psoriasis scalp information

7/30/2019 psoriasis scalp information

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A positive approach

to psoriasis and

psoriatic arthritis

Scalp Psoriasis


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What is psoriasis?

Psoriasis (Ps) is a long-term (chronic) scaling disease

of the skin, which affects 2%-3% of the UK population.

It appears as red, raised scaly patches known as

plaques. Any part of the skin surface may be involved

but the plaques most commonly appear on the

elbows, knees and scalp. It can be itchy but is not

usually painful. Nail changes are present in 50% of

people and 10%-20% of people will develop psoriatic

arthritis.

What happens?

Normally a skin cell matures in 21-28 days and during this

time it travels to the surface, where it is lost in a constant

invisible shedding of dead cells. In patches of psoriasis

the turnover of skin cells is much faster, around 4-7 days,

and this means that even live cells can reach the surface

and accumulate with dead cells. The extent of psoriasis

and how it affects an individual varies from person to

person. Some may be mildly affected with a tiny patch

hidden away on an elbow which does not bother them

while others may have large visible areas of skin involved

that significantly affect daily life and relationships. This

process is the same wherever it occurs on the body.

Psoriasis is not contagious.

What is scalp psoriasis?As the term suggests, scalp psoriasis is psoriasis

involving the scalp. It is common and approximately half

of all people with psoriasis have it on their scalp. The

reason it deserves special mention is that it can be

particularly difficult to treat and usually requires

specifically formulated medicines.

Psoriasis in the scalp forms in the same way as in other

parts of the body but the affect of the hair is to trap the

scale and stop it being rubbed away as it is, for instance,

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with psoriasis on the elbow. The result is that the scale

can quickly build up causing a thicker plaque which

becomes more difficult

to treat. This difficulty

is compounded by

the hair which also

acts as a physical

barrier obstructing

t h e a p p l i c a t i o n

o f c r e a m s a n d

ointments to the

affected skin.

The net result can be stubborn thick scaly plaques

which require specifically formulated scalp treatments.

Other things affecting the scalp

These can include scalp acne, infestations, fungal

infections and alopecia. Make sure you get a correct

diagnosis before starting any treatments. your doctor or

healthcare provider will provide appropriate advice.

What are the symptoms?

Scalp psoriasis causes redness and scaliness w h i c h

m a y a l s o involve the hairline, the forehead, behind the

ears and the back of the neck. It can range from very

mild w i th s l igh t f i ne s c a l i n g t o v e r y severe

crusted thick scaling covering the entire scalp which can

in some cases cause hair loss during the flare, but will

normally grow back.

A correct diagnosis of scalp psoriasis is essential in

treating the condition as there are other skin disorders

which may look similar such as seborrhoeic dermatitis.

The difference being that scalp psoriasis scales appear

fine with a silvery colour, whilst seborrhoeic dermatitis

scales often are yellowish and greasy. One of the most

frustrating symptoms is the constant shower of scale on

to your collar and shoulders.

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What is the treatment?

There are many treatment options that can help scalp

psoriasis and they all need to be used regularly.

Treatments can be time consuming and it is important to

select one that fits in with your lifestyle. On rare occasions

scalp psoriasis has been known to have spontaneous

remissions but can also remain on the scalp for lengthy

periods of time too. Bear in mind however, that the

treatments used should never be worse than the psoriasis

itself. If this is the case consult your doctor for further

advice or alternative treatment options.

It is also important to realise that good patient

compliance and experimentation to find an effectivetreatment plan which may include treatments such as

topical medications and

ultra violet UV light can

often be combined and

rotated depending onpsoriasis resistance to

repeated medicinal use.

With all treatments it

can take at least eightweeks until you get

adequate control of the

plaques. Once you have achieved this it is important to

maintain any improvement, and this can usually be done

with regular use of a tar shampoo.

It should be mentioned that children can get scalp

psoriasis too. Treatments will be much the same as used

for adults.

Here is a list of topical treatments that you may find

useful for scalp psoriasis:

Tar products

Tar shampoos, gels, ointments and creams are commonly

used to treat scalp psoriasis. They may be combined with


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other medications such as salicylic acid, to help remove

scale, or coconut oil, to moisturise the skin. Tar is effective

but it can stain clothing and jewellery and has a strong

smell. As a result, some people dislike using it. The

precise instructions for use will depend on the formulation

of the product but tar products are usually massaged into

the scalp, left in contact for a period of time, and then

rinsed off. Clothes and bedding can be protected from

staining by wearing a shower cap during the contact

period.

Topical steroids

These scalp products are usually formulated as liquids,

gels, oils, foams, sprays or shampoo. They range frommild to very strong potency. They should not be used for

long periods of time. Ideally, they should be used regularly

for a few weeks to bring the psoriasis under control, and

then gradually phased out, giving way to maintenance

with a coal tar shampoo. Abrupt stopping of steroids canresult in a rebound or worsening of psoriasis. It is not

advisable to use steroid preparations on your face, other

areas of sensitive skin such as under the breast and

genitals and around the eyes, unless directed by your

doctor. Most topical steroid medications are designedspecifically for treating scalp psoriasis. These formulations

are usually water and alcohol based which make them

easier to wash out after treatment. You can become

resistant to some topical steroids used in the treatment of

scalp psoriasis. If this happens consult your doctor foralternative medications. It should also be noted that it can

take several months before such topical steroid

medications will work again for skin that has become

resistant.

Vitamin D analogues

Vitamin D analogues are available in water and oil based

scalp formulations. They are usually applied once or twice

a day and left in contact with the scalp. They do not smell

or stain clothing, and are relatively easy to use. They can

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be used to bring the scalp psoriasis under control and

maintain that control. Such medications should be

confined to the scalp region only as it can irritate

unaffected skin particularly the face. It may be advisable

if you think you are prone to sensitivities to test a small

patch before applying it to the entire scalp. Avoid contact

with the eyes.

Vitamin A derivative (topical retinoids)

These can be applied as creams or gels for the treatment

of psoriasis and can be used in the treatment of scalp

psoriasis too. These medications may be less irritating for

the people with dry or sensitive skin. To avoid the drying

out of skin too much and to reduce irritation, applying amoisturiser 30 minutes before these are used may help.

These medications can be used on the face but should

never be applied around the eye region and treated skin

should not be covered.

Antimicrobial treatment

If bacterial or yeast infections are present scalp psoriasis

can become worse. A crusting scalp together with scaling

and/or swollen lymph nodes in the neck may indicate to

your doctor that antimicrobial treatment will be necessary

as there is infection present.

Mild scalp psoriasis can respond well to treatment with

anti fungal shampoos that will help to reduce the yeast

infection. Anti fungal shampoos may have to be used

once or twice a week thereafter to maintain results.

Ultra violet light

Successful outcome for using UV light treatments can bevariable on the scalp because the hair blocks UV light

from penetrating the scalp. It works best on shaved

heads. Natural sunlight may also help again if your head

is shaved or hair is thin. It is therefore not surprising that

this is not a first line treatment.

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Dithranol

Dithranol creams are effective in scalp psoriasis but like

coal tar can be difficult to use. Dithranol is usually applied

to the scaly plaques and left in contact for up to 30minutes before being rinsed out. It needs to be applied

with great care as it can irritate and cause purple staining

of blonde or red hair. Dithranol can burn non affected skin.

Lipid stabilised dithranol, if used correctly, can

reduce staining.It should also

be noted that

dithranol will

stain clothing

a n d b a t h s ,showers and

wash basins.

Extra attention

is needed.

Medicated shampoos

There are many coal tar and non coal tar medicated

shampoos for treating scalp psoriasis available from your

local chemist. For further advice ask your pharmacist whomay be able to give you further guidance. You should also

bear in mind that medicated shampoos are designed for

the scalp not the hair so the use of a regular shampoo and

conditioner after your scalp treatments will reduce the

smell of any unpleasant medicated shampoo and leaveyour hair shiny and manageable. Scalp psoriasis can get

worse if it becomes infected with bacteria or yeasts and

sometimes medicated shampoos with antifungal

medicines can be useful in reducing the plaques. The

choice of which of these treatments is best for you is apersonal one. It is a good idea to shop around and try

different treatment options. In this way you can discover

which one suits you best.

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Some useful tips

Scalp psoriasis may progress down onto the forehead,

neck and around the ears. These areas can be treated

with the same products you use for your scalp only if

indicated to use on such areas. Be careful about your

face. Strong steroids should not be used on the face and

dithranol can stain and burn facial skin. Avoid getting

medication in the eyes.

A lot of product treatments will contain salicylic acid,

known as a keratolytic. This ingredient aims to loosen

psoriasis scales so they can be washed away more easily.

This ingredient will be contained in both over the counter(OTC) and prescription products mostly found in

shampoos and soaps. It should be noted that treatment

with high concentrations of this ingredient can cause

irritation and used over large areas of skin the body may

absorb it leadingto the weakening

of ha i r shaf ts ,

causing them to

break and leading

to temporary hairloss. Hair should

return to normal

after stopping

the treatment.

Such productsmay be easier to apply at night and the head covered

with a shower cap to avoid messiness and more

convenient as they can be time consuming at the

beginning of the day before going to work.

Softening and loosening thick scale makes it easier for

topical medications to penetrate plaques and clear them.

Soaking the scalp in warm water can help loosen scales

which can then be removed using a comb. But be gentle

do not break the skin.

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Round or fine tooth combs or brushes are generally

used to remove psoriasis scales. Comb or brush the scalp

gently with a light circular motion holding the comb or

brush flat against the scalp. Loosen the scale gently then

you can shampoo to flush the scale from the scalp and

out of the hair. A hairdryer can be used to blow additional

scales away from the scalp and the hair. Do not remove

scales too fiercely as this can break the skin leading to

infection. The Koebner (name given to the development

of psoriasis on damaged skin) response can occur, this

can also occur if you scratch or scrape your scalp roughly.

If any treatments you use aggravate your psoriasis and

scalp always consult your doctor. Care should be taken

when removing the scales and applying topical

medications so as to avoid the Koebner response.

Never use a shower cap or other occlusion method

when using prescription scalp medications unless

specified by your doctor.

Scalp itch As mentioned refraining from scratching and

picking of psoriatic scales will reduce infection and the

Koebner response. Over the counter medicated

shampoos can help in alleviating itching. Please speak to

your pharmacist about this.

Combination medications The treatment of psoriasis

should be tailor made to each person. A doctor may try

various combinations of medications before finding what

works for you. Good communication between you and

your doctor and good compliance will ensure optimum

results for you. Always be aware that when medications

are combined they may activate adverse reactions. By

being aware of this and consulting your doctor if you are

unsure will reduce the likelihood of further discomforts.

Another alternative is to soften and loosen the scales is

to use oils, lotions, creams or ointments applied to a

damp scalp providing they do not cause you irritation.

To add to their effectiveness a hot towel placed around

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the head to act as an occlusion will also help loosen and

soften the scales. The heating of olive oil and application

to the scalp and wrapping your head in a towel for a long

period of time may also help or to speed the process up

applying the olive oil and then sitting under a hairdryer. Be

careful not to

burn the scalp

with too much

intensive heat.

If you are

prone or suffer

from dry hair

conditioners and

cream rinses

may help to

minimise and moisturise the hair and scalp. There is no

evidence to suggest the use of hair dyes, hair sprays or

perms will affect your scalp, however please advise your

hairdresser before embarking on any treatments so that

they can apply patch tests to see if any of their products

will irritate your scalp or psoriasis lesions. They may be

able to use gentler products. If you have the need to use

head lice shampoo preparations it is unlikely you will have

a reaction but they can be irritating and great care should

be taken not to get the solution into open cuts or lesions

or extensively scratched skin.

It can be highly embarrassing for you finding or going to

a new hairdresser or barber. If they are reputable and

understanding they should have a knowledge of

conditions such as scalp psoriasis and therefore will be

able to best advise you on styles, colourings and hair

products. It is always worth making general enquiries of

friends and relatives about local hairdressers or contacting

the Hairdressers Council for further advice that may be

useful. Some hairdressers are also happy to visit your

home if you would prefer not to go to a salon

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When applying scalp products part the hair and hold

it in place while you drip the oil or lotion directly onto

your scalp. Repeat this process until the whole of

the affected area has been treated.

Conditioners and cream rinses to help combat dry

hair can be used after you have completed using

your medication

Hair dyes and sprays do not usually irritate the scalp

in scalp psoriasis. However, it may be sensible to

test a cosmetic product on a small area of your

scalp before committing to it.

Please note:

This leaflet is one of many produced by PAPAA as a guide.

Material produced by PAPAA should not be used as a

replacement for medical advice.

Always consult your own doctor or medical healthcare

provider.

This material was produced by PAPAA 2008. Please be

aware that treatments and research is ongoing. For the

latest and up to date information or any amendments to

this material please contact us our visit our website.

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The Charity for Peoplewith psoriasis andpsoriatic arthritis

PAPAAthe new single identity of the PsoriaticArthropathy Alliance and Psoriasis Support Trust

The organisation is independently funded and

aims to be a definitive source of information and

educational material for people with psoriasis and

psoriatic arthritis in the UK.

To be a support to both patients and professionals

by providing material that can be trusted

(evidence based), which has been approved and

contains no bias or agendas.

We will be looking to provide positive advice that

enables people to be involved as they move

through their healthcare journey in an informed

way, which is appropriate for their needs

and any changing circumstances.

Psoriasis and Psoriatic Arthritis Alliance is a company limited by guarantee

registered in England and Wales No. 6074887

Registered Charity No. 1118192

Contact:

PAPAAPO Box 111 St Albans Herts AL2 3JQ

Tel: 0870 770 3212

Fax: 0870 770 3213

Email: [email protected]

www.papaa.org

9 781906 143152

ISBN 978-1-906143-15-2

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