Psoriasis is an inflammatory medical condition of the skin characterized by slightly raised bumps, itching, red scaling, all of which merge together to form psoriatic plaques. Psoriasis can be a source of great irritation and it also affects a person's appearance and quality of life. There are some individuals who have a genetic predisposition towards this disease. Psoriasis typically appears on the elbows and knees; however, it can occur anywhere on the skin. In many individuals, the scalp is also affected with psoriasis. As is the hallmark of the disease, the plaques which develop on the scalp produce excessive scaling and itch quite a lot. If the psoriasis is severe, then the patient can also lose hair which can re-grow if the disease is controlled and managed properly.
There is no cure for psoriasis. The aim of treatment is to manage and control the disease and its symptoms. Treatment comprises of topical medications and in severe cases oral medications.
Causes Of Scalp Psoriasis
- Scalp psoriasis, just other psoriasis, is thought to be related to genetic disorders which affect the immune system.
- Environmental factors also play a hand in triggering this condition, especially if the person is genetically predisposed to this disease.
- Other factors, such as mental or emotional stress, are also thought to trigger or exacerbate an already existing psoriasis.
Signs & Symptoms Of Scalp Psoriasis
- Appearance of small raised papules covered with scales.
- These raised papules merge together and form plaques which are covered with excessive layers of calloused skin giving a silvery scaled appearance.
- These silvery scales start to shed and appear as dandruff.
- The scaling and the shedding happen in excessive amounts and can be quite unsightly.
- Patient also experiences itching and has an urge to scratch these plaques to relieve the itching or to remove the papules.
- Scratching in order to remove the papule is not recommended, as it can lead to Koebner phenomenon (isomorphic response) where there is a strong tendency for developing of psoriasis in the regions of trauma, such as can occur after itching or scratching. Scratching the papules will injure the area and aggravate the psoriasis.
Investigations For Scalp Psoriasis
Physical exam and medical history is done. Because of hair growth in the scalp region, it can be relatively difficult to arrive at the correct diagnosis. Sometimes, scalp psoriasis can be confused with seborrheic dermatitis of the scalp due to the similarities like itching and excessive scaling.
The doctor will look for the characteristic scaling plaques on the areas of the body which is typical in distribution of psoriasis. This will help in making the diagnosis.
Treatment For Scalp Psoriasis
- Treating scalp psoriasis comprises of topical as well as oral medications.
- It is very important that an effective amount of medication gets applied/absorbed in the scalp/skin.
- The hairs as well as the scales covering the disease can be a hindrance for treatment. So, it is important to remove the scales in a manner which will cause least trauma.
- Frequent shampooing with shampoos containing tar, selenium or salicylic acid, is one method where the scales can be removed in a mild and gentle manner.
- Shampooing needs to be done twice a week if the scales are thick. Also you should gently rub off the scales with the fingertips and NOT your nails.
- The scaling does not occur due to dryness, but occurs due to overproduction of the skin's horny layer.
- Covering the scalp with mineral oil and keeping it overnight and shampooing the next day also helps in removing the scales.
- Topical steroids are used if the disease is moderate or severe.
- Steroids can be used in lotion, foam or solution form and the strength of the steroids also depend on the severity of the psoriasis and the doctor's as well as the patient's preference.
- The medications should be able to get past the hair barrier and get absorbed in the scalp.
- Other medications like topical calcipotriene (Sorilux or Dovonex) can be beneficial.
- In rare cases, the psoriatic plaques are directly injected with triamcinolone acetonide. The benefit of this medicine lasts for a maximum of six weeks.
- Narrow band ultraviolet light therapy treatment in wavelengths of 313 nm can also be beneficial in some patients. However, the hair barrier needs to be removed for this treatment to be effective.
- If the psoriasis is very severe and is present not only on the scalp but on other parts of the body too, then topical medications do not benefit much and oral/systemic medications need to be taken. These medications carry greater risk than topical medications.
- Oral medications include methotrexate, cyclosporine, acitretin etc.
- Biological drugs, such as infliximab, can also be administered intravenously. Etanercept, adalimumab and ustekinumab can be injected into the deeper layers of the skin.
Prognosis Of Scalp Psoriasis
Psoriasis is an incurable medical condition, so it needs to be continuously managed, treated to be kept under control. Sometimes, there can be a spontaneous resolution of this disease; however, it happens very rarely. Psoriasis can be difficult to camouflage which can make the patient self-conscious and depressed.
Patient should enroll into support groups like the National Psoriasis Foundation for help with coping with this condition and moral support.
Home Remedies For Scalp Psoriasis
Given below are some home remedies for scalp psoriasis which are definitely worth trying:
- Vitamin D and zinc supplements help in controlling and treating scalp psoriasis.
- Daily exposure to some amount of sunlight is important for metabolizing vitamin D; and also the sunlight helps with controlling of the itching.
- Lubrication of scalp with any type of oil, especially vitamin E and olive oil, helps with the itching of the lesions by preventing the scalp from becoming excessively dry.
- Application of hair pack made of bananas and yogurt and keeping it for one hour and then washing off with plain water also helps with scalp symptoms.
- Mix a quarter-cup of organic oatmeal in water and keep it aside for half an hour. Strain and add some drops of lavender and rosemary oil to this liquid and apply this mixture to the lesions on the scalp for relief.
- Always use mild shampoos, so as to prevent irritation to the scalp.
- Also try using sulphate free shampoos and use shampoos which contain jojoba and wheat germ oil.
- Always comb your hair and avoid using hair brushes on the scalp, as much as possible to prevent further irritation of the lesions.
- Make a base mixture of the following oils: tea tree, neem, rosemary and lavender oil. To this, add 3 teaspoons of almond, olive, wheat germ/ coconut oil and massage gently on the irritated regions. This will help with soothing the irritation, softening the skin, and nourishing the scalp.
- Application of Vaseline on the lesions also helps with the symptoms. It should be kept overnight and washed off the next day.
- Application of castor oil, keeping it overnight and washing off the next day is beneficial.
- Milk thistle, evening primrose oil and fish oil capsules are also helpful.
- Avoid using soaps, perfumes with fragrances and dyes in them. Also avoid coloring your hair.
- Drinking chamomile tea and also rinsing the scalp with it, helps in soothing the inflammation and irritation of the scalp.
- Rinse your scalp with a mixture of cool water and a cup of apple cider vinegar also helps with itching.
- Ice cubes can also be applied to lesions to reduce irritation and pain.