Scalp Psoriasis: Symptoms, Causes, and Treatment Methods

Scalp psoriasis is a chronic skin condition that affects millions of people worldwide and represents a constant challenge for those affected due to its significant impact on the quality of their daily lives. Although medical research has advanced in understanding this disease, psoriasis, as it is commonly called, may not be completely curable. Thus, it requires a combination of medical treatments and care to achieve a balance between alleviating symptoms and preventing their worsening.

In this article, we will explain what this disease is and discuss its symptoms, causes, and treatment methods.

What is Scalp Psoriasis?

Scalp psoriasis is a chronic skin disease characterized by red, scaly patches on the scalp, which may be painful, itchy, and sometimes cause a burning sensation. Cases of psoriasis can range from mild, with fine scales, to severe, with thick, scaly plaques covering large portions of the scalp. It may also extend beyond the hairline to the forehead, neck, and around the ears. Therefore, the apparent symptoms of this disease may lead to significant psychological damage, including feelings of embarrassment and a tendency toward social isolation.

Symptoms of Scalp Psoriasis

Scalp psoriasis manifests through a variety of symptoms that can vary in severity from person to person. The main symptoms include:

• The Appearance of Red Spots: These spots, also known as plaques, are inflamed areas of skin that appear red or purple, depending on skin tone. They are often covered with thick, silvery-white scales. These spots can appear anywhere on the scalp, including the hairline, forehead, back of the neck, and around the ears. In severe cases, they may cover larger areas. Redness indicates an inflammatory condition that may be accompanied by a burning sensation.

• Scalp Flaking: The hallmark of psoriasis is scales, which consist of dead skin cells that quickly accumulate on the surface of the skin, forming silvery layers. These scales can range from smooth plaques resembling normal dandruff to thick plaques with a sometimes greasy texture, which are noticeable and difficult to remove.

• Itching: The severity of itching may vary from mild to severe and is often one of the most annoying symptoms. Persistent itching can exacerbate the inflammatory condition and cause bleeding and secondary infections.

• Dry Scalp: Psoriasis disrupts the skin's natural moisture barrier, causing the scalp to dry out and have a rough, cracked surface. The severity of this dryness can vary greatly, and in severe cases, it can cause the skin to crack and bleed.

• Temporary Hair Loss: Temporary hair loss can occur due to dryness and inflammation of the scalp, as well as the presence of thick plaques on its surface. However, the hair follicles themselves are not damaged, so hair usually grows back once the inflammation subsides. Severe or long-term psoriasis can sometimes lead to permanent hair loss.

Causes of Scalp Psoriasis

Like most types of psoriasis, the exact cause of scalp psoriasis remains unknown. However, there are two main factors believed to cause it:

• Immune System Disorder: Scalp psoriasis is an autoimmune disease, meaning that the immune system attacks healthy tissue by mistake, causing the body to send wrong signals telling skin cells to grow too quickly. This leads to a buildup of dead skin cells that form the thick red patches and scales characteristic of this condition.

• Genetic Factors: If a close relative, such as a parent, has psoriasis, it increases the risk of developing it. The reason for this is that genes play a role in how the immune system works, and some genetic differences may make a person more susceptible to psoriasis.

• Stress: Emotional stress is a known trigger of psoriasis flare-ups, including scalp psoriasis. Stress can disrupt the immune system and worsen inflammation.

• Skin Injury: Scalp injuries, such as cuts, scratches, or sunburn, can lead to the so-called Koebner phenomenon, which causes psoriasis to appear at the site of the injury.

• Certain Medications: Some medications, such as beta blockers, lithium, and antimalarials, can trigger or worsen psoriasis.

• Climatic Factors: Cold and dry weather may exacerbate dry scalp and the appearance of psoriasis symptoms.

Scalp Psoriasis Treatment

Scalp psoriasis is a chronic skin condition that has no definitive cure, but there are effective solutions that help relieve symptoms by reducing inflammation, slowing the growth of skin cells, and alleviating itching and discomfort. Here are some of them:

Topical Treatments

Topical treatments are applied directly to the scalp and are often the first line of defense for relieving the symptoms of mild to moderate psoriasis. Some common types include:

• Over-the-Counter Shampoos and Creams: These lotions often contain ingredients such as salicylic acid or coal tar to help reduce inflammation, scaling, and itching, or corticosteroids to control the immune system's attacks on skin tissue.

• Prescription-Strength Shampoos and Creams: Dermatologists may prescribe stronger preparations that contain higher levels of corticosteroids to relieve more severe symptoms.

• Coal Tar: This traditional remedy with a strong smell helps slow the growth of skin cells and reduce inflammation and the appearance of scales. It is available in different concentrations and comes in several forms such as shampoo, cream, and oil.

• Vitamin D Analogues: These synthetic forms of vitamin D, such as calcipotriene and calcitriol, help slow skin cell growth and reduce inflammation.

Pharmaceutical Treatments

For moderate to severe scalp psoriasis, or when topical treatments are not enough, doctors may prescribe oral or injectable medications. These medications reduce the severity of immune system attacks, which contribute to psoriasis. The most common types are:

• Methotrexate: This medication is commonly used to treat psoriasis. It suppresses the immune system and slows the growth of skin cells.

• Cyclosporine: This is another immunosuppressive drug used to treat psoriasis, but it can have more serious side effects than methotrexate.

Important Note: These medications are designed to suppress the immune system, the main cause of psoriasis. They must be taken under complete medical supervision, as they increase the risk of infection and other health problems.

Light Therapy

This type of treatment uses ultraviolet light to slow the growth of skin cells and reduce inflammation. This treatment is often helpful for moderate to severe scalp psoriasis, especially when other treatments are not effective. There are two main types of UV light used to treat psoriasis:

• Ultraviolet B (UVB) Light: The scalp is exposed to this type of light in a doctor's office using an artificial light source, either alone or with topical treatments.

• Excimer Laser: The excimer laser device sends a more focused beam of ultraviolet (UVB) light to deliver UVB light directly to affected areas of the skin while reducing exposure of unaffected areas to this light.

In Conclusion

Managing scalp psoriasis requires a comprehensive approach that addresses the chronic nature of the condition and its impact on daily life. While there is no definitive cure, combining topical applications, pharmaceutical interventions, and light therapy—can significantly alleviate symptoms and improve quality of life. Patients must work closely with their healthcare providers to tailor a treatment plan that suits their needs and conditions. With proper management and care, individuals with scalp psoriasis can better control their symptoms and lead more comfortable, fulfilling lives.

References

Scalp psoriasis: Symptoms, causes, and treatment

Scalp psoriasis: Symptoms

Scalp Psoriasis: Causes, Symptoms, Treatment, and Shampoos

Light Therapy for Psoriasis | NYU Langone Health