There’s no cure for scalp psoriasis, but there are ways to manage its symptoms. “I always remind my patients that they’ll need to continue treating it to keep it under control,” says dermatologist Steve Daveluy, MD, an associate professor at Wayne State University School of Medicine in Detroit.
And, according to Strachan, treating your psoriasis promptly is the best way to reduce its impact on your appearance.
Treatments for scalp psoriasis may involve a combination of therapies, including the following:
Topical Treatments
The first step in treating scalp psoriasis effectively involves removing or lifting thick scales, which helps medication penetrate the plaques and clear them up.
Scale Softeners These are products “which contain active ingredients, such as salicylic acid, urea, lactic acid, or phenol, that are designed to dissolve skin flakes or scales,” says Strachan. “Another way to soften and loosen scalp scales is to apply oils, lotions, creams, or ointments to a damp scalp,” she adds.
Once the medication softens the psoriasis scale, you can carefully remove it with a fine-tooth comb or brush.
“Gently comb the scalp in a light circular motion, holding the comb almost flat against the scalp,” advises Strachan. “Once the scale is loosened, shampooing is a good way to get the scale away from your scalp and out of your hair. But be gentle. Brushing or combing too vigorously can break the skin and lead to an infection. It can also break hair off at the scalp, causing temporary hair loss.”
Shampoos — both with and without coal tar medication — are available to treat scalp lesions. “We actually don’t know exactly how coal tar works, but it’s one of the oldest treatments for psoriasis,” Dr. Daveluy says. “In mild scalp psoriasis, it may be the only treatment necessary to keep it under control.”
- tapinarof (Vtama)
- calcipotriene (Dovonex)
- calcipotriene and betamethasone (Taclonex)
- tazarotene (Tazorac)
- topical corticosteroid solutions, oils, and foams
- roflumilast (Zoryve)
“Liquid or foam topical medication [like steroids and calcipotriene] are easy to apply to the scalp,” says Strachan. But for anyone who may have thicker, curlier hair, applying these topical treatments may be particularly challenging.
Before starting any topical scalp treatment, Strachan suggests applying a test patch of the medication to an inconspicuous spot on your head.
“In some cases, treatments may cause irritation or temporary hair loss,” she says. “Your hair should grow back. But if hair loss persists after you’ve treated the psoriasis, you should consult a dermatologist.”
Severe flares may require the use of oral medication in conjunction with such topical treatments.
Systemic Treatments
Systemic treatments, which work throughout the whole body, are often an important part of scalp psoriasis therapy. Biologics are targeted medications for psoriasis and are often prescribed if older therapies like methotrexate (Trexall), oral retinoids, and cyclosporine are not recommended by your physician.
Phototherapy
Ultraviolet light or phototherapy may be used if psoriasis is also on other parts of the body.
Steroid Injections
Injections of corticosteroid medication can target persistent, itchy plaques on the scalp. Because these shots can be uncomfortable, a dermatologist may recommend injecting only a few areas until other treatments help.