Scalp Psoriasis

What is scalp psoriasis?

Psoriasis is an inflammatory disease of the skin estimated to affect about 2.2% of the adult population. Psoriasis is influenced by the genes that are inherited from parents. The genes affected seem to be involved with control of the immune system. Psoriasis appears as red scaling papules the combine into plaques that are classically present on the elbows and knees but can affect any part of the skin. The scalp is also characteristically affected in many patients with psoriasis. Like psoriasis anywhere, 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.

What is the cause of scalp psoriasis?

The belief that "emotional stress" is a cause of psoriasis is difficult to support experimentally. There is no question, however, that psoriasis of the scalp is an extremely stressful experience.

What are topical treatments and home remedies for scalp psoriasis?

The most important consideration in treating scalp psoriasis is getting an effective medication into the skin. Both the hair and any scale covering the disease is an impediment to treatment. Removal of the scale in a nontraumatic fashion is very important. This can be accomplished by washing the hair with a shampoo frequently. Using tar, selenium, or salicylic acid-containing shampoos can be helpful. This may have to be done at least twice a day initially if the scale is sufficiently thick. Gently rubbing the scale with the fingertips and not the nails is important.

It should be appreciated that scaling is not due to dryness but to the excessive production of the horny layer of the skin. Occasionally it may be necessary cover the scalp overnight with mineral oil. To avoid an unpleasant mess, it is necessary to cover the scalp with a shower cap or swim cap. With moderate or severe scalp disease, the addition of a topical steroid is often required. The strength of the steroid would depend on the severity of the condition. The type of vehicle (lotion, solution, or foam) depends on physician and patient preference. It is important to remember that the medication must get past the hair in order to reach the scalp skin. Occasionally other medications may be of benefit, such as topical calcipotriene (Dovonex, Sorilux) in a lotion or foam form.   
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