Your head is itchy and flaking. Small balding patches are showing up on your scalp. Your hair always looks dirty, and you can’t wear black anymore. And you’re trying one dandruff shampoo after another. Is this a simple case of dandruff, or is it something more serious?
Approximately half of the 7.5 million Americans who have psoriasis specifically have scalp psoriasis. They may also have psoriasis on other parts of their body.
Scalp psoriasis appears as red, raised and sometimes scaly patches on the scalp, and can spread to the back of the neck, behind the ears, or the forehead. This condition is not contagious and its cause is not truly known. It may be caused by the immune system growing skin cells too quickly. The skin cells build up as patches that are itchy and flaky.
Mild scalp psoriasis might mean only very fine, slight scaling. Severe cases of scalp psoriasis can result in intense itching that interferes with daily functioning and sleep. The scratching can result in hair loss around the patches. Skin infections can also set in. The scalp may feel like it is sore or burning. The silvery white scales fall into the air and on clothing, causing embarrassment and shame.
Topical treatments for scalp psoriasis begin with medicated shampoos, gels, oils, soaps, and creams. Some are available over-the-counter, but stronger topical medications need to be prescribed by a doctor. One of these two FDA-approved medications are most often in these treatments: coal tar, or salicylic acid.
For tougher cases, your doctor may prescribe coal tar, salicylic acid or a combination; Anathralin; antimicrobials (for yeast or bacterial infections that are associated with scalp psoriasis); Calcipotriene (a vitamin D derivative); topical or injected steroids; or Tazarotene (vitamin A derivative). It is important to follow the doctor’s advice precisely to get scalp psoriasis under control. This may take two months or longer.
When nothing else works, the doctor may use a laser treatment or UV light therapy to treat scalp psoriasis.
The hair loss associated with scalp psoriasis is temporary. Once the condition is under control and the patient is following directions for medications, and is shampooing with the right shampoos on schedule, the hair around the patches should grow back. If the hair was lost due to another condition, such as hormonal-related male-pattern balding, it may not grow back — this should be discussed with a qualified hair loss physician.
If you have dandruff, and regular dandruff shampoo is not working, visit your doctor or dermatologist for a diagnosis.