Your Essential Care Guide for Scalp Psoriasis

From healthcentral.com

Check out these dermatologist-approved techniques to manage scalp psoriasis flakes and find lasting relief for your hair type 

Have you ever run your fingers through your hair and wondered, How can I get rid of these flakes? If you’re one of the estimated 3.5 million people in the US who have scalp psoriasis (per the Cleveland Clinic), it’s a common question.

Scalp psoriasis is a type of psoriasis, a chronic autoimmune disorder that causes the body to attack its own skin. It can look like fine scaly areas along the hairline or thick, crusted patches all over the scalp, and it’s caused by a mix of factors.

“Most cases develop due to a combination of genetic susceptibility along with an environmental trigger,” says Veena Vanchinathan, M.D., a board-certified dermatologist who practices at Kaiser Permanente in California’s San Francisco Bay area. That means if you have a family history of psoriasis, you might be prone to it, and it can then be kick-started by something like stress, an injury to the skin, a chemical irritant, or an allergen. Once triggered, your immune system mistakenly identifies your skin as a threat, leading to inflammation and increased skin cell production. All those extra skin cells pile up into thick, sometimes itchy patches on your scalp that become dry, scaly, and flaky.

Those persistent flakes aren’t just annoying—they can be uncomfortable and embarrassing. But should you try to remove psoriasis scales yourself, or could that make things worse? We asked top dermatologists for their very best DIY strategies to safely manage your scalp psoriasis at home—plus, when it’s time to put down the coal tar and seek professional help.

Treating Psoriasis Scales on Your Scalp

Psoriasis scales are very different from other scalp flakes, like dandruff. “Psoriasis typically involves much thicker, white or yellow, and more adherent scaling than dandruff, which tends to have fine, white flaking,” says Dr. Vanchinathan. Unlike dandruff, which is typically caused by seborrheic dermatitis or scalp eczema, psoriasis scales are not easily removed by brushing or combing.

“If you have scalp psoriasis, it’s never a good idea to physically scrape or comb out the flakes,” says Alison Ehrlich, M.D., a board-certified dermatologist in Chevy Chase, MD, and the former founding chair and director of clinical research in the department of dermatology at The George Washington University in Washington, D.C. “Picking at scales on the scalp can lead to irritation and bleeding,” she says.

Dr. Vanchinathan doesn’t recommend manual removal or exfoliation either. “Removing those scales can be very uncomfortable, even painful, and it’s not a long-term fix,” she says. “It increases the risk of skin infection and can lead to permanent hair loss.” If you do try to peel off a patch of psoriasis scales, you might see dots of blood underneath. “That’s called the Auspitz sign,” says Dr. Vanchinathan. It’s confirmation that the inflammation and the blood vessels are much closer to the surface in those psoriasis patches and underscores why being super gentle is important, she says.

Still, there are safe, effective ways to manage scalp psoriasis and reduce flaking and scaling with targeted, dermatologist-approved treatments.

Exploring the Effectiveness of Scalp Psoriasis Treatments

There are a number of over-the-counter and prescription psoriasis scalp treatments that can moisturize and soften scales and gently exfoliate dead skin cells, without the risk of irritation.

Medicated Shampoo

“I am a huge fan of over-the-counter shampoos,” says Dr. Vanchinathan. “Shampoos with ingredients such as ketoconazole and zinc pyrithione, which reduce inflammation and fight fungal overgrowth on the scalp, can be incredibly helpful for long-term scale reduction,” she says. These types of shampoos can also ease itching. If over-the-counter products aren’t giving you the results you want, your doctor can prescribe a stronger formula.

Salicylic Acid

Commonly found in topical solutions and shampoos, salicylic acid is an excellent ingredient for treating the scaly patches of psoriasis. Studies show salicylic acid can soften and loosen the outer layer of skin, helping to remove dead skin cells that build up at the surface. That said, “salicylic acid can be too drying for people with curly or textured hair,” says Dr. Ehrlich, who recommends using a moisturizing conditioner after shampooing.

Coal Tar

Coal tar has been used for over a century to treat psoriasis by slowing down cell turnover, according to the American Academy of Dermatology (AAD). “It soothes scaling and itching,” says Dr. Ehrlich. Coal tar shampoos are thick, so be gentle when working it into your scalp. And wear a hat when you head outdoors—the AAD notes coal tar can make your skin more sensitive to the sun.

Lactic Acid and Urea

Lactic acid promotes exfoliation and urea helps to break down the thick scales of psoriasis. “Together these ingredients can be helpful for softening scales and reducing flakes,” says Dr. Ehrlich. Research shows creams containing the combo can reduce skin thickening and improve the appearance of psoriasis patches. But be careful if you have broken or irritated skin. “These ingredients can cause burning or stinging,” says Dr. Vanchinathan.

Moisturising the Scalp

“Keeping the scalp moisturized can help prevent scales from becoming dry, flaky, and itchy,” says Dr. Vanchinathan. Look for scalp oils or moisturizers with the National Psoriasis Foundation (NPF) Seal of Recognition—they’re vetted to be free of common irritants. Try applying one and letting it sit on your scalp for 10 to 15 minutes before rinsing with warm (not hot) water. Just note: “Moisturizing feels good, but it doesn’t treat the underlying psoriasis,” says Dr. Ehrlich.

Should You Use a Soft Brush?

Experts advise against brushing your hair—even softly—due to the risk of scalp wounds, infection, and permanent hair loss. If you do try to manually loosen scales with a brush, be as gentle as possible. Use a soft-bristle brush, go slowly to minimize irritation and injury to the skin, and stop immediately if you feel pain or see blood (the Auspitz sign).

Light Therapy

Professional light therapy, or phototherapy, relies on shining a narrow band of UV-B light directly on affected areas of the scalp to ease inflammation and reduce the scaling, redness, and itch of psoriasis. “It’s one of the most helpful treatments I have for patients who don’t respond to topicals,” says Dr. Vanchinathan. Phototherapy is usually done in a clinic or doctor’s office and involves a series of treatments, two or three times a week for a few months. Hair on the scalp can make it tricky to get good results, says Dr. Ehrlich, so your dermatologist may combine it with other treatments.

A Healthy Scalp-Care Routine for Psoriasis

Want to keep your scalp flake-free? “The best way to minimize scaling is to treat the underlying psoriasis that’s causing it,” says Dr. Ehrlich. Talk to your doctor to create a treatment plan that makes sense for the severity of your scalp psoriasis, which might involve over-the-counter psoriasis scalp treatments, prescription topicals, or systemic medications. After that, how you wash your hair matters, too.

The AAD recommends using a medicated shampoo every two to three days, and washing gently—no aggressive rubbing or scrubbing, which can make psoriasis flare. “Shampooing with powerhouse skincare ingredients can reduce scaling and is a successful long-term strategy,” says Dr. Vanchinathan.

Medicated shampoos can dry out your hair, so be sure to follow up a suds session with a conditioner. If you have curly or textured hair, you might prefer to wash once a week and use a prescription treatment in between, says Dr. Ehrlich. And if you have especially thick patches of scalp psoriasis, consider adding a salicylic acid-based scale softener to your routine.

Be cautious about social media advice. “It’s never a good idea to put undiluted essential oils on your scalp, or to ‘correct the pH’ of your skin with lemon juice or vinegar,” warns Dr. Vanchinathan. “And never use unsafe tools like knives to remove psoriasis scales.”

Always consult your dermatologist before trying trending online remedies.

If you don’t see improvement after three to four weeks of using an over-the-counter shampoo or psoriasis scalp treatment, check in with your dermatologist. “There are effective prescription treatment options, including newer oral and injectable medications,” says Dr. Ehrlich. “If one doesn’t work, another might.”

Diet and Lifestyle Adjustment to Ease Scalp Psoriasis

In a survey published in Dermatology and Therapy, psoriasis patients reported skin improvements when they cut back on alcohol, gluten, and night shades, and also when they ate more fish and vegetables and took a vitamin D supplement.

Certain diets, like the Mediterranean, Pagano, vegan, and Paleo, have also been linked to clearer skin. The Mediterranean diet in particular, which is based on eating fresh fruits and vegetables that have anti-inflammatory properties, has positive effects on both skin and heart health, which is important since psoriasis is linked to an increased risk of cardiovascular disease.

Moving more can help your scalp psoriasis, too. In a study published in Skin Health and Disease, psoriasis patients who walked regularly for 20 weeks saw major improvements (half experienced 50% clearer skin), likely because increased blood circulation helps deliver anti-inflammatory compounds to affected skin while supporting the removal of dead skin cells and toxins. Exercise also improved their blood pressure and mental health.

Bottom Line

“Picking at scalp scales can result in hair loss,” says Dr. Ehrlich, so it’s not a good idea to remove psoriasis scales on your own. Instead, focus on managing and reducing scales with scalp psoriasis treatments made with ingredients that soften skin and encourage cell turnover, likeketoconazole, zinc pyrithione, salicylic acid, coal tar, lactic acid, and urea, and be gentle when applying them.

Your scalp psoriasis may also improve if you make healthy food choices, avoid smoking and drinking alcohol, and get more exercise. And if over-the-counter shampoos and treatments aren’t keeping your scalp psoriasis scales in check, it’s time to explore prescriptions and other treatments with your dermatologist.

https://www.healthcentral.com/condition/psoriasis/your-essential-care-guide-for-scalp-psoriasis