Scalp Psoriasis: A Complete Guide to Relief.

What Is Scalp Psoriasis?

Scalp psoriasis is a chronic autoimmune skin condition that causes red, raised, and scaly patches on the scalp, often accompanied by itching, flaking, and discomfort. It is not contagious but can be persistent and distressing.

Key Features

• Appearance: On lighter skin, well-defined patches or plaques have silvery-white scales; on darker skin, patches appear purple or brown with grey scales.
• Location: Can affect part or all of the scalp, sometimes extending to the forehead, neck, or behind the ears.
• Symptoms: Itching, burning, soreness, dandruff-like flaking, and in severe cases, temporary hair shedding (not permanent hair loss).
• Chronic nature: It tends to flare up and subside in cycles, often triggered by stress, infections, cold weather, or certain medications.

Underlying Cause

• Immune system dysfunction: The body’s immune system mistakenly speeds up the skin cell cycle, causing a rapid buildup of skin cells that form thick plaques.
• Genetic predisposition: Family history of psoriasis increases risk.
• Not contagious: You cannot “catch” scalp psoriasis from another person.

Diagnosis

• Clinical examination: Dermatologists usually diagnose it by examining the scalp.
• Differential diagnosis: Must be distinguished from seborrheic dermatitis (dandruff), fungal infections, or eczema, which can look similar.

Treatment Options

• Topical therapies: Medicated shampoos (coal tar, salicylic acid, ketoconazole), corticosteroid lotions, and vitamin D analogues.
• Phototherapy: Controlled UV light exposure in resistant cases.
• Systemic treatments: For severe or widespread psoriasis, oral or injectable medications (like methotrexate, cyclosporine, or biologics) may be prescribed.
• Supportive care: Gentle scalp care, avoiding harsh scratching, and using emollients to reduce dryness.

Self-Care & Prevention Tips

• Use fragrance-free, medicated shampoos regularly.
• Avoid scratching or forcefully removing scales, which can worsen irritation.
• Manage stress, as it is a common trigger.
• Protect the scalp from cold, dry weather and excessive sunburn.
• Maintain a healthy lifestyle (balanced diet, reduced alcohol, no smoking) to reduce flare-ups.

Quick Comparison: Scalp Psoriasis vs. Dandruff

• Because autoimmune rapid skin turnover—overgrowth of yeast (Malassezia) + oily skin
• Appearance: Thick, raised plaques with silvery/grey scales—greasy, yellowish flakes without thick plaques
• Itching: Often intense, with soreness—mild to moderate
• Chronicity: long-term, relapsing. Can be controlled more easily

Common Signs and Symptoms

• Plaques and scales: Raised, inflamed patches covered with silvery-white scales (on lighter skin) or grey/purple scales (on darker skin).
• Itching and irritation: Often intense, leading to scratching that can worsen inflammation or cause bleeding.
• Flaking: White or silvery flakes resembling dandruff, but usually thicker and more adherent.
• Dryness and tightness: The scalp may feel dry, sore, or tight.
• Burning or soreness: Some people experience pain or a burning sensation.
• Hair shedding: Temporary hair loss may occur due to scratching or inflammation, but psoriasis itself does not cause permanent baldness.
• Spread beyond scalp: Lesions may extend to the forehead, back of the neck, or behind the ears.

How It Differs from Dandruff

• Scale type: Thick, silvery/gray, adherent–Loose, greasy, yellowish
• Plaques: Well-defined, raised patches—Diffuse flaking without thick plaques
• Symptoms: Itching, soreness, burning —Mild itching, no pain
• Chronicity: long-term, relapsing; often improves with medicated shampoo

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Scalp psoriasis causes

Scalp psoriasis is caused by an overactive immune system that triggers skin cells to multiply too quickly, leading to thick, scaly patches on the scalp. Genetics, immune dysfunction, and environmental triggers all play a role. It is not contagious.

Core Causes

• Immune system dysfunction:
• Psoriasis is an autoimmune condition.
• The immune system mistakenly signals skin cells to reproduce in days instead of weeks, causing a buildup of thick plaques.

Genetic predisposition:

• Having a family history of psoriasis increases risk.
• Certain genes linked to immune regulation are more common in people with psoriasis.

Inflammatory pathways:

Overproduction of cytokines (immune messengers like TNF-α, IL-17, and IL-23) drives inflammation and rapid skin turnover.

Triggers That Can Worsen or Activate Scalp Psoriasis

• Stress: Emotional or physical stress can trigger flare-ups.
• Infections: Especially strep throat, which is linked to psoriasis flares.
• Weather: Cold, dry climates often worsen symptoms.
• Medications: Beta-blockers, lithium, antimalarials, and some anti-inflammatory drugs may trigger or aggravate psoriasis.
• Skin injury (Koebner phenomenon): Scratches, cuts, or burns on the scalp can lead to new lesions.
• Lifestyle factors: Smoking, heavy alcohol use, and obesity are associated with more severe disease.

Why It’s Different from Dandruff

• Psoriasis: Autoimmune-driven and chronic, with thick plaques and silvery scales.
• Dandruff (seborrheic dermatitis): Caused by yeast overgrowth and oily skin, with greasy, yellowish flakes.

How do I make my scalp psoriasis go away?

Scalp psoriasis cannot be permanently “cured,” but it can be effectively managed and controlled with the right combination of medical treatments, lifestyle adjustments, and self-care. The goal is to reduce inflammation, clear plaques, relieve itching, and prevent flare-ups.

Medical Treatment Options

The video explains what not to do during scalp psoriasis

• Topical therapies (first-line):
• Medicated shampoos with coal tar, salicylic acid, or ketoconazole help reduce scaling and flaking.
• Topical corticosteroids (lotions, foams, and gels) reduce inflammation and itching.
• Vitamin D analogs (calcipotriol) and topical retinoids (tazarotene) slow skin cell growth.
• Phototherapy: Controlled exposure to UV light can help in resistant cases.
• Systemic medications (for severe cases):
• Oral drugs like methotrexate, cyclosporine, or acitretin.
• Biologic injections (e.g., adalimumab, secukinumab, ustekinumab) target specific immune pathways.
• These are usually prescribed when topical treatments fail or disease is widespread.

Home & Self-Care Strategies

• Gentle scalp care: Use mild, fragrance-free shampoos; avoid harsh scratching or picking at scales.
• Moisturise: Apply coconut oil, olive oil, or mineral oil to soften plaques before shampooing.
• Warm compresses: Help loosen thick scales for easier removal.
• Stress management: Meditation, yoga, or relaxation techniques can reduce flare-ups.
• Avoid triggers: Cold weather, infections, smoking, and alcohol can worsen psoriasis.
• Healthy lifestyle: Balanced diet, regular exercise, and good sleep support immune balance.

When to See a Doctor

• If itching, pain, or flaking interferes with daily life.
• If plaques spread beyond the scalp or worsen despite home care.
• If there are signs of infection (redness, pus, swelling).
• If you need systemic or biologic therapy for severe disease.
• If over-the-counter shampoos or treatments don’t improve symptoms.

Scalp psoriasis treatment

Scalp psoriasis has no permanent cure, but it can be managed effectively with a combination of medicated shampoos, topical treatments, light therapy, and—if severe—systemic or biologic medications. The goal is to reduce inflammation, clear plaques, relieve itching, and prevent flare-ups.

Phototherapy:

• Controlled UVB light therapy can be used when topical treatments are insufficient.
• Special comb devices allow light to penetrate through hair to the scalp.
• Systemic medications (for moderate to severe cases):
• Oral drugs: methotrexate, cyclosporine, and acitretin.
• Biologic injections: adalimumab, etanercept, secukinumab, and ustekinumab—these target specific immune pathways (TNF-α, IL-17, and IL-23).
• These are reserved for patients with widespread or resistant disease

Conclusion

• Scalp psoriasis develops from a combination of immune system overactivity, genetic susceptibility, and environmental triggers. While the exact cause isn’t fully understood, managing triggers and treating inflammation are central to controlling the condition.
• You can’t make scalp psoriasis “go away” permanently, but you can keep it under control. Most people achieve long-term relief with a combination of medicated shampoos, topical treatments, and lifestyle adjustments.  Severe cases may require systemic or biologic therapies under a dermatologist’s supervision.