Overview

Scalp psoriasis is a common chronic skin condition characterized by red, inflamed patches of skin covered with silvery-white scales, specifically affecting the scalp. It can appear as a single patch or affect multiple areas of the scalp and may also extend to the forehead, back of the neck, and around the ears. Scalp psoriasis is not contagious but can cause significant discomfort, itching, and self-consciousness. The severity of scalp psoriasis can range from mild flaking to thick, crusted plaques covering large areas of the scalp.

Causes

The exact cause of scalp psoriasis is not fully understood, but it is known to involve an overactive immune response. Several factors contribute to the development and flare-ups of scalp psoriasis:

• Genetic predisposition: Family history of psoriasis increases the risk.
• Immune system dysfunction: An abnormal immune response causes skin cells to grow rapidly, leading to scale formation and inflammation.
• Triggers: Environmental and lifestyle factors like stress, cold weather, skin injuries, and infections can provoke or worsen scalp psoriasis.
• Medications: Certain drugs such as beta-blockers, lithium, and antimalarials may trigger flare-ups.
• Hormonal changes: Hormonal fluctuations, particularly during puberty or menopause, can influence psoriasis.
• Alcohol and smoking: These lifestyle factors are associated with increased severity of psoriasis.

Symptoms

Scalp psoriasis symptoms can vary in intensity and presentation, with common signs including:

• Red patches on the scalp: Areas of skin inflammation, often covered with thick, silvery scales.
• Itching and discomfort: Persistent itchiness, which can lead to scratching and further irritation.
• Dry scalp and flaking: Dandruff-like flaking is common but more severe in psoriasis.
• Bleeding: Scratching the affected areas may cause bleeding.
• Temporary hair loss: Hair loss may occur due to excessive scratching or from treatments but usually regrows after flare-ups subside.
• Crusting and soreness: Severe cases can cause painful thick crusts on the scalp.

Diagnosis

Scalp psoriasis is usually diagnosed through clinical examination. Diagnostic steps may include:

• Medical history: Discussion of symptoms, family history, and triggers.
• Physical examination: A dermatologist examines the scalp and other areas of the skin for typical psoriatic plaques.
• Skin biopsy: In uncertain cases, a small sample of skin may be taken for microscopic examination to rule out other skin conditions such as seborrheic dermatitis or fungal infections.

Treatment

While there is no permanent cure for scalp psoriasis, various treatments help manage symptoms and control flare-ups:

• Topical treatments: Medicated shampoos, corticosteroid lotions, tar-based shampoos, salicylic acid, and vitamin D analogues like calcipotriol.
• Phototherapy: Light therapy using ultraviolet B (UVB) light can help improve scalp psoriasis in some cases.
• Systemic medications: In moderate to severe cases, oral or injectable treatments like methotrexate, cyclosporine, or biologic drugs (e.g., adalimumab, secukinumab) may be prescribed.
• Biologic therapies: These target specific parts of the immune system to reduce inflammation and are often used in severe or resistant cases.
• Moisturizers: Regular use of emollients helps reduce dryness and flaking.
• Lifestyle changes: Stress reduction, smoking cessation, and minimizing alcohol intake can help reduce flare-ups.

Prognosis

Scalp psoriasis is a chronic condition that can come and go throughout a person’s life. The prognosis is generally manageable with proper treatment:

• Chronic nature: While incurable, many people can control symptoms effectively with treatment.
• Flare-up control: Early treatment and trigger management help reduce the frequency and severity of flare-ups.
• Hair regrowth: Hair typically regrows after flare-ups resolve, especially if damage from scratching is minimized.
• Individual variability: Some individuals may experience long periods of remission, while others may have persistent symptoms.
• Quality of life: With modern therapies, most people with scalp psoriasis can lead a normal life with minimal disruption from symptoms.

Regular follow-up with a dermatologist and adherence to treatment plans can greatly improve long-term outcomes in scalp psoriasis.