Scalp Psoriasis
Overview
Scalp psoriasis is psoriasis involving the scalp. Psoriasis is an autoimmune condition where the immune system mistakenly attacks the skin, causing excessive skin growth and proliferation. This classically occurs on extensors surfaces such as the elbows and knees, but is also seen on the trunk and scalp. Many people confuse seborrheic dermatitis with scalp psoriasis and there is even a term "sebopsoriasis" which refers to seborrheic dermatitis that has a psoriasis appearance but this is not technically scalp psoriasis. Most patients with scalp psoriasis will have psoriasis plaques elsewhere on the body. The cause of scalp psoriasis is genetic and it classically presents with salmon colored plaques with fine micaceous scale. It is diagnosed by a dermatologist and commonly treated with topical anti-inflammatories and occasionally systemic therapy if needed. While scalp psoriasis is chronic, it can be controlled with medication. In this article we will review scalp psoriasis causes, symptoms, diagnosis, treatment, and prognosis.
Cause
Scalp psoriasis is caused by a defect in the immune system where the body mistakenly attacks healthy skin cells. The exact cause is unknown but it is believed to be genetic. There are many triggers that can worsen scalp psoriasis such as trauma, stress, infection, and weather changes.
Symptoms
The most common symptom of scalp psoriasis is itching. This can range from a mild itch to severe, constant itching that can interfere with daily activities. Other symptoms include:
- scalp redness
- scalp scaling and flaking
- hair loss
- burning or soreness
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License: Masryyy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
Diagnosis
Scalp psoriasis is diagnosed by a dermatologist through clinical examination. The doctor will look at the scalp and check for other symptoms of psoriasis. They will also ask about medical history and any family history of psoriasis. In cases of diagnostic uncertainty a scalp biopsy may be done to rule out other conditions with similar symptoms.
Treatment
There is no cure for scalp psoriasis, but there are treatments that can help to control the symptoms. The most common treatments are topical steroid solutions, creams, and ointments. Non steroid topical therapy can be utilized as well including new topical treatments such as roflumilast (zoryve). Light therapy and oral medications such as apremilast (otezla) and sotkyu (deucravacitinib) can be helpful . In severe cases, a biologic medication such as risankizumab (Skyrizi) or guselkumab (tremfya) may be prescribed.
Outlook / Prognosis
Scalp psoriasis can be a difficult condition to live with. It can be embarrassing and uncomfortable. It can also be painful and itchy. If you have scalp psoriasis, it is important to talk to your doctor about the best way to treat your symptoms. There are many options available and the treatment that is right for you will depend on the severity of your symptoms.