Scalp psoriasis can make the scalp feel itchy and tight, and cause dandruff-like flakes to fall.
It is very common for plaque psoriasis to occur on the scalp. It usually looks similar to plaque psoriasis on other areas of the body, but can be prone to quite a thick build-up of scaly skin, which may cause dandruff-like flakes to fall. Scalp psoriasis may also be visible around the hairline, on the forehead, neck and behind the ears. It can make the scalp feel itchy and tight. In severe cases, the thickness of the scale can cause thinning of the hair, but usually this is temporary and goes back to normal with effective treatment of the psoriasis.
Some shampoo treatments can be bought over the counter, however, if your scalp is covered with thick scale or doesn’t clear up, do consult your GP. There is a wide range of topical treatments that can be prescribed including coal tar, dithranol, salicylic acid, steroid creams and ointments, Vitamin D based treatments, as well as oils for moisturising the scalp, such as coconut oil. Various scalp treatments are available in cream, ointment, mousse, gel or shampoo formulations. If your scalp psoriasis is particularly difficult to treat, your GP may refer you to a Dermatologist, Dermatology Nurse Specialist, or GP with a Special Interest in skin.
It is important to get the method of applying scalp treatment right – the treatment needs to be on the scalp rather than on the hair. It might be best to part the hair in sections and apply the treatment on the exposed areas of scalp. You may need someone to help you to reach the top and back of your head properly. You will find that some treatments need to be left on and some need to be washed out after a set period of time. Do follow the instructions that come with the product or the advice of your doctor, nurse or pharmacist.
It is normal to want to comb or brush hair, and it can actually be helpful to remove loose scales. Just take care not to scratch the scalp.
Scalp psoriasis does not necessarily mean you can’t have hair treatments, but you do need to be careful. Certain things that do not touch the scalp – such as highlights – should be fine, and treatments that do touch the scalp (such as perms and dyes) usually require a ‘patch test’ to be done in advance, to make sure you do not have a reaction. If there is broken skin on the scalp then it is not advisable to have dyes or perms applied. It is always a good idea to discuss your scalp psoriasis with your hairdresser, who should have up to date information about possible options, and if in doubt always consult your doctor.
A good hairdresser should have been trained in various scalp conditions, and should be able to help you manage your hair. Telephone in advance and speak to a stylist to explain the situation or try to find a hairdresser who will visit you at home.
Some people with severe scalp psoriasis see temporary thinning of the hair. This is often because of a build-up of scale, or from scratching.
Psoriasis tends to come and go. After treating their scalp psoriasis, some people may be lucky enough not to have a further flare up, and others may have periods of no scalp psoriasis followed by a flare up where it comes back again.
• Brush and comb hair gently and regularly
• Buy some pillow case protectors or keep a supply of old pillow cases for times when you are using treatments
• Give all treatments a good chance to work - weeks rather than days
• Always read the instructions carefully on all treatments, as they can differ in how they should be applied
• Tell your GP or Dermatologist if any treatment is causing you problems or discomfort
• Try different hairstyles to cover any psoriasis on the hairline
• Try using an oil to soften the scalp and make scaling easier to lift - olive or coconut oil for example
• Wearing light coloured clothes on the top half of your body will help to disguise falling scales
• Keep up to date with new treatments - the Psoriasis Association has details