Scalp psoriasis, resulting from excessive scaling occurring together with
inflammation, affects at least half of all psoriasis patients (Figure 5). Because
scales on the scalp, face and clothing can be very obvious, this ailment can be
very rough on a patient’s emotional and psychological well-being. Some patients
even try to scrape their severe scaling off. Don’t be one of them! Scraping
damages the scalp skin and worsens psoriasis.
There is good news and bad news regarding scalp psoriasis. The good news is
that with so many treatment options available, most patients can be helped. The
bad news is that the scalp is one of the most difficult areas to treat, and many
patients do not easily tolerate the treatment agents. Thus, frequent alterations in
their medication plans are needed. It is a constant challenge to clear scalp psoriasis
effectively, maintain improvements and modify treatments based on patients’
reactions to the toxicity of medications.
There are a few conditions that mimic the symptoms of scalp psoriasis, but
they are actually different diseases. Seborrhoeic dermatitis or seborrhoeic
eczema of the scalp is probably the most common condition that looks like scalp
psoriasis. If your dermatologist has prescribed dithranol (anthralin) be sure that
someone in the clinic (usually it’s a nurse) gives you detailed instructions, so
that you can avoid unnecessary staining and irritation. Most importantly,
remember to shampoo backwards, away from the face, to prevent the dithranol
from dripping onto your forehead and from there into your eyes.
Imidazole lotions or creams are effective for some patients and once they have
achieved maximum improvement, patients can usually reduce their applications
from daily to occasional use and still effectively control their psoriasis.
Cortisone-containing scalp preparations are frequently helpful (Figure 5d).
Injecting cortisone directly into the lesions of scalp psoriasis can lead to long
periods of improvement for some patients with tough but localized cases. PUVA
(psoralen-ultraviolet-A) therapy may help— particularly with thin-haired patients
—and sunlight therapy is sometimes effective as well.
Vitamin D scalp lotion (Dovonex) or tazarotene gel (a new type of vitamin A)
can be applied to the scalp at night—if they irritate then use a cortisone scalp
lotion or foam (Olux and Luxiq foams in the USA) every other night.
I believe that shampoos are vitally important in controlling scalp psoriasis,
even though there have been few scientific studies on them. Therapeutic
shampoos, usually available without a doctor’s prescription, usually contain coal
tars, wood tars, salicylic acid, sulphur, selenium and zinc parathione or they may
combine several of these agents in one shampoo. I give samples of several
shampoos to my patients and allow them to select one that proves most
beneficial and least irritating. I have found that some patients with blonde or
dyed hair resist using tar shampoos because they sometimes stain the hair. As
these shampoos can be expensive, one of my patients offered the following tip to
reduce the cost.
‘I apply tar soap (Polytar) as the first coat. I then apply the tar shampoo
such as T-Sal, T-gel or Pentrax, which are highly concentrated and require
smaller quantities. A bar of tar soap lasts a very long time. Any shampoo or
conditioner can then be used after the tar shampoo has been rinsed out.’
Examples of shampoos which can be bought without prescription include:
Alphosyl, Capasal, Ceanel, Clinitar, Ionil T, Nizosal, Polytar (UK); Ionil T,
Nizoral, Selsun, T Gel (USA)
Newer, less messy scalp treatments
A prescription shampoo called Nizoral contains ketoconazole to reduce yeasts
present on scalp skin, which in turn may improve scalp psoriasis in some
patients.
Tazarotene gel (known as Tazorac in the USA and Canada and Zorac in
Europe) applied to the scalp nightly or on alternate nights is very helpful in
improving psoriasis. Some patients also benefit from Dovonex scalp lotion (see
previous page).
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