In the best-case scenario, scalp psoriasis might be barely noticeable or not even noticeable at all. But in the worst-case scenario, sufferers must endure significant physical discomfort from an itchy, red scalp with raised lesions and a build up of scales that flake off like dandruff, sometimes causing severe embarrassment and depression.
An estimated 7.5 million Americans have psoriasis, and approximately one-half of that number will have an outbreak of scalp psoriasis at some point [source: National Psoriasis Foundation]. Psoriasis is a chronic disease, with flare-ups typically interspersed with periods of remission or times when the condition is less active.
Psoriasis, which is not contagious, is a disorder of the immune system. A type of white cell called a T cell (T lymphocyte) attacks healthy skin cells instead of doing what it is supposed to do -- fight off harmful bacteria or viruses. As a result, the growth cycle of skin cells speeds up. Normally, it would take several weeks for new skin cells to work their way to the skin's surface, but psoriasis shortens the process to days. This rapid turnover leads to thick, scaly patches building up on the skin [source: Mayo Clinic].
Psoriasis comes in several variations. By far, the most common type is plaque psoriasis, which is identified by its red lesions and silvery scales. Scalp psoriasis is a form of plaque psoriasis. Scalp psoriasis can consist of a single patch, multiple patches or it can cover the entire scalp. Sometimes it goes beyond the scalp to the forehead, the back of the neck or behind the ears.
The lesions (plaque) of scalp psoriasis can be so minor that they're barely noticeable, or they can be quite inflamed and swollen. The silvery-white scales that appear look a lot like dandruff. Other symptoms are a burning sensation, temporary hair loss, dry scalp and itching. Not everyone will experience every symptom. Hair loss is usually temporary and comes from too much scratching or being too harsh in removing scales [source: American Academy of Dermatology].
Although scalp psoriasis sounds scary and can be quite unpleasant, treatments can interrupt the cycle of rapid cell growth, remove the scales and treat plaques that have formed. This article will delve into the causes of the disorder and explain medical and at-home treatments.
Causes of Scalp Psoriasis
No one knows exactly what causes psoriasis, but genes are believed to play a role. Approximately one-third of psoriasis sufferers have a close relative with the disease. In addition to family history, other risk factors are obesity, medical conditions such as HIV or recurring infections such as strep throat, smoking and stress [source: Mayo Clinic].
Environmental factors also seem to play a role. In fact, many psoriasis sufferers find that certain factors will trigger an outbreak or worsen one that is already underway. Triggers include an infection, a skin injury such as a scrape or sunburn, cold weather, alcohol consumption, stress and some medications [source: Mayo Clinic].
The physical component of dealing with psoriasis ranges from mild disruption to severe disruption of daily life. Psychological complications are not unusual, especially when the condition is readily visible to others, as can happen with scalp psoriasis. Some people suffer from depression, stress and anxiety as a result. They may withdraw to escape the social stigma that outsiders at times attach to the condition.
The following pages delineate the many effective treatments devised for managing scalp psoriasis. Some people can manage with over-the-counter products. For others, prescription treatments are necessary. Read on to learn more.
Scalp Psoriasis Treatments
Scalp psoriasis cannot be cured, but its symptoms can be treated and management of the disease can be effective. Treatment typically begins with a topical medication. Anthralin, for example, is a scalp treatment that is applied to the scalp, left on for a short period of time and then washed off. Anthralin's most common side effects are irritation and skin staining. In fact, it stains more than skin, so persons using it should be careful during application. A 1 percent concentration anthralin cream called Psoriatec often limits staining [source: National Psoriasis Foundation].
Derivatives of vitamins A and D are also used to treat scalp psoriasis. Calcipotriene (Dovonex) is derived from vitamin D and is used at night in combination with a shower cap or plastic bag. The vitamin A derivative known as Tazarotene (Tazorac) is available as a gel or cream. Like Dovonex, this medication is applied before bed. Doctors may also prescribe a topical steroid, or corticosteroid. Available in various forms, including gels, foam and lotion, these medications vary in strength from mild to strong [source: National Psoriasis Foundation].
Pills and injections are more likely to be used in cases where psoriasis is found not only on the scalp but also on other areas of the body. In this case, cyclosporine, methotrexate, corticosteroid, oral retinoids or oral vitamin D derivatives can be used to treat the combined conditions. Another type of medication called biologics, or immunomodulators, can be used for particularly severe cases. These medications, which include alefacept, efalizumab, etanercept, infliximab and ustekinumab, work by blocking communication between cells in your immune system [sources: American Academy of Dermatology and Mayo Clinic].
In September 2009, the U.S. Food and Drug Administration approved a new injection medication for treatment of plaque psoriasis. The medication, called Stelara, can be used for moderate to severe psoriasis. Stelara stops proteins involved in the overproduction of skin cells in psoriasis sufferers. It also combats inflammation. An advantage of Stelara is that injections are only required every 12 weeks, after two more closely spaced treatments. Other injectable treatments require injections that are more frequent. The medication has some potentially dangerous side effects, including an increased risk of contracting a serious infection. There may also be an increased cancer risk associated with Stelara [source: Hitti].
It may be that a scalp psoriasis sufferer never needs to use prescription-strength medication. Read on to learn about at-home treatments.
Home Remedies for Scalp Psoriasis
For people with mild to moderate scalp psoriasis, over-the-counter products or home remedies might work for you.
Salicylic acid, which can be found in a variety of soaps and shampoos, is frequently used to soften scales, thus making them easier to remove. But be prepared for some possible damage or hair loss; salicylic acid can weaken hair shafts, making them susceptible to breakage. However, any hair loss should be temporary.
You can also use heated olive oil to soften scales. After application to the scalp, treatment consists of wrapping the head in a towel for several hours or sitting under a hair dryer. Other over-the-counter scale-softening topical medications include ingredients such as urea, lactic acid and phenol.
Tar products -- both coal and, less frequently, wood -- are effective scalp psoriasis treatments. Tar products come in a variety of forms, but are often seen in shampoos. The drawbacks of tar products are the strong odor and staining. Tar can stain and discolor bedding, linens, clothing and white or gray hair. Tar products are massaged into the scalp and left on for a certain period of time before being rinsed off. If a tar product is used in shampoo form, try following it with a non-medicated conditioner to help eliminate the tar smell [source: National Psoriasis Foundation].
Phototherapy -- either at-home or done by a medical professional (such as with an excimer laser) -- can also be used to effectively treat scalp psoriasis. Phototherapy can be as simple as using natural sunlight. It's also possible to use a hand-held UV comb to get light treatment to the scalp. The National Psoriasis Foundation's Web site has a database that allows visitors to search for treatments that are most effective for the scalp or other body parts [source: National Psoriasis Foundation].
No matter what you choose -- prescription, over-the-counter or home remedy, it's important to note that the National Psoriasis Foundation cautions that if the treatment for scalp psoriasis seems worse than the actual disease itself, it's too harsh and changes should be made to your treatment plan [source: National Psoriasis Foundation].
For additional information or support regarding scalp psoriasis, visit the links on the next page.
Related HowStuffWorks Articles
- American Academy of Dermatology. "Understanding Scalp Psoriasis May Head Off Hair Loss." 8/8/07 (Accessed 9/26/09)http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis.html
- American Academy of Dermatology. "What is Scalp Psoriasis?" 9/9/08 (Accessed 9/25/09)http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis_overview.htm
- Hitti, Miranda. "FDA Oks New Psoriasis Drug Stelara." WebMD 9/25/09 (Accessed 9/30/09)http://www.webmd.com/skin-problems-and-treatments/psoriasis/news/20090925/fda-oks-new-psoriasis-drug-stelara
- Mayo Clinic. "Psoriasis." 4/10/09 (Accessed 9/27/09)http://www.mayoclinic.com/health/psoriasis/DS00193
- Mayo Clinic. "Scalp Psoriasis vs. Seborrheic Dermatitis: What's the Difference?" 10/19/07 (Accessed 9/25/09)http://www.mayoclinic.com/health/scalp-psoriasis/AN01177
- National Psoriasis Foundation. "Psoriatic Arthritis." (Accessed 9/30/09)http://www.psoriasis.org/netcommunity/learn02
- National Psoriasis Foundation. "Scalp Psoriasis." (Accessed 0/29/09)http://www.psoriasis.org/netcommunity/sublearn03_loc_scalp
- National Psoriasis Foundation. "About Psoriasis." (Accessed 9/29/09)http://www.psoriasis.org/netcommunity/learn01
- National Psoriasis Foundation. "Treating Psoriasis. Specific Location: Scalp." (Accessed 9/29/09)http://www.psoriasis.org/netcommunity/sublearn03_loc_scalp