Fun fact: Your skin is the largest organ in your body (that's according to literally everywhere, like the American Academy of Dermatology)—and, as a chronic skin condition, psoriasis can happen anywhere on that organ. But when it shows up on your scalp, it's specifically called scalp psoriasis.
A quick refresher: Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales, according to the U.S. National Library of Medicine (NLM)—but it's not a communicable disease, meaning you can't catch it. Instead, psoriasis stems from an issue with your immune system. Your skin goes through something called cell turnover, where skin cells grow and rise to the surface of your skin. In most people, this happens over the course of a month, per the NLM—but in those with psoriasis, it can happen over the course of a few days, leading to those thick, scaly patches.
But when psoriasis occurs on the scalp, it's a little bit different. The skin on the scalp is a little bit thicker than the rest of your skin, and hair that grows on the scalp can also get in the way, per the AAD. Here are four more things you need to know about scalp psoriasis—and what to do if you have it.
1. Scalp psoriasis is actually pretty common among those with psoriasis.
Overall, more than eight million Americans have psoriasis, according to the National Psoriasis Foundation (NPF)—and nearly 80 percent of patients with psoriasis will also have scalp psoriasis.
Conversely, some patients will only have scalp psoriasis, says Jessica Kaffenberger, MD, a dermatologist and psoriasis expert at The Ohio State University Wexner Medical Center. It can manifest as mild (fine scaling) or severe (thick crusted plaques), according to the NPF. Scalp psoriasis can also extend onto the forehead, the back of the neck, and around the ears.
2. Scalp psoriasis can look a lot like dandruff.
While dandruff is accompanied by flaking and dryness, scalp psoriasis looks silvery and has well-defined red, raised plaques, not just flaking and dryness. “The scales from psoriasis can flake off much like dandruff,” says Richard Torbeck, MD, a dermatologist at Advanced Dermatology in New York City. “Additionally, itching from psoriasis is quite similar to itching from dandruff. However, each condition needs to be treated very differently," he adds.
3. Scalp psoriasis can lead to hair loss.
Unfortunately, hair loss is common with scalp psoriasis, per the NPF—but it's more about damage to the hair shaft and follicles from excessive itching, rubbing, and combing; or from the ingredients in products, than it is about the psoriasis itself.
The good news: Hair loss from psoriasis is almost always temporary, and, with appropriate treatment, normal hair growth will return once psoriasis is managed.
4. There are a few different treatments for scalp psoriasis.
When you meet with your healthcare provider to discuss how to treat your scalp psoriasis, expect to be offered several options, including topical treatments, phototherapy and systemic medication, depending on how extensive your scalp psoriasis is, whether you have it elsewhere on the body and how much it affects your daily life.
As far as topical treatments go—that means medication that can be directly applied to the skin—corticosteroids that can be applied as a foam, shampoo, cream, gel or lotion are often prescribed. “This usually brings your scalp psoriasis under control within two to four weeks,” says Erum Ilyas, MD, a dermatologist in Philadelphia. “Once you take that, your scalp psoriasis can be maintained with topical calcipotriene (a synthetic, topical form of vitamin D) and shampoos that contain coal tar and salicylic acid.”
Phototherapy is another option. “This is done with a UV comb that permits the light to get directly to the scalp,” Dr. Ilyas says. “Light therapy for psoriasis has been around for decades as it has been shown to help treat psoriasis by reducing certain inflammatory cells in the skin.” While this therapy can be effective, the downside is that you may be required to undergo two to three treatments a week at your doctor’s office over the course of several weeks, Dr. Ilyas says.
Of course, these topical sorts of treatments are best used alongside systemic medications, says Dr. Kaffenberger. They work by altering the immune system to control psoriasis from the inside out—and they're especially helpful if your psoriasis is widespread and not just limited to your scalp.
In the end, experts recommend speaking with your healthcare provider about the treatment options that are best for you. One tip: If you have this immune disease, don’t underestimate the way stress can contribute to flare-ups. “I always remind patients that there tends to be a strong stress correlation to flares,” Dr. Ilyas says. “It’s important to know this to help control symptoms, too.”
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