampoos
- Capsaicin pepper in creams or ointments
Talk to your doctor before using any alternative or complementary therapies.
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Calcipotriol + Corticosteroids: A Powerful Combination
Simultaneous use of calcipotriol and corticosteroids has been found to be more effective than either therapy alone, and the combination appears to minimize the side effects of both. The combination works as quickly as the faster acting corticosteroid component, producing good results in about four weeks.
Combination products are available in a variety of formulations, though they can be far more expensive than some of the generic steroids that are available.
One option when cost is a factor is to be prescribed the two products separately and use them, for example, on alternating days. Some doctors, noting that the combination products are only modestly more effective, and recognizing that complexity in a treatment regimen reduces compliance, simply start off with a topical corticosteroid for scalp psoriasis.
Best Budget: Cortizone 10 Anti
Itchiness can be one of the most debilitating symptoms of psoriasis, making it hard for you to focus on your everyday life. Cortizone-10 Anti Itch Lotion specifically targets that symptom to provide long-lasting relief to irritated skin. Included in the product is maximum strength hydrocortisone, a leading ingredient in treating itchiness. The hydrocortisone is combined with seven different types of moisturizers and two vitamins to hydrate the skin while helping it heal.
Customers say the lotion is the holy grail of aiding their psoriasis because its non-drying, compared to other anti-itch creams on the market, and it relieves their red and irritated skin patches.
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Psoriasis Uncovered: Myths Vs Truths
Myth: Psoriasis is just “dry” skin.Truth: Psoriasis is an immune disorder leading to skin inflammation with itching and thick, dry, scales on the skin. It cause embarrassment and distress for patients.
Myth:Psoriasis is contagious.Truth: You cannot “catch” psoriasis from someone else, even if you come into contact with their skin. It is not an infectious disease.
Myth:Psoriasis can be cured.Truth: Psoriasis is a chronic condition that has no cure however, there are many effective treatments, and ongoing research for this condition is active.
What Does Scalp Psoriasis Feel Like
Scalp psoriasis appears as raised, red or purple, itchy patches with silvery white scales that often start in one spot behind the ear, for example and spread through the hair. Symptoms include mild to severe itching, burning, cracking or bleeding skin. Members of MyPsoriasisTeam described how it feels in their own words:
- Feels like chicken pox in my scalp during a flare-up.
- My scalp feels like sandpaper.
- Looks like it’s constantly snowing from my head.
- My scalp is so itchy I feel like pulling out my hair.
- The plaque gets so thick, it feels like super glue in my hair and hard to get out.
- My scalp gets so bad it bleeds and is sometimes painful, especially behind the ears.
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Topical Treatments For Moderate To Severe Scalp Psoriasis
If your symptoms are more severe and the plaques on your scalp are thick, you will probably need prescription treatment. Your GP can recommend a topical treatment containing corticosteroids, vitamin D analogues, or dithranol. Prescription products containing these ingredients include dermovate scalp application, locoid scalp lotion, dithrocream and dovobet gel.
You should use these treatment exactly as directed by your doctor. Make sure that you apply the medicated product directly to the scalp, and not to the hair.
In addition to these medicated treatments, you might also try using emollients on your scalp, as these can help to soften thick plaques. An emollient is a rich moisturiser which can prevent itching and inflammation, and create a protective barrier on the skin, sealing in moisture. One to consider using is grahams natural psoriasis cream, which is made from manuka honey and calendula. Formulated with natural ingredients, this moisturising treatment offers effective relief will helping to normalise the skins structure.
If you are going to use an emollient on your scalp, you should try the following method:
Article Summary: Scalp Psoriasis Is Highly Bothersome And Hair Makes It Harder To Treat But There Are A Number Of Prescription Treatments In A Variety Of Formats Including Sprays Foams Gels And Shampoos To Help Treat The Scalp Effectively As Well As Treatments For The Whole Body That Have Demonstrated Strong Success In Treating Scalp Psoriasis
Psoriasis of the scalp is very common. Nearly 80% of psoriasis patients develop plaques on the scalp at some point in their life with psoriasis.
Scalp psoriasis is especially distressing to many patients. It can be extremely itchy, and when psoriasis extends beyond the hairline onto the face and around the ears or down the back of the neck, it is highly visible. In some cases, it can also cause temporary loss of hair in places where the psoriasis patches are thick on the scalp. Add to this the difficulty in applying medicine only to psoriasis patches, often covered by hair, without also treating the healthy skin and its not surprising that patients are eager for effective treatments.
Fortunately, there are a variety of medications that when applied directly to scalp psoriasis, are able to reduce or resolve it for a period of time and many of the newest psoriasis treatments, designed to treat psoriasis all over the body, have demonstrated excellent clearance of scalp psoriasis as well. Over-the-counter products can play an important supporting role.
Our message for those suffering with the frustration, itch, and pain of scalp psoriasis is: dont lose hope, as there are options available today that will likely provide you substantial relief from your scalp psoriasis.
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Dont Scratch That Itch
Refrain from rubbing or scrubbing your scalp when shampooing, as tempting as it may be to dig into those itchy spots. Scratching induces trauma which in turn induces psoriasis, a process known as Koebnerization, Bagel explains.
If youre finding it hard not to scratch, try applying a dab of hydrocortisone, a mild corticosteroid, to itchy spots, to help decrease itching and inflammation, the NPF says. Start with the least powerful topical steroid that works for you, and use it just three to four times a week.
Methotrexate : A Longer
Methotrexate , is a folic acid antagonist, meaning it blocks the action of folic acid. Methotrexate is often abbreviated “MTX”.
- Methotrexate comes as a once-weekly oral tablet or injection that suppresses the immune system and DNA synthesis to slow down skin cell turnover.
- MTX can be used long-term for moderate to severe psoriasis and for psoriatic arthritis, but results with MTX may not be seen for several months. Review MTX dosing here.
- Your doctor may also prescribe folic acid in addition to MTX to help lessen stomach and other side effects.
- MTX can be toxic to the liver and other organs lab monitoring will be needed.
MTX should NOT be used in women who are pregnant or planning a pregnancy men should also stop its use 3 months before conception. Use effective contraception during and after treatment with methotrexate.
- Effective birth control is recommended for females of reproductive potential during therapy and for at least 6 months after the final dose.
- Effective contraception is recommended for males with female partners of reproductive potential during therapy and for at least 3 months after the final dose of methotrexate.
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How Does Salicylic Acid Work To Treat Plaque Psoriasis
Salicylic acid works by helping the scaly outer layer of plaques to be shed from the skin. It can also have the effect of softening psoriasis scales, and some people find that it can also help to reduce itch2. It is available in many different forms, including:
A large number of products containing salicylic acid can be found in the United States. For many patients, salicylic acid is more effective when it is used in combination with other types of psoriasis treatments, such as topical corticosteroids and the prescription topical treatment tacrolimus. Researchers think that combination treatment is effective because the salicylic acid helps the other types of topical medicines to penetrate more deeply into the skin
If the salicylic acid preparation used to treat psoriasis symptoms is strong, it may irritate the skin if it is left on too long. Patients are usually advised not use salicylic acid on large areas of the skin because it can be absorbed into the body and cause side effects. Salicylic acid can also make ultraviolet less effective, so it is recommended not to use it before UVB phototherapy treatments.
Scalp Psoriasis: Symptoms And Treatment
Thick, red scales. Excessive dandruff. Hair loss. Scalp psoriasis is a common but serious health challenge for many people with psoriatic disease. Besides the maddening itch, obsessive scratching and picking can create raw, bleeding lesions on the scalp that impact physical appearance, self-esteem, and overall quality of life.
At least 50 percent of people with plaque psoriasis will experience a scalp psoriasis flare at some point in their lives, according to the American Academy of Dermatology . Excessive scaling on the scalp can leave dark clothing covered with white flakes. Visible plaques on the head, ears, neck, and hairline drive more than 70 percent of people with psoriasis to hide under hats and wigs or in the safety of their own homes.
Members of MyPsoriasisTeam share their frustrations about excessive flaking and hair that thins or falls out. My scalps a holy mess, lamented one member. Another was scared to wash her hair because it comes out in clumps.
Juggling shampoos, topical creams, and medications that promise to restore healthy hair sends some members into a slump. No one seems to have an answer. It makes me so depressed, said one woman. Another called it a soul-destroying affliction. None of the treatments prescribed over the years have worked for me.
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Systemic Treatments And Biologics
Patients who have troublesome scalp psoriasis that does not respond to scalp-targeted medications might consider the wide range of treatments that work on the entire body: the pills, injections, and infusions typically used for moderate to severe plaque psoriasis.
Most of the biologics have clinical data demonstrating their effectiveness in treating psoriasis of the scalp, and the others have extensive anecdotal evidence of effectiveness. Many of the latest biologics, in fact, have been able in clinical trials to obtain total resolution of scalp lesions for many psoriasis patients over a period of weeks or months. Read more about biologics for treating psoriasis.
Other systemic treatments can also improve scalp psoriasis. Data from a clinical trial of the PDE4-inhibitor pill Otezla show it improved scalp psoriasis for almost half of patients after four months.
Heads Up: Anthralin For Scalp Psoriasis
Anthralin is a prescription topical cream or shampoo for the scalp that slows down the growth of skin cells.
- Anthralin, like coal tar, can be messy, stain fabrics, and has a strong odor.
- Anthralin can also stain the skin or hair with a temporary reddish brown color.
- Treatment may be applied for short periods to help lessen staining and irritation. Follow your healthcare providers instructions for use.
Like coal tar, anthralin may be used in combination with UV light to help with skin symptoms of psoriasis, including dryness, redness, flaking, scaling, and itching.
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Best Natural: Wild Naturals Eczema & Psoriasis Cream
Looking for a lotion that provides itchiness relief, repairs damaged skin cells, and smooths the skin, all while not using any harmful additives, fragrances, or chemicals? Then Wild Naturals Eczema & Psoriasis Cream could be the lotion for you.
The formula boasts all-natural ingredients, including organic aloe veraan anti-inflammatory that penetrates deep to soothe cracked skinand manuka honey, which provides healing properties. In all, the moisturizer combines vitamins, minerals, and amino acids to help seal in moisture so the skin stays hydrated for hours on end. Customers say the product brightens and smoothes their skin while minimizing psoriasis patches.
How To Choose The Product That Is Right For Your Scalp
So how do you choose the right over-the-counter product for you? First you need to determine the severity of your condition. The more severe the case the stronger the active ingredient may have to be to help treat your scalp psoriasis. Remember to read the packaging. The FDA recommends levels of Sal Acid and Tar from 1-3% for Salicylic Acid and from .5-5% for tar. It is always better to start lower and increase concentration if the medication is not working effectively for you. Never go right for the highest concentration because this could irritate your scalp and cause the psoriasis to become worse.
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