Scalp psoriasis is a chronic skin condition that affects millions of people worldwide. It is characterized by red, scaly patches on the scalp, which can be itchy and painful.
Scalp psoriasis can also lead to hair loss and social embarrassment, making it a highly distressing condition for those who suffer from it.
See also What Causes Menopause Hair Loss, Plus How to Prevent It? and How Often Should You Use Shampoo?
While there is no cure for scalp psoriasis, numerous treatments are available to manage its symptoms and improve quality of life.
In this article, we will explore what causes scalp psoriasis, its common symptoms, and various treatment options for managing this condition.
What is Scalp Psoriasis?
According to the Psoriasis National Foundation, 45-56% of people with psoriasis have scalp psoriasis. Further research also shows that 90% of psoriatic patients will have their scalp affected by the disease at some point in their life.
Scalp psoriasis is an inflammatory, autoimmune skin condition that can occur on the part of the scalp or the whole scalp. In some cases, it can extend onto the forehead, back of your neck, or behind the ears, and sometimes inside.
It causes patches of red, dry, flaky, and scaly skin with raised discolored plaques.
Scalp psoriasis may present differently depending on your skin tone. In light-to-medium skin tone, it will appear as raised reddish or salmon-colored patches with white scales.
For darker complexions, the plaques can appear purple with grey scales.
The exact cause of scalp psoriasis is unknown, but it has been shown to occur due to genetic and environmental factors causing an immune system overreaction. This can result in inflammation and speed growth of new skin cells.
While your skin cells are expected to renew every 28 to 30 days, this duration often comes down to 3 to 4 days in people with psoriasis, leading to skin cell buildups like plaques.
Risk Factors of Scalp Psoriasis
Several factors may increase your risk of developing scalp psoriasis, including:
1. Race
Race is thought to be a risk factor for scalp psoriasis. Studies have shown that people of certain racial groups are more likely to develop the condition than others. For example, white people have been shown to have a greater risk than those who are black or Hispanic.
According to the 2009-2010 National Health and Nutrition Examination Survey (NHANES), it was estimated that 3.6% of Caucasian adults had psoriasis followed by 1.9% of African American and 1.6% of Hispanics.
2. A positive family history
If you have a family member with scalp psoriasis, you may be more likely to develop the condition. This is because it is believed to be caused by an overactive immune system, and this is often passed down through families. Certain genes have been linked to an increased risk of developing scalp psoriasis.
3. Stress
Stress is a common trigger of psoriasis. In fact, some studies show that most people have their first psoriasis flare during a particularly stressful time. At the same time, psoriasis flare-ups can result in stress, making it a difficult cycle to break.
If you’re struggling with stress, there are some things you can do to help manage it. Exercise, relaxation techniques, and therapy can all be helpful in managing stress.
If you’re finding it difficult to manage your stress on your own, talk to your doctor about other options that may be available to you.
3. Skin injury
Injured skin (from a cut, scrape, bug bite, or sunburn, for example) can cause new psoriasis lesions to form or existing ones to become worse. This is often referred to as the Koerner response.
The Koebner response is a phenomenon in which skin lesions appear at the site of trauma or injury. It is named after Heinrich Koebner, who first described it in 1876. The Koebner response is seen in a variety of inflammatory skin disorders, including psoriasis, lichen planus, and vitiligo.
In psoriasis, the Koebner response can occur with any type of trauma, including cuts, scrapes, burns, and insect bites.
The lesions typically appear within 10-20 days of the injury and are often more severe than the original injury. The risk of developing a Koebner response increases with the severity of psoriasis and the number of previous injuries.
While the exact mechanism is unknown, it is thought that the Koebner response is due to an abnormal immune reaction to injury.
In some cases, it may be possible to prevent the Koebner response by using prophylactic treatments such as corticosteroids or calcipotriene before injury occurs.
4. Tobacco
Tobacco smoking is a known risk factor for many chronic health conditions, including psoriasis.
In fact, studies have shown that smokers are more likely to develop psoriasis than nonsmokers. This is due to the effects of nicotine on the immune system. Smokers are also more likely to experience severe symptoms than nonsmokers.
An Italian cross-sectional study found that psoriasis patients who smoked more than 20 cigarettes per day increased their risk of severe psoriasis by twofold more than those who smoked 10 cigarettes daily.
Further research has also shown that smoking can impact the severity and treatment response of the condition.
This is why most smokers with psoriasis are predisposed to other comorbidities, including inflammatory bowel disease, heart disease, and various cancers.
If you smoke tobacco, quitting smoking is one of the best things you can do for your overall health, including treating scalp psoriasis.
Many resources are available to help you quit smoking, so talk to your doctor or therapist about what might work best for you.
5. Alcohol
According to research, alcohol intake has been associated with triggering a new psoriasis diagnosis or worsening symptoms in a person already diagnosed.
This is partly because alcohol can cause the body to produce more toxins, leading to inflammation and triggering a flare-up of scalp psoriasis.
So if you drink alcohol regularly, you may be more likely to experience a flare-up than someone who doesn’t drink.
If you have psoriasis or are at risk, for example, if you have a positive family history of the condition, it’s good to limit your alcohol intake or avoid it altogether.
Moreover, alcohol can cause other health issues, including high blood pressure, heart disease, digestive issues, liver disease, stroke, a weak immune system, and various cancers, including cancer of the esophagus, throat, voice box, mouth, liver, colon, rectum, and even breast.
If you have scalp psoriasis, it is important to limit your alcohol intake or avoid it altogether.
6. Obesity
Research shows that being overweight or obese increases your risk of getting psoriasis. Or make existing symptoms worse. Losing even a few pounds can help improve the symptoms or lower your risk.
That said, obesity alone cannot cause psoriasis. However, for someone with additional risk factors, there’s an increased chance of developing it.
7. Cold temperatures
A survey by the National Psoriasis Foundation (NPF) found that 4 in 10 people with psoriasis experience flare-ups during winter when the temperatures are low. This is because the air is dry during winter, which can cause the upper layer of the skin to lose moisture.
In addition, the heating systems used at home during this period can make the skin more dry. Dry skin can trigger symptoms not just in psoriasis but in any skin condition.
8. Medications
Research has linked various medications to psoriasis, including beta blockers, lithium, and antimalarial drugs like interferons, chloroquine, terbinafine, and imiquimod.
9. Infections
Certain disease-causing bacteria species have been shown to induce and exacerbate psoriasis. This includes streptococci, staphylococci, Candida, Malassezia, human immunodeficiency virus, hepatitis C, and human papillomavirus.
10. Immune system dysfunction
The immune system plays a critical role in protecting the body from harmful pathogens such as viruses, bacteria, and fungi.
However, when it becomes weakened or compromised, it can lead to a range of health problems, including infections and autoimmune diseases like psoriasis.
Common symptoms of scalp psoriasis:
According to the American Academy of Dermatology, psoriasis can present with various symptoms, including:
- Dandruff-like flaking silvery-white scale
- Reddish patches on the scalp
- Itching
- Dry scalp
- Temporary hair loss
- Bleeding
- Soreness
- Cracks
- Irritation or pain
How to diagnose scalp psoriasis?
If you suspect you have scalp psoriasis, see your doctor for an evaluation. They will likely perform a physical examination and ask about your medical history and symptoms. Be sure to mention if you have any family members with psoriasis or other autoimmune conditions.
Your doctor can usually diagnose scalp psoriasis just by looking at your scalp. A skin biopsy can also be done. This involves removing a small piece of skin and sending it to a laboratory for analysis.
A skin biopsy can confirm the diagnosis of psoriasis, including the specific type, and rule out other conditions with similar symptoms.
Treatment options for scalp psoriasis:
The first step in treating scalp psoriasis is to identify the triggers that cause your flare-ups and try to avoid them.
Common triggers include stress, certain medications, cold weather, and infections. Once you know what triggers your flares, you can take steps to avoid them.
That being said, scalp psoriasis can be tricky to treat because the scalp is covered with hair, making it difficult to get medication to the affected area. In addition, the scalp is often sensitive and can be easily irritated.
Nonetheless, several different treatment options are available, including medicated shampoos, topical treatments, light therapy, and oral medications. The best treatment plan will be individualized based on your condition’s severity and preferences.
1. Medicated Shampoos
Medicated shampoos containing ingredients like coal tar, salicylic acid, or selenium sulfide can help reduce the symptoms of scalp psoriasis.
These shampoos are available over-the-counter or by prescription. Be sure to follow the instructions on the package carefully to avoid irritating your scalp.
2. Topical Treatments
Topical treatments are applied directly to the skin and are often used in conjunction with medicated shampoos.
Common active ingredients include corticosteroids, vitamin D analogs, retinoids, coal tar, salicylic acid, calcineurin inhibitors, and anthralin. These treatments can help reduce inflammation and itchiness while promoting healing.
3. Light Therapy
Light therapy involves exposing the skin to ultraviolet (UV) light under medical supervision. The common type of light therapy often used is known as narrow-band UVB phototherapy.
UVB is present in sunlight and has been shown to penetrate the skin and slow the growth of affected skin tissues.
Other types of light therapy include UVB broadband and excimer laser.
This method is often used when other treatments, like topical applications, have failed.
4. Systemic Medications
These may include pills, injections, and intravenous (IV) infusions.
Common medications used include steroids, methotrexate, cyclosporine, biologics, and retinoids.
5. Lifestyle Changes
- Take daily, gentle baths with lukewarm water and gentle soaps.
- Keep your scalp moisturized. For very dry skin, consider applying ointment-based moisturizers, as they can stay longer than creams and lotions.
- Avoid psoriasis triggers, including smoking, alcohol, etc
- Avoid scratching. An anti-itch cream or ointment can help
- Cover the affected area overnight.
- Eat a healthy balanced diet. Avoid all processed foods and sugar
- Reducing stress levels through meditation or other relaxation techniques can help reduce flares
Additional Tips to Live with Psoriasis
- Find a support system – whether it be friends, family, or an online community, having a support system that understands what you’re going through can make a big difference.
- Educate yourself about your condition – the more you know about psoriasis, the better you will be to deal with it.
- Focus on the positive – it can be easy to get bogged down by all of the negative aspects of having psoriasis but try to focus on the positive aspects of your life.
- Set realistic goals – if you set unrealistic goals for yourself, you are setting yourself up for disappointment. Be realistic about what you can accomplish and give yourself credit for small successes.
- Take one day at a time – some days will be better than others, but try not to dwell on the bad days. Take each day as it comes, and do your best to cope with whatever symptoms you may experience.
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Final Thoughts
Scalp psoriasis is a chronic and distressing skin condition that affects millions of individuals worldwide.
The symptoms can range from mild to severe and can cause significant discomfort and embarrassment.
While there is no cure for scalp psoriasis, various treatments can help manage the condition and improve quality of life.
It’s essential to work closely with a healthcare professional to determine the best treatment plan for an individual’s unique needs.
Additionally, making lifestyle changes such as reducing stress levels, maintaining a healthy diet, and avoiding triggers can have a positive impact on managing scalp psoriasis symptoms.
With proper care and management, individuals with scalp psoriasis can lead fulfilling lives without letting their condition hold them back.
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