Scalp is commonly involved in psoriasis. Many times psoriasis starts on the scalp and remains localized to the scalp for many years. The lesions are usually spread to the other areas of body by the application of a super potent class of topical corticosteroids like clobetasole propionate. Treatment with systemic steroids followed by sudden stoppage of the medication can also cause the flares in other parts of the body.
Signs and Symptoms of Scalp Psoriasis
Psoriasis scalp may be associated with scattered, isolated psoriasis plaques elsewhere on the body or generalized psoriasis. The area behind the ears is the most common site affected in scalp psoriasis. Occipital area is another common site of involvement.
The lesions on the scalp may be either red, raised, scaly plaques scattered at different areas of the scalp or diffusely scaly involvement of the whole scalp. The former is more common. Itchy and scaly scalp is the usual presenting symptom of scalp psoriasis. Itching may vary in severity depending upon the scaliness and inflammation of the scalp. It is to be noted that even with generalized scalp involvement, psoriasis of scalp does not usually cause hair loss.
When the scales are scrapped off with nails or comb, bleeding points appear underneath. This is called auspitz sign, one of the diagnostic features of psoriasis. Harsh scrapping or vigorous rubbing can cause psoriasis plaque to appear in uninvolved areas of the scalp. This is the well known koebner phenomenon in psoriasis. Hence this should be avoided.
What are the Other Causes of Itchy and Scaly Scalp?
Psoriasis of the scalp has to be differentiated from severe dandruff or seborrhoeic dermatitis. Seborrheic dermatitis is generalized on the scalp while psoriasis is localized to certain areas.
The other causes of itchy scaly scalp are tinea amiantacea, tinea capitis (ring worm of scalp), contact allergy to hair lotions, creams or shampoos, dry scalp, lichen planus of the scalp, folliculitis etc.
How to Treat Scalp Psoriasis
Remedies for the itchy, scaly scalp depend upon the severity of the scalp psoriasis and extend of involvement.
- Treatment of the Mild Scalp Psoriasis. In mild type of psoriasis scalp, these is only superficial scaling, the thick scaly plaques are absent. The first line of treatment is tar or ketaconazole shampoos followed by betamethasone valerate scalp solution. In the absence of inflammation, calcipotriene solution can replace or alternate with the steroid topical application.
- Treatment of Severe Scalp Psoriasis. In severe psoriasis of the scalp, there are thick adherent scaly plaques on the scalp. Unless the scales are removed, the antipsoriatic medication will not be able to act on the skin. Hence the first step is to remove the scales.
- Removal of Thick Scales of Scalp Psoriasis. The following steps will help remove the scales: Wet the scalp thoroughly, cover the involved area of the scalp with either a 10% salicylic acid in mineral oil or a coconut oil based tar and salicylic acid pomade. This is covered with a plastic wrap overnight. 20% urea cream is an alternative. A tar and salicylic acid containing shampoo is used in the morning to remove the scales.
- Topical Applications in Scalp Psoriasis. Once the scales are removed, a combination of calcipotriene and betamethoasone dipropionate gives best results in controlling the scalp psoriasis. Other alternatives are tar solutions, steroid-salicylic acid combinations, anthraline, and steroid lotions like clobetasole propionate.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Reference
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
- Psoriasis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
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