Scalp psoriasis: what it is and how it's treated

Not medical advice. This guide is general information from the sources listed, not a diagnosis or a substitute for a pharmacist, GP or dermatologist. If you are worried, or symptoms are severe or not improving, get advice. Read our health information policy.

What it is

Psoriasis is a common, long-term skin condition that causes itchy and sometimes painful patches of dry, flaky skin. The NHS lists the head and behind the ears among the most common places. On white skin patches tend to look pink or red with silvery-white scale; on brown or black skin they can look grey.

Psoriasis is not contagious — you can't catch it or pass it on. It's thought to be caused by a problem with the immune system, and it's more likely if someone in your family has it.

How it differs from dandruff

Dandruff and seborrhoeic dermatitis usually cause looser, finer flakes. Scalp psoriasis tends to form well-defined, raised plaques with thicker, stuck-on scale, often extending onto the forehead, neck or ears, and you may have patches elsewhere (elbows, knees, lower back). The two can be hard to tell apart, so if you're unsure, ask a GP.

Triggers

The NHS lists things that can trigger or worsen psoriasis, including stress, drinking alcohol or smoking, certain medicines, infections (such as strep A), injury to the skin and, for some, sunlight. Scratching or picking at scalp plaques can make them worse.

Treatments

Dermatologists note the scalp can be harder to treat than other areas and often needs a combination of treatments. Options include:

• Coal tar shampoos, which can help mild scaling. They have a strong smell, can stain fabrics and may make skin more sensitive to the sun. On their own they're not enough for severe scalp psoriasis.
• Descaling treatments containing salicylic acid and/or oils such as coconut oil, applied to the plaques for an hour or longer before washing out, to lift thick scale so other treatments can reach the skin.
• Steroid scalp treatments (lotions, gels, mousses or shampoos) prescribed by a GP — usually the first prescription treatment for scalp psoriasis. Lotions, gels and foams suit hairy skin better than creams or ointments.
• Vitamin D–type treatments (such as calcipotriol), sometimes combined with a steroid.
• Specialist treatments from a dermatologist if these don't work.

Treatment is aimed at controlling the condition rather than curing it, and courses of stronger steroids are kept time-limited.

Living with scalp psoriasis

• Be gentle. Comb and brush carefully, and avoid picking or scratching scale.
• Follow product instructions closely, especially contact times and how often to use a steroid.
• Emollients and flames: the NHS warns that clothing and bedding in contact with emollients burn more easily — don't smoke or go near naked flames.
• Psoriasis can affect how you feel. If it's getting you down, tell your GP.