Psoriasis can pop up almost anywhere on your body. It can occur on your hands, back, and even your nails. One place where psoriasis is more common than you might expect is your scalp. But the good news is you have treatment options to help manage it. About 50% of people with psoriasis experience it on their scalp to some degree. Scalp psoriasis is often characterized by a dry, flaking scalp with itching, burning, or soreness. TIP: Try not to scratch!
Speaking of hair loss, this can happen even if you don’t scratch. Seborrheic dermatitis and plaque psoriasis can present very similarly. However, plaque psoriasis patches tend to look more silvery in appearance whereas seborrheic dermatitis scales can appear more yellowish. The first thing you should do if you have scalp psoriasis is talk to a dermatologist. Don’t have one? Find one using our Dermatologist Locator. Your primary care doctor can help you find a psoriasis specialist who will help you manage your symptoms.
Immediate relief options (over-the-counter and at-home care)
Sometimes you need quick relief. Over-the-counter products may help you temporarily relieve some of the symptoms of psoriasis. Many scalp psoriasis shampoos and creams may help with symptoms. Coal tar is another popular treatment that may offer temporary relief. For some, coal tar has been shown to slow skin growth and reduce inflammation.
DID YOU KNOW: There are remedies to help manage scalp psoriasis with products you may already have in your pantry. Coconut oil can help gently soften scales. Apply to entire scalp, cover with a shower cap, and let it sit for 10-60 minutes. Apple cider vinegar may be able to soothe itching. Put some in a spray bottle and apply it to your scalp a few times a week. Although there is no scientific evidence to support it, bathing with epsom salts may provide some relief from itching and lessen scales. Curcumin, the active ingredient in turmeric, is thought to be behind turmeric’s ability to heal. REMINDER: Don’t use home remedies if your scalp is cracked or bleeding.
To improve the look and feel of your scalp: Apply scale softener. A scale softener containing salicylic acid can help loosen scales on your scalp and allow medication to work better. Apply the scale softener directly to your scalp. Don't pick at your scalp scales. This can cause hair loss and trigger a scalp psoriasis flare. Use medicated shampoo. Over-the-counter medicated shampoos can be effective at treating scalp psoriasis. Choose one that contains coal tar or salicylic acid to ease itchiness and remove scales. Be gentle when washing your scalp to avoid irritation. Don't scratch. Scratching your scalp can make your psoriasis worse, as well as cause bleeding and hair loss. Shampoos containing coal tar or menthol can help reduce itching. If itchiness continues, your doctor might recommend that you take an oral antihistamine medication to provide relief.
Topical and systemic treatments your doctor might prescribe
Try topical medications. Your doctor might recommend the topical treatments anthralin (Dritho-Scalp), calcipotriene (Dovonex), tazarotene (Tazorac, Avage) or a combination of betamethasone and calcipotriene (Taclonex). Side effects vary. Anthralin stains anything it comes into contact with and calcipotriene, tazarotene, and betamethosone and calcipotriene can cause skin irritation. Follow your doctor's directions for when and how long to use the medication. If your scalp psoriasis is severe, you might need a medication that affects your entire body (systemic). Light therapy also might be helpful.
All right, but what about light therapy? Light therapy is a first line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Sunlight, UVB broadband, UVB narrowband, PUVA, and Excimer laser are options with varying intensity and duration. Short-term side effects might include nausea, headache, burning and itching.
Oral or injected medications. If you have moderate to severe psoriasis, or if other treatments haven't worked, your health care provider may prescribe oral or injected (systemic) drugs. Steroids, retinoids (such as acitretin), biologics (for example etanercept, infliximab, adalimumab, ustekinumab, risankizumab, ixekizumab, guselkumab, bimekizumab, secukinumab), and targeted oral medicines can be considered. Biologics must be used with caution because they carry the risk of suppressing the immune system in ways that increase the risk of serious infections. Some of these are approved for children. Your doctor will help determine the best option based on severity and prior response.
Be mindful of treatment considerations. You and your health care provider will choose a treatment approach based on your needs and the type and severity of your psoriasis. You'll likely start with the mildest treatments - topical creams and ultraviolet light therapy (phototherapy).
Lifestyle, triggers, and coping strategies
Alternative medicine, including aloe extract cream, fish oil supplements, and Oregon grape, may be explored, but always discuss with your provider before starting any supplement. Sign up for free updates on research advancements, health tips, and management strategies. Take daily baths with lukewarm water and mild soaps, keep your skin moisturized, and apply moisturizer while the skin is still moist after bathing. Cover affected areas overnight with an ointment-based moisturizer and wrap with plastic wrap if advised by your clinician. Expose your skin to small amounts of sunlight with professional guidance to avoid triggering outbreaks or increasing cancer risk.
Avoid scratching. It might help to apply a nonprescription anti-itch cream or ointment containing hydrocortisone or salicylic acid. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. Keep your nails trimmed so that they won't hurt your skin if you do scratch.
Avoid psoriasis triggers. Notice what triggers your psoriasis, and take steps to prevent or avoid it. Stay cool. Being too hot can make your skin feel itchy. Wear light clothing if you're outside on hot days. If you have air conditioning, use it on hot days to keep cool. Keep cold packs in your freezer and apply them to itchy spots for a few minutes of relief.
Managing itch and the itch-scratch cycle
The goal in treating psoriatic itch is to inhibit the itch-scratch cycle. “Currently available medications don’t directly address the symptom of itching in psoriasis, however, most medications seem to improve the itch before they improve the psoriasis itself,” says dermatology experts. Since there are fewer places to go during difficult times, professional guidance remains essential for choosing the right regimen.
Coping and support
Coping with psoriasis can be a challenge, especially if the affected skin covers a large area or is visible to others. Learn more about psoriasis, understand possible triggers, and follow your health care provider's recommendations. Consider joining a support group, and in times when you feel self-conscious, use cover-ups or cosmetic products to improve appearance. Reducing stress through exercise, yoga, or relaxation techniques may help minimize flares and itchiness.
Preparing for your appointment: You’ll likely first see your primary care provider or a dermatologist. A clear discussion of symptoms, scalp condition, and prior treatments will guide your plan. A biopsy may be used to confirm diagnosis if needed.
In addition to direct treatments, practical scalp care-gentle washing, avoiding harsh chemicals, and using medicated shampoos-plays a key role in reducing itch and preventing flare-ups.
Recommended care path and plan
1) Start with a dermatologist visit to confirm diagnosis and tailor treatment. 2) Use a medicated shampoo containing coal tar or salicylic acid, and apply a scale softener as directed. 3) Consider topical therapies (steroids, vitamin D analogues, retinoids) as prescribed, monitoring for side effects. 4) If needed, explore light therapy or systemic medications under medical supervision. 5) Implement lifestyle adjustments to manage triggers and stress, and maintain skin moisture to reduce itching and scaling. 6) Keep nails trimmed and avoid scratching to prevent hair loss and infection.