What Else Should I Ask My Healthcare Provider
If you have psoriasis, ask your healthcare provider:
- How can I prevent outbreaks and control symptoms?
- What medication will work best for me?
- What else should I do to improve symptoms?
- What are my options if creams dont work?
- Will psoriasis ever go away?
A note from Cleveland Clinic
Psoriasis, an itchy skin condition, can come and go throughout your life. Its related to an overactive immune response and is not contagious. If you have skin changes that arent going away, talk to your healthcare provider. There is no cure for psoriasis, but psoriasis treatments can improve symptoms. Your provider may prescribe a special cream or moisturizer or medications. Other therapies are available if creams or medicines dont work. Maintaining your overall health will also help improve symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/17/2020.
What Treatment Options For Late
The National Psoriasis Foundation recommends topical ointments for older adults with mild psoriasis. These include over-the-counter products like coal tar and salicylic acid, and prescription treatments such as retinoids, steroid creams, and forms of vitamin D. For older adults with severe psoriasis, the NPF recommends or biologic drugs, but only with careful monitoring.
What Are The Signs And Symptoms Of Psoriasis
Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.
While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:
Type of psoriasis you have
Places psoriasis appears on your body
Amount of psoriasis you have
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What Is Scalp Psoriasis When Can Scalp Psoriasis Begin
Psoriasis is an inflammatory disease of the skin that is estimated to affect about 2.2% of the adult population. In children, the onset of psoriasis can be before the age of one year but peaks around 5-8 years. Psoriasis produces scaly, itchingbumps on the skin. Some people may have a genetic predisposition to psoriasis. The genes affected seem to be involved with control of the immune system. Psoriasis appears as red scaling, slightly raised bumps that merge to form plaques. Psoriasis classically appears on the elbows and knees, but it can affect any part of the skin. The scalp is also characteristically affected in many people. Like psoriasis anywhere on the body, scalp plaques produce excess scale and can itch. Severe disease can cause a loss of scalp hair, which usually will return if the disease can be controlled. Scalp psoriasis somewhat difficult to treat when the scalp is covered with hair sufficient to act a barrier to the application of topical medications.
What Causes Scalp Psoriasis
Regardless of where psoriasis forms, the cause is the same. Psoriasis develops when a persons immune system has faulty signals that tell skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not shed these excess skin cells. The skin cells pile up on the surface of the skin, causing patches of psoriasis to appear.
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What Is The Treatment
There are many treatment options that can help scalp psoriasis and often a combination approach using a number of different treatments may be required until the symptoms have settled. It is important to remember to continue to treat the scalp even if hair falls out. Hair usually grows back once the inflammation and scale has cleared.
Treatments can be time-consuming and you may find them easier if you ask someone to help you. It is important to choose one that suits your lifestyle carrying out intensive treatments over the weekend, for example, when you have more free time. Psoriasis is not curable, but the signs and symptoms can be well controlled.
It can take at least eight weeks until you gain adequate control of the plaques, whichever treatment you use. Remember to try to treat psoriasis daily when it is active.
If, however, you have seen no improvement after 4 weeks continuous treatment, you should return to your doctor or nurse for further assessment.
Once you have achieved clearance, it is important to maintain the improvement. This can usually be done with regular use of a tar shampoo and or by moisturising the scalp occasionally with an oil or emollient. Some people find daily treatment of the scalp an advantage in keeping the scales from returning, but this would be a personal reference depending on your circumstances. If you have no success in controlling your scalp psoriasis, ask your GP to refer you to a specialist.
Vitamin D analogues
What Are The Symptoms Of Scalp Psoriasis
According to Dr. Wofford, If youve already been diagnosed with psoriasis, you know what youre looking for. In most cases, the way your psoriasis looks and feels on other parts of your body will be very similar to how scalp psoriasis looks and feels. Its important to remember that the visible symptoms of psoriasis are often the proverbial tip of the iceberg. If you have severe symptoms of psoriasis on your skin, you are likely also experiencing increased levels of internal inflammation. Specifically, people with scalp psoriasis are at a significantly higher risk for developing psoriatic arthritis, even compared to those who only have psoriasis on other parts of their body. Working with a dermatologist ensures youre managing flare-ups and minimizing the risk of adverse effects on your whole body.
Scalp psoriasis ranges from very mild and often overlooked cases to severe and prolonged cases that may impact an individuals overall health and well-being. You can explore some of the most common symptoms of scalp psoriasis in the proceeding sections, and you should contact your dermatologist for an examination and diagnosis if you notice any of the warning signs discussed in the next sections.
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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 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 .
Home Treatment For Psoriasis
There are some home remedies that may help minimize outbreaks or reduce symptoms of psoriasis:
- Exposure to sunlight.
- Apply moisturizers after bathing to keep skin soft.
- Avoid irritating cosmetics or soaps.
- Do not scratch to the point you cause bleeding or excessive irritation.
- Over-the-counter cortisone creams can reduce itching of mild psoriasis.
A dermatologist may prescribe an ultraviolet B unit and instruct the patient on home use.
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Scalp Psoriasis Can Lead To Hair Loss
Unfortunately, hair loss is common with scalp psoriasis, per the NPFbut it’s more about damage to the hair shaft and follicles from excessive itching, rubbing, and combing or from the ingredients in products, than it is about the psoriasis itself.
The good news: Hair loss from psoriasis is almost always temporary, and, with appropriate treatment, normal hair growth will return once psoriasis is managed.
Dandruff Vs Psoriasis Flakes
While psoriasis flakes arent actually different than dandruff , in many ways they can be more distressing, as they tend to be more intense, says Dr. Bressack. Some patients experience severe shedding of large flakes on their scalp or the areas of their body where their psoriasis flares. Flakes are, however, usually less noticeable on the body than the scalp, he says.
What causes skin to flake in dandruff versus in psoriasis is very different. Psoriasis flakes are the result of your overactive immune system speeding up the rate at which your skin cells grow, causing skin cell buildup or plaques that then may flake off. Garden-variety dandruff, on the other hand, can occur for a number of reasons, including skin that is too dry or oily, a fungal infection, or sensitivity to hair care products.
Treating psoriasis flakes with dandruff-oriented products alone may not work. You need medications that address the root cause of psoriasis with the appropriate topical, biologic, or systemic treatments.
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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.
Visit Your Trusted Dermatologist
If youre struggling with scalp psoriasis or youre just ready for an annual skin exam, the U.S. Dermatology Partners team is here to help. You can get started planning your visit right away by completing our online scheduling request form. After we receive your appointment request, a team member will be in touch to finalize appointment details.
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What You Can Do: Reach Out
If youve been feeling low for a while, consider getting help from a mental health professional like a counselor. Build a good support system, too. You can join a psoriasis help group through the National Psoriasis Foundation. It can make you feel better to talk about what youre going through, especially with people who understand. They can help remind you that youre more than your skin.
Psoriasis Can Cause Arthritis
For an unknown reason, psoriasis can cause a form of arthritis known as psoriatic arthritis. Symptoms include:
- discomfort, throbbing or swelling in one or many joints
- tenderness in any joint
- pain caused by inflammation in the joints, which stimulates nerve endings.
- The joints most likely to be affected are the last joint in the fingers or toes, the sacrum , wrists, knees or ankles.
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What Are The Clinical Features Of Psoriasis
Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface. The most common sites are scalp, elbows, and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.
Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification characterised by thickened leathery skin and increased skin markings. Painful skin cracks or fissures may occur.
When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.
What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
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Can Psoriasis Affect Only My Nails
In some cases, psoriasis may involve only the fingernails and toenails, although more commonly, nail symptoms will accompany psoriasis and arthritis symptoms. The appearance of the nails may be altered, and affected nails may have small pinpoint pits or large yellow-colored separations on the nail plate called “oil spots.” Nail psoriasis can be hard to treat but may respond to medications taken for psoriasis or psoriatic arthritis. Treatments include topical steroids applied to the cuticle, steroid injections at the cuticle, or oral medications.
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:
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What Else Is There To Know About Scalp Psoriasis
Scalp psoriasis can really disrupt someone’s life and overall well-being. While you might think it’s solely a condition that affects the skin, in some cases, psoriatic arthritis can occur especially if the psoriasis is left untreated. According to the National Psoriasis Foundation, out of the 8 million people with psoriasis, approximately one-third of them will develop psoriatic arthritis, affecting the joints and the tendons. Having psoriasis doesn’t guarantee a psoriatic arthritis diagnosis, but, unfortunately, the risk is higher. If you’re concerned, visit a rheumatologist to screen for the condition and catch it early if you can.
Keeping the scalp soothed and calm is integral to a healthy head of hair. Whether you’re dealing with scalp psoriasis or not, steering clear of astringent chemicals and highly perfumed products is the way forward. Invest in a hair wellness system that takes a gentle, natural and effective approach to maintain your mane and keep your crowning glory glossy and happy.
Turn Up With Turmeric
Another noted anti-inflammatory and skin soother, a daily turmeric supplement can help treat psoriasis .
If youd rather not take a turmeric pill, you can add the spice directly to your food. Whether you enjoy a turmeric latte or a delicious curry, there are lots of turmeric recipes to try to help your skin.
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A Guide To Confident Conversations With Your Hairdresser
2/3 of people have postponed or avoided hairdresser appointments because of their scalp psoriasis.* We have developed a double-sided discussion guide to help you have confident conversations about your scalp psoriasis with your hairdresser or barber. The first page can be used by your hairdresser or barber and the second page is for you to use.
What Are Scalp Psoriasis Symptoms And Signs Can Scalp Psoriasis Cause Hair Loss
Psoriasis appears as a small bump, a papule, surmounted by scale. When these papules coalesce, a plaque is formed that is often covered by thick layers of horny scale. When this scale is shed, it appears as dandruff, which can be quite unsightly. Scratching these plaques, either because of itching or because of the impulse to remove it, is a very poor idea because of what is called the Koebner phenomenon . This may cause psoriasis to develop in areas of inflammation and trauma. Scratching off the scale will only make things worse. Although most patients do not note hair loss, there can be extensive alopeciahair loss in severe cases.
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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: