Severe Plaque Psoriasis On Scalp

What Is Scalp Psoriasis

This skin disease happens when your immune system sends faulty signals and skin cells grow too quickly. These pile up in red patches, often with silvery scales. At least half the people with psoriasis have it on their scalp. But you can also get it on your forehead, behind the ears, and down the back of your neck.

Tips For Living With Scalp Psoriasis

Having short hair or a shaved head can help the effectiveness of ultraviolet light therapies and topical treatments . 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.3

Flare-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 , then it may help to explain that it is not contagious and it is not a fungal infection.

Associated Features And Comorbidities

Assess risk factors and comorbid disease of psoriasis at presentation and as indicated thereafter.

• Cardiovascular risk factors, and management of these
• Measure blood pressure, lipid studies and fasting glucose at least annually.

Children

Children with psoriasis may have higher rates of associated comorbid disease. Recommended screening for risk factors and comorbid disease depend on the childs age .

• All ages psoriatic arthritis, lipids, annually for depression and anxiety
• From age 2 annually for elevated body mass index
• From age 3 annually for hypertension
• From age 10 3 yearly for diabetes in patients who are obese or overweight and have 2 or more risk factors for diabetes screen for NAFLD in those who are obese or overweight with additional risk factors for NAFLD.
• From age 11 annual substance abuse screening

Eye conditions may occur more commonly in people with psoriasis . Consider asking patients about ocular symptoms at each follow-up appointment .

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Why Do People Get Scalp Psoriasis

According to the National Psoriasis Foundation , about 45-56% of people with psoriasis have scalp psoriasis. Additionally, the NPF states that scalp psoriasis is common in people of color.

“We don’t know why some people get it on the scalp and some don’t,”Adam Friedman, MD, professor of dermatology at George Washington School of Medicine and Health Sciences, tells Health.

He explains that while it’s not known exactly what causes plaque psoriasis, a combination of genetic makeup and environmental factors are believed to be involved.

While skin cells usually grow and fall off in a month’s cycle, the skin cells of those with plaque psoriasis grow faster, due to an overactive immune system. The skin cells tend to grow in about three to four days, yet they don’t fall off at the same pace, leaving dead skin cells to buildup on the skin.

While there isn’t a known reason for why people get psoriasis on different parts of the body, Dr. Friedman says he finds that those with scalp psoriasis also get inverse psoriasis, which occurs on the folds of skin like the groin and underarms. He notes that because those areas can be moist, psoriasis might look different.

“So, people who have this are often underdiagnosed because it doesn’t have that classic appearance. In the groin area, it can be assumed it’s a yeast infection or sexually transmitted disease. This is why it’s important to make a correct diagnosis,” Dr. Friedman says.

What If Those Psoriasis Treatments Dont Work

If psoriasis doesnt improve, your healthcare provider may recommend these treatments:

• Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
• PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
• Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
• Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
• Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
• Immune therapies: Newer immune therapy medications work by blocking the bodys immune system so it cant jumpstart an autoimmune disease such as psoriasis.

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What Are The Clinical Features Of Chronic Plaque Psoriasis

Chronic plaque psoriasis is the most common type of psoriasis in children and adults, accounting for 5590% of cases . The scalp, extensor elbows, knees and glutealcleft are the most frequently involved sites. Plaques are erythematous with defined margins and often have a silvery scale. Scale is less evident after bathing or after the application of a moisturiser. The plaques are frequently pruritic. In people with darker skin, hyperpigmentation may be present .

What About Perms And Other Hair Treatments

Scalp psoriasis does not necessarily mean you cant have hair treatments, but you do need to be careful. Certain things that do not touch the scalp such as highlights should be fine, and treatments that do touch the scalp usually require a patch test to be done in advance, to make sure you do not have a reaction. If there is broken skin on the scalp then it is not advisable to have dyes or perms applied. It is always a good idea to discuss your scalp psoriasis with your hairdresser, who should have up to date information about possible options, and if in doubt always consult your doctor.

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Moderate To Severe Psoriasis Treatments

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 . Apply this cream once a day for 10 to 30 minutes.
• Calcipotriene . 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 . 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 . 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.

Do Scalp Psoriasis Home Remedies Work

How you take care of your hair and scalp can have a big impact on your scalp psoriasis flare-ups. In addition to the treatment plan your doctor recommends, you may want to try some of the following tips at home12:

Skip styling tools when possible: Since heat can further dry out your scalp and exacerbate symptoms, its best to avoid blow-drying, curling, and straightening tools if you can. When brushing your hair, use gentle pressure to avoid further irritation. If you have natural hair and are used to consistent styling that requires heat, talk to your dermatologist or stylist to figure out a plan that reduces the risk of potential flare-ups while maintaining the health of your hair.

Avoid the tight up-do: If you have longer hair and have hair loss, you may also want to avoid pulling it back tightly in a ponytail, since that can pull on the already-fragile scalp and possibly lead to more hair loss. If you must pull your hair back, keep the hair low and loose to prevent excess tugging.

Choose hair products wisely: Using certain hair products, such as hair dyes, can also be irritating to your scalp. Ask your dermatologist for brand recommendations or if there are ways your stylist can dye your hair that might be more gentle on your scalp.

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Are There Complications Of Psoriasis

In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:

• Use medicated shampoo for scales on your scalp.

Other steps you should take to stay as healthy as possible:

• Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
• Lower your stress with meditation, exercise or seeing a mental health professional.

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.

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Moderate To Severe Plaque Psoriasis With Scalp Involvement

It Can Affect The Scalp Hairline Forehead Back Of The Neck And Skin Around The Ears

Did You Know?

Symptoms may include fine scaling that looks like dandruff, or appear as thick, crusted plaques that cover the entire scalp. Other skin disorders, such as seborrheic dermatitis, may resemble psoriasis. However, scalp psoriasis appears powdery with a silvery sheen, while seborrheic dermatitis looks yellowish and greasy. Scalp psoriasis is common in patients of color, but treating it can be particularly tough due to the hair type.

Scalp psoriasis may be an indicator of psoriatic arthritis , as many people have both. If you think you have scalp psoriasis, see a dermatologist to diagnose scalp psoriasis and visit a rheumatologist to screen for psoriatic arthritis.

No matter how severe your scalp psoriasis is, there are options for treating the itching and flakes â from over-the-counter shampoos and topicals to light therapy, oral treatments and biologics.

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Treatment For Scalp Psoriasis

Your dermatologist can treat mild scalp psoriasis with topical medications. For more stubborn cases, oral or injectable treatments are also effective but may have side effects including increased infections.

At UCLA Dermatology, our specialists may recommend one or more of the following:

• Topical medications applied to the scalp, such as tar shampoos and steroid sprays, creams and solutions
• Medicated shampoos

Safety And Side Effects

Keep in mind that these products wont cure scalp psoriasis, but they may help manage flare-ups.

If your condition worsens, its best that you check in with your doctor. Some cases of scalp psoriasis are more severe and may require prescription shampoos.

As with any new product, be sure to do a patch test before using a scalp psoriasis shampoo over your whole head. To do a patch test, put some product on the inside of your wrist and wait 24 hours. Keep an eye out for any signs of irritation.

Coal tar might not be safe to use during pregnancy or on infants, so its always best to talk with your doctor first.

Using some of these shampoos alone can be drying to your hair because coal tar and salicylic acid strip away oils. Find a good conditioner and make sure that youre keeping your hair and scalp moisturized.

Kenkoderm, Head & Shoulders, and Vanicream have conditioners that pair with their respective shampoos. As for other shampoos, you can pair them with moisturizing or intensive care conditioners.

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Treatment: Where To Start

The most common treatments for mild cases are medications that 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 injection.

If your psoriasis doesn’t respond well after repeated use of one medication, your doctor may replace 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 products to your scalp to help soften scales and make them easier 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:

What Are The Most Common Scalp Psoriasis Symptoms

Youre probably wondering, What does scalp psoriasis looks like? Generally, you might notice flaking or scaly patches of raised skin on your scalp first, Dr. Bhutani says. These patches can also be inflamed, thick, and swollen6, and sometimes extend to the forehead, the back of the neck, or behind the ears. On light skin tones, psoriasis plaques on the scalp typically appear pink or red with silvery scales. For people with dark skin, these lesions may range in color and appear salmon-y pink, silvery white, violet, or brown, depending on your specific skin tone7.

But the signs of scalp psoriasis go far beyond the physical effects. Scalp psoriasis, honestly, causes some of the largest impact on quality of life, Dr. Bhutani says. Thats because severe symptoms can interrupt sleep, create feelings of anxiety, and hurt a persons self-esteem, especially if the scalp psoriasis plaques are clearly visible.

In addition to plaques, other scalp psoriasis symptoms include6:

• An extremely itchy scalp that can be distracting
• A burning sensation or soreness on your scalp
• Cracked and/or bleeding skin from scratching too much or from having a dry scalp
• Temporary hair loss if you excessively touch your scalp or attempt to pick off your scales, which can forcibly remove hair follicles

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Otezla For Moderate To Severe Scalp Psoriasis

As you may already know, the scalp is one of the most commonly affected areas in plaque psoriasis, and can be hard to treat. Otezla is a systemic therapy, different from non-systemictopical treatments like creams or shampoos that are applied directly to the scalp. Thats because Otezla is a medication that treats beneath the skinits a pill for moderate to severe scalp psoriasis.

Tips For Managing Scalp Psoriasis

The following tips can help people to manage scalp psoriasis:

Seek treatment: A health professional can provide a topical ointment or oral medication that will help manage symptoms and itchiness.

Treat the scalp gently: People with this condition should avoid washing and combing the hair vigorously, as this can lead to breakage, especially if the hair is fragile due to treatment.

Avoid scratching: Scratching can lead to bleeding and possibly an infection.

Moisturize: Keeping the scalp moist will not cure psoriasis, but it may help improve the appearance of the skin.

Avoid triggers: If possible, individuals should identify their triggers for scalp psoriasis and consider things ways to limit them.

It is important to seek treatment, as this can reduce the risk of further complications, such as hair loss or cracked and bleeding skin on the scalp.

It is difficult to prevent scalp psoriasis, because the exact cause remains unclear.

However, treating the condition as soon as symptoms appear may prevent it from becoming worse.

Scalp psoriasis affects individuals differently. Some people have an occasional flare-up while others deal with the condition frequently.

If a person knows what triggers symptoms for them, they can try to avoid these factors.

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