What is this scaly rash on my scalp?
Scalp Psoriasis
Scaling of the scalp can be a nuisance. Patients with a scaly scalp have often become used to living and dealing with it. Often it is just something that I notice during an examination. Not necessarily something patients always ask about. Many say they have already tried all the shampoos and treatments and they’ve given up. So, when is a scaly scalp more serious and not something to just tolerate? Scalp Psoriasis.
Compared to other scaling disorders of the scalp like seborrheic dermatitis (the fancy name for dandruff), scalp psoriasis is more well-defined, pink plaques with more adherent thick scale. Usually, with psoriasis, you can draw a line around the affected area, versus more diffuse loose flaking in seborrheic dermatitis.
Psoriasis is a disorder of the skin that affects about 2% of the US population. It can affect anywhere from the top of the head to the tip of the toes. Usually, luckily, it spares the face. At different times of life, patients with psoriasis can have areas affected on different parts of the body.
Psoriasis’ importance is more than skin deep. It can affect the joints with psoriatic arthritis. In addition, patients with psoriasis have a reduced life span due to comorbidities like coronary artery disease and diabetes. To learn more about comorbidities in psoriasis, you can read our previous post linked below.
Scalp psoriasis can be difficult to treat. But here are some of the top tips I give in the office.
1-Wash more not less. May patients think they are drying their scalp out by washing it. Reducing washing allows for further accumulation of scale as well as bacteria and yeast that can live in that scale.
2-Use dandruff or anti-inflammatory shampoo. The most common dandruff shampoos OTC are Head and Shoulders and Selsun Blue. Selsun Blue can discolor light hair, so be careful. Head and Shoulders is Pantene with medication in it, so it comes in a variety of scents and styles, making it more appealing. The most common prescription shampoos we prescribe are Ketoconazole Shampoo that kills yeast and clobetasol shampoo that is anti-inflammatory. Two additional options OTC are TGel shampoo and TSal shampoo. TGel contains tar as an anti-inflammatory but can also stain hair and smells bad. TSal contains salicylic acid that helps dissolve scale and is anti-inflammatory. No shampoo is best for everyone. That’s why I mention so many different choices. Try them, rotate or alternate them, and leave them in for a few minutes prior to rinsing them. Medicated shampoos should be treated like scalp treatments. Leave them on your scalp for 2-10 minutes prior to rinsing. The treatment can be followed by washing your hair (for those with longer hair) with your regular shampoo and conditioner if you like.
3-Use Bakers solution. Nothing dissolves the scale like this product. Bakers P&S liquid can often be found on Amazon. It is made by a company called Bakers Cummins. It can be used like a scalp treatment as needed, usually only once or twice a week. Apply to a scaly area, leave on for 8 hours, then wash out with your shampoo of choice.
4-If psoriasis is impacting your life or affecting your joints, it’s time for prescription medications or laser. Psoriasis is a disorder that can impact many areas of life. When psoriasis is limiting social interaction and daily function, it’s time to look further. There are a variety of treatment options. Pills, shots, and even laser treatments can improve psoriasis. Sometimes scalp psoriasis is very, very stubborn, but we will exhaust all our options to find a solution that works for you.
If you or a family member is suffering from a scaly scalp, try these tips. If it is stubborn, schedule an appointment to explore your options. The National Psoriasis Foundation online is a great non-biased resource as well at www.psoriasis.org.
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