The Mental Burden Of Skin Flakes In Psoriasis And Psoriatic Arthritis
You dont need a medical study to tell you that scaling and flaking is bothersome, but the evidence exists nonetheless: 65 percent of patients rank flaking, peeling, and shedding on their body as one of the top three most distressing symptoms they experience, per research published in The Journal of Dermatological Treatment.
The problem with any skin disease is that its on the outside. You have to deal with how the world is interacting with you and your skin disease. It can cause a lot of pain and suffering, says Amy Wechsler, MD, who is board-certified in both dermatology and psychiatry and author of the book The Mind-Beauty Connection. For instance, if psoriasis flakes are on your hands, you may be worried about shaking hands in work or social settings to say hello.
The challenge then becomes controlling and responding to flares, cleaning up flakes, and explaining them to friends, colleagues, and loved ones. Generally, the more widespread the disease, or the more difficult it is to cover up, the greater the effect it has on quality of life, says Dr. Bressack.
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.
Look For Scaly Patches Of Skin
The best way to look for this particular psoriasis symptom is to feel around on your scalp. You’re looking for patches of skin — particularly in areas you might not see in the mirror — that feel raised, bumpy, or scaly in nature. These bumpy patches of skin are the result of overactive skin cell growth. It’s believed that an autoimmune issue is the cause of this skin buildup. When skin grows so quickly like that, your body can’t shed cells fast enough. If you feel small patches or large areas of scaly skin on your scalp, it’s likely psoriasis.
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Is It Scalp Psoriasis Or Dandruff
At the onset, scalp psoriasis often is confused with seborrheic dermatitis . Dandruff is a flaky, itchy scalp without signs of inflammation .
Researchers arent entirely sure why some people develop dandruff. It may be due to hormone levels, a weakened immune system, types of yeast, a lack of certain nutrients, or nervous system problems.
You are more likely to have dandruff if you have certain conditions, such as HIV, Parkinsons disease, or depression. In some cases, dandruff could be the sign of an underlying issue, like a vitamin deficiency or problem with the immune system, according to the Mayo Clinic. Certain medications, such as lithium and interferon, can also raise the risk of developing dandruff.
Dandruff tends to itch more, and it has a greasy-appearing yellow scale. In contrast, psoriasis whether it’s on your scalp or any other body part tends to have a thick, silvery scale, Strachan explains.
Jody Alpert Levine, MD, dermatologist and cofounder of Plastic Surgery & Dermatology of NYC in New York City, adds, Scalp psoriasis may itch and become easily irritated during a flare, and it also may affect your hairline or creep down onto your forehead, nape of your neck, or your ears.
According to the National Psoriasis Foundation, around half of those with psoriasis have it on their scalp.
Do I Pick A Spot Treatment Or Shampoo
If your scales dont have pesky hair sprouting out of them or surrounding them, you can bust out the good stuff. Youll need to find a cream or topical treatment containing those good ol active ingredients. These tend to be stronger than psoriasis shampoos.
Hair getting in the way? Then the shampoos are the way forward. Yes, theyre milder and gentler , but theyll still do a fine job of softening those scales up.
Check out this list of shampoos recommended by the National Psoriasis Foundation. They know their stuff when it comes to scale-softening suds.
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How Do You Treat Dandruff
The way you treat your dandruff will depend on the type you have. Bridgette does recommend you look for products with ingredients such as selenium sulfide, salicylic acid, sulfur, coal tar, zinc, and alpha-hydroxy acids no matter what type of dandruff you have. In general, zinc and coal tar-based products applied to the scalp with anti-microbial properties will prevent unhealthy bacteria and fungus that can be developed on the scalp as a result of dry flakes on the scalp.
Amino acids are a beneficial scalp care ingredient that can work for greasy and dry dandruff. Sulfur amino acids, such as cysteine and methionine, help with managing dandruff by reducing skin cell buildup as well as offer antimicrobial properties, Bridgette notes. Selenium sulfide is for use on the scalp only and not to be used on the hair fiber. Also use selenium sulfide only on the specific area where there is dandruff, bacterial or fungal infections, and extreme oiliness. Selenium sulfide is an agent that treats dandruff, and fungal infections on the scalp and skin. This agent also controls and reduces inflammation, itchiness, and redness of the scalp.
Now, lets dive into how to treat the two different types of dandruff.
How To Treat Scalp Psoriasis
In order to deal with any form and type of psoriasis, first you should prove the diagnosis and turn to a dermatologist who assigns a therapy. There are several treatment modes applied in various cases. The most common solutions for scalp psoriasis are topical medications including scalp psoriasis shampoo with coal tar. Because of hair it is better to apply gels, lotions, foams, but not creams or oils, which can be prescribed for any other part of the body.
The best treatment for scalp psoriasis intended for removal of plaques is salicylates. Phototherapy is also efficient and such scalp psoriasis home remedies as oral medications can be of help. Once treatment is started, the doctor should follow up the patient to state improving. And one more advice: youd better ask for scalp psoriasis natural treatment if the diagnosis is psoriasis on face in order not to do much harm, cause scars and other consequences.
All photos of scalp psoriasis
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Shampoo For A Dry And Flaky Scalp
Several kinds, both over the counter and prescription, can help. Try selenium sulfide , zinc pyrithione, ketoconazole , or tar-basedones for thin plaques.
For thicker scales, salicylic acid shampoos can work well. Not all of these work for every person. You may have to try one for a few weeks and switch to another if it doesnt work.
Use the medicated shampoo first when youd normally lather up. Its OK to use your regular shampoo and conditioner afterward. Know that tar-based options can be a bit smelly.
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
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Scalp Psoriasis Is Actually Pretty Common Among Those With Psoriasis
Overall, more than eight million Americans have psoriasis, according to the National Psoriasis Foundation and nearly 80 percent of patients with psoriasis will also have scalp psoriasis.
Conversely, some patients will only have scalp psoriasis, says Jessica Kaffenberger, MD, a dermatologist and psoriasis expert at The Ohio State University Wexner Medical Center. It can manifest as mild or severe , according to the NPF. Scalp psoriasis can also extend onto the forehead, the back of the neck, and around the ears.
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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What Injections Or Infusions Are Available For Psoriasis
Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:
Drug choice can be complicated, and your physician will help in selecting the best option. In some patients, it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.
What Does Psoriasis Look Like On The Scalp
Psoriasis on the scalp looks like patches of dense dandruff but reddish in color. It can either be present on your scalp in patches, or can cover your entire head like dandruff, and even extend to your back, neck, and inside of the ears. This can block the nourishment to your scalp and make your hair appear dry and dull.
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What Does Plaque Psoriasis Look Like
A plaque psoriasis rash looks like raised patches of thick, inflamed skin. On light skin, it looks red and scaly, often with a layer of silver on top. On skin with more pigment, the plaques look purple, gray, or darker brown and tend to be thicker.
Plaques can develop anywhere but are most likely to appear on your:
- lower back
Plaques also tend to be symmetrical. For example, youre more likely to have plaques on both knees or elbows than on just one side. Other symptoms include:
You can spot this type of psoriasis rash by small, raised round spots called papules. They sometimes have a scaly appearance. The spots might look red on light skin and purple or brown on skin with more pigment.
Guttate psoriasis can start at any age. For most people, though, it starts in childhood or adolescence. It can develop after an infection, such as strep throat or tonsillitis.
Its most likely to develop on the limbs and torso, though some people get it on the scalp, face, or ears.
Psoriasis can appear anywhere on the body. It can develop in just one area, or it can show up in several. For example, theres:
Plaque, inverse, and guttate are the most common types. Others include:
How Common Is Scalp Psoriasis
It is common and approximately half of all people with psoriasis also have it on their scalp. The reason it deserves special mention is that it can be more difficult to treat and usually requires specifically formulated treatments.
Psoriasis on the scalp forms in the same way as on other parts of the body but the hair traps the scale and so it does not rub away as it would, for instance, on the elbow. The result is that the scale can quickly build up, causing a thicker plaque which becomes more difficult to treat . This difficulty is compounded by the hair, which acts as a physical barrier obstructing the easy application of creams and ointments to the affected skin. Children can get scalp psoriasis too. Treatments will be much the same as those used for adults. On rare occasions, scalp psoriasis has been known to disappear spontaneously, but it can remain on the scalp for lengthy periods of time too.
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What Causes Scalp Psoriasis
While we know what causes psoriasis plaques to develop on the scalp , experts dont fully understand why someone develops the condition in the first place or what determines where those lesions will appear. Experts suspect there is a genetic component to psoriasis because people who have a family history of the condition are more likely to develop it, but the specific genes that could be linked to psoriasis are unknown8.
What experts do know, however, is that certain environmental factors can trigger psoriasis for the first time in people who are predisposed to having the condition. According to the Cleveland Clinic, common psoriasis triggers include9:
- Really stressful situations, such as a divorce or losing a loved one
- Having a skin injury, such as a cut, sunburn, or scratch
- Developing certain infections or illnesses, such as strep throat or bronchitis
- Being exposed to cold weather
Scalp Psoriasis Vs Dandruff
Both dandruff and psoriasis can cause itchiness, skin flakes, and general irritation. However, dandruff in general tends to be milder than scalp psoriasis and certain symptoms of psoriasis are not associated with dandruff.
Skin flaking is one of the most common signs of dandruff. You may notice white flakes on your clothing if you experience dandruff, often accompanied by mild itching. While psoriasis can cause skin flaking as well, it is much more common in cases of dandruff.
Psoriasis generally causes more intense itching, although mild scalp psoriasis may feel similar to dandruff. The itchiness will generally persist longer, however, while dandruff may go away within a few days. Severe scalp psoriasis can cause burning and pain, neither of which are associated with dandruff.
You can also differentiate between psoriasis and dandruff by examining your scalp. Red or white scales are a telltale sign of psoriasis. Dandruff usually does not cause rashes. Although, if you have been scratching your scalp, you may notice some mild skin irritation.
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A Flaking Scalp And Skin Are Some Of The Most Frustrating Symptoms Of Psoriasis And Psoriatic Arthritis Heres How To Stop Shedding
It can be enough of a challenge to deal with psoriasis or psoriatic arthritis flare-ups the physical appearance and itchy discomfort of psoriasis plaques is upsetting and frustrating for patients. But when psoriasis plaques begin to build up and flake off the skin, leaving behind dandruff-like evidence of the condition on your clothes and surroundings, it can make things even worse. Many patients feel like flaking adds to the stigma they already experience, in part because it calls more attention to the disease from others.
Psoriasis is an autoimmune condition that causes skin cell buildup that appears as red, scaly, itchy patches on your skin and scalp that can burn and sting. These plaques can also become so thick and dry that they start to flake off the skin in large, silver-toned scales. When it happens on your scalp, it can look like severe dandruff. Research shows that about half of psoriasis patients experience scalp psoriasis, though some estimates say that 90 percent of patients will deal with scalp psoriasis at some point. Sometimes psoriasis plaques on your body shed their scales, too. In one study, doctors rated flaking, along with itch, as one of the most physically bothersome symptoms in their psoriasis patients.
Scalp Psoriasis Vs Seborrheic Dermatitis
Occasionally, seborrheic dermatitis of the scalp can be confused with scalp psoriasis since both can produce excess scale and can itch. Pathological examination of the skin biopsy material occasionally may be helpful in distinguishing the two entities. As a practical matter, this is rarely necessary because most patients with psoriasis have typical psoriatic lesions present in other areas, such as the elbows, knees, or torso. In addition, both conditions generally respond to similar topical medications.
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What Is Psoriasis And What Causes It
Psoriasis is a chronic autoimmune condition. If you have psoriasis, it means your skin cells regenerate much faster than usual, causing them to build up. Anyone can get psoriasis, but its not contagious.
Some common triggers for psoriasis are:
- certain medications