Scalp Psoriasis – What You Need To Know

Quick Summary: Understanding Scalp Psoriasis

About Scalp Psoriasis: A common autoimmune disorder marked by red, scaly patches on the scalp. Scalp psoriasis can significantly affect daily life, with symptoms like itching, bleeding and temporary hair loss.

Understanding the Condition: Scalp psoriasis results from an overactive immune response, leading to rapid skin cell build up that can become inflamed and itchy. Triggered by a blend of genetic and environmental factors, recognising and managing triggers like stress and skin injury is crucial for control. 

Treatments and Care: Effective management includes medicated shampoos, topical treatments, and lifestyle adjustments such as gentle hair care and stress reduction. Advanced options like phototherapy and oral medications can offer further relief.

Seeking Expert Advice: For persistent symptoms, consulting with dermatologists or trichologists is key. They provide targeted treatment plans and can guide those considering hair transplants on how best to care for their scalps beforehand.

Key Takeaway: With the right treatment and care strategy, living with scalp psoriasis can be manageable. Professional guidance is vital for personalised treatment plans and enhancing your quality of life. For those considering hair transplant surgery, discussing the risks and benefits with expert surgeons is essential.

Diving into the world of scalp psoriasis, this article explores everything from its causes and symptoms to treatments and care tips. Whether you’re looking for relief or simply want to understand this condition better, we’ve got you covered with insights and strategies for managing scalp health effectively.

What is Scalp Psoriasis?

Scalp psoriasis is more than just a skin condition. It’s a chronic autoimmune disorder that affects the scalp, causing thick, red patches covered with silver-white scales to form on the surface of the skin.¹ Psoriasis can affect any part of the body, but this form stands out due to its location on the scalp, where it not only affects the skin but can also influence hair health and appearance.

Psoriasis is quite common, with up to 2% of the population worldwide affected.  Scalp psoriasis impacts up to 80% of those with psoriasis – making it a significant concern for many. It can appear solely on the scalp or alongside other forms of psoriasis, extending to visible areas like the forehead, ears, and back of the neck. This condition is both a physical burden and a psychological one, as patients can feel self-conscious about their inflamed skin. 97% of individuals with scalp psoriasis said it interfered with their daily life, especially with bothersome symptoms like itchiness and scales shed as dandruff.² 

Symptoms of Scalp Psoriasis

Recognising scalp psoriasis early can lead to more effective management. Here are some common symptoms you need to look out for³: 

• Reddish patches covered with thick, silvery-white scales: Can range from barely noticeable raised areas on the scalp to thick and inflamed areas.
• Dandruff-like Flaking: Silvery-white scale that flakes off but is different from dandruff.
• Dry Scalp and Bleeding: Dry skin can tempt you to scratch your scalp. Scratching is abrasive and can cause bleeding. This can worsen the condition.
• Itching, Burning sensations and Soreness: These irritable sensations may range from mild to intense, and can disrupt daily activities and sleep.
• Temporary Hair Loss: Hair loss (alopecia) can result from aggressive scratching or removal of scales. It is often reversible once scalp psoriasis is under control. In severe cases, however, long term scratching and removal of scales may lead to scarring alopecia⁴. This highlights the importance of following a good treatment plan and gentle scalp care.

The Science Behind Scalp Psoriasis

The overactive immune response in psoriasis leads to the rapid production of skin cells. These cells accumulate faster than they can be shed, resulting in a build up of scaly patches of skin. 

Though experts are still unravelling how scalp psoriasis develops, it’s widely understood that the roots of psoriasis involve a complex interplay between genetic, hormonal, immune and environmental factors. Understanding this condition, from causes to triggers, is key to managing it effectively⁵. 

Genetic factors: 

Psoriasis (and scalp psoriasis) is primarily an autoimmune condition, where the immune system attacks healthy skin cells by mistake, speeding up the skin cell life cycle. Genetics play a significant role in determining an individual’s likelihood of developing such autoimmune conditions. Your chances of developing psoriasis is higher if you suffer from other immune conditions, such as HIV or AIDS. 

Hormonal factors:

Hormone level changes (e.g during puberty, postpartum and menopause) can influence how often you get flare-ups of psoriasis, as well as the severity of each one. 

Environmental factors:

The world around us can affect our skin. Overexposure to UV radiation, contact with harsh chemicals, and skin injuries, can all play roles in triggering psoriasis flare-ups.

Lifestyle factors: 

Stress, obesity, smoking, and excessive alcohol intake are lifestyle factors that can trigger or worsen psoriasis. Your lifestyle can affect the immune system and increase inflammation throughout the body.

Identifying and Avoiding Psoriasis Triggers

Recognising what can initiate a psoriasis flare-up is crucial for management, and this can vary between individuals. Common triggers include^6,7:

• Skin Injury: Physical trauma (e.g. cuts, sunburn, bug bites) can lead to new psoriasis patches, a phenomenon known as the Koebner effect.
• Stress: A major trigger, stress prevents your immune system from working at its optimum. This can both cause and exacerbate psoriasis flares. 
• Smoking and Alcohol: Smoking (even second-hand) and alcohol consumption are both known to worsen psoriasis, and make treatments less effective.
• Medications: Certain drugs, including heart conditions medications (beta-blockers) and specific anti-malarial medications, can trigger psoriasis.
• Weather: Extreme weather conditions, such as those with cold and dry air, can trigger flares.
• Infections: Infections, particularly streptococcal infections (bacterial infections, that often cause sore throats or skin issues), can lead to guttate psoriasis, a specific type of flare.

Knowing your triggers, avoiding them where possible, and managing unavoidable ones through lifestyle changes and treatment can help reduce the frequency and severity of psoriasis flares.

Current Treatment Options For Scalp Psoriasis

Treatments for scalp psoriasis have significantly improved in the past years, offering relief and helping to manage symptoms effectively. While we don’t yet have a cure, sticking to a regular treatment plan can greatly reduce psoriasis flare-ups and make the condition more manageable. Here’s a very simplified overview of the current treatment options available^8,9:

Topical Treatments

Topical treatments are remedies applied directly to the skin, like creams, ointments, oils, gels, and shampoos.

Medicated Shampoos: These special shampoos are formulated with active ingredients to tackle psoriasis symptoms. For example (in order of effectiveness):

• Clobetasol Propionate Shampoo (0.05%): A powerful anti-inflammatory corticosteroid that reduces swelling and slows down excessive skin cell production.
• Salicylic Acid Shampoo: Helps remove scales by softening and lifting them, making the scalp clearer by breaking down outer layers of thickened skin.
• Coal Tar Shampoo: Known historically for reducing inflammation and slowing down the rapid growth of skin cells, providing relief from itching and scaling.

Topical Corticosteroids: 

Recognised as one of the most effective treatments, these come in various forms like creams and lotions. They work by easing inflammation and slowing down the overproduction of skin cells. Common examples include Clobetasol propionate and Betamethasone (found in products like Betnovate and Betacap for the scalp).

Vitamin D Analogues (Calcipotriol 0.005%): 

A gentler option that targets skin cell growth, making it a good choice for those looking for a less intense treatment. While it may take longer to see results, it’s effective in reducing redness, flaking, and itching.

Combination Therapy: Using a combination treatment, containing both corticosteroids and Vitamin D, has shown to be highly effective. 

Phototherapy

A special kind of ultraviolet (UV) light treatment, UVB phototherapy can help calm scalp psoriasis for some. 

Even though hair might make it a bit tricky to get the light directly on the scalp, doctors use special handheld devices to make it work. Studies have shown that this method is as good as some creams, safe to use, and is associated with a lower chance of symptoms coming back.

Systemic Treatments

For severe cases, oral or injected medications that work throughout the body may be necessary.

Applying treatments for scalp psoriasis can be tricky and messy as hair is in the way, making it harder for people to stick to their treatment plans. Choosing the right formulation for your hair type, like foam, gel, solution, shampoo, or spray, is key. It’s important to express your preferences to your doctor, as everyone’s hair is different.

Advice on Scalp Care and Management

Living with scalp psoriasis requires a balanced approach, focusing on both the root cause and its day-to-day symptoms. It’s crucial to stick to your treatment plan consistently to see results, while adapting your hair care routine to manage flare-ups.

Here are some examples of how you can tweak your lifestyle habits:

1. Mindful Hair and Scalp Care:

• Gentle brushing of the scalp with a soft-bristled brush helps remove scales without irritating the skin.
• Select shampoos formulated for sensitive scalps, avoiding those with harsh additives – it’s best to get advice from your GP or dermatologist on which shampoos are safe and effective.

2. Moisturising and Nourishing:

• Regular application of nourishing oils or creams can maintain scalp moisture, reducing dryness and quell flakiness. A softened scalp also helps you absorb your treatments better. 

3. Dietary Choices and Lifestyle Modifications: Making thoughtful changes to your dietary habits can help with psoriasis: 

• Enrich your diet with foods high in omega-3 fatty acids, like salmon and flaxseeds, along with fruits, vegetables, nuts, and whole grains to combat inflammation. These ingredients are also good for hair health.
• Reducing alcohol consumption and stopping smoking can reduce inflammation and help prevent psoriasis flare-ups.
• Since stress can aggravate psoriasis, finding relaxation and stress-management techniques such as deep breathing, yoga, or engaging in hobbies can offer significant relief.

How Can I Limit Flare-ups?

Actively taking preventive measures can lessen the likelihood of psoriasis flare-ups:

When to See a Specialist

It’s essential to seek professional advice if you notice persistent or worsening symptoms of scalp psoriasis, including severe itching, pain, or hair loss. If over-the-counter solutions aren’t providing relief, or if your scalp psoriasis is affecting your daily life and well-being, please talk to your GP, who can then refer you to a dermatologist or trichologist – they can offer targeted treatments and personalised care plans. 

Getting help from a specialist early on can make a big difference in managing scalp psoriasis effectively and avoiding more serious problems down the line. 

If you’re looking to learn more about psoriasis before talking to a doctor, The Psoriasis Association and The British Skin Foundation offer lots of helpful information online. It’s a great starting point for understanding your condition better.

Can You Have a Hair Transplant with Scalp Psoriasis? 

Yes, individuals with scalp psoriasis can consider hair transplant surgery to treat their hair loss. However, the decision depends heavily on the severity of your psoriasis and your management of the condition. An important factor to discuss with your hair transplant surgeon is the Koebner Effect we mentioned earlier, which could be triggered by surgery. Consulting with expert hair transplant surgeons, like our team, to weigh the benefits and risks is essential before proceeding.

Conclusion

To wrap up, understanding and managing scalp psoriasis is about finding the right balance between medical treatments, personal care routines, and lifestyle adjustments. 

Whether you’re considering advanced treatments like hair transplants or looking for ways to alleviate symptoms, it’s crucial to work closely with healthcare professionals and our team to guide you through personalised solutions. 

Remember, you’re not alone in this journey, and with the right approach, living with scalp psoriasis can be made more manageable. 

To explore further treatment options, please don’t hesitate to reach out to our clinic, where our team of hair transplant Surgeons and specialists are ready to support you towards achieving better scalp health and confidence in your appearance.

References

1. NHS. (2022, April 8). Psoriasis Symptoms. NHS choices. Available From: https://www.nhs.uk/conditions/psoriasis/symptoms/   
2. Blakely, K., & Gooderham, M. (2016). Management of scalp psoriasis: current perspectives. Psoriasis (Auckland, N.Z.), 6, 33–40. https://doi.org/10.2147/PTT.S85330 
3. AAD. Scalp psoriasis: Symptoms. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/treatment/genitals/scalp-symptoms 
4. Almeida, M. C., Romiti, R., Doche, I., Valente, N. Y., & Donati, A. (2013). Psoriatic scarring alopecia. Anais brasileiros de dermatologia, 88(6 Suppl 1), 29–31. https://doi.org/10.1590/abd1806-4841.20132241 
5. Ebtisam, E., & Stanway, A. (2022, November). Scalp psoriasis. DermNet. Available from: https://dermnetnz.org/topics/scalp-psoriasis  
6. AAD. Are triggers causing your psoriasis flare-ups?. Are Triggers Causing Your Psoriasis Flare-ups? Available from: https://www.aad.org/public/diseases/psoriasis/triggers/flares  
7. Dr Doug McKechnie, M. (2023, May 18). What causes psoriasis? Available from: https://patient.info/news-and-features/psoriasis-causes  
8. NHS. (2022, April 8). Psoriasis Treatment. NHS choices. Available From: https://www.nhs.uk/conditions/psoriasis/symptoms/  
9. Mosca, M., Hong, J., Hadeler, E., Brownstone, N., Bhutani, T., & Liao, W. (2021). Scalp Psoriasis: A Literature Review of Effective Therapies and Updated Recommendations for Practical Management. Dermatology and therapy, 11(3), 769–797. https://doi.org/10.1007/s13555-021-00521-z  
10. Scalp Psoriasis Flare-ups management illustrated using BioRender.com