How is it treated?
Many treatment options can help control scalp psoriasis and its symptoms. Sometimes scalp psoriasis will clear on its own (a spontaneous remission), or it can remain on the scalp for long periods of time.
It is important to select scalp treatments that are agreeable to you. Treatments should never be worse than the psoriasis itself. Consider your lifestyle, available time and the cost to help you decide among the options.
Tar products and salicylic acid are generally sufficient for treating very mild scalp psoriasis. More severe scalp psoriasis may require persistence and experimentation to find an effective treatment plan. Treatments include topical medications (applied to the skin) and occasionally ultraviolet (UV) light. Treatments are often combined and rotated because a person's psoriasis can become resistant to medications after repeated use. Systemic (oral or injected) psoriasis treatments are not commonly used just for scalp psoriasis, but they may be tried if psoriasis is present elsewhere on the body and/or the psoriasis is severe.
Treatment schedules
Scalp treatments must be repeated until you get adequate control of your lesions. This can take up to eight weeks or longer.
Once you achieve clearing, or a level of acceptable clearing, you may be able to keep psoriasis from coming back by using a tar shampoo or other medicated shampoo daily or twice a week. Moisturizing the scalp may also help.
Tar products
Tar products, usually available without a prescription, are widely used to treat scalp psoriasis. You will be able to find over-the-counter (OTC) tar shampoos, creams, gels, oils, ointments and soaps. Tar also can be prescribed by your doctor in a variety of strengths. It may be used as a single treatment or in combination with other treatments.
While tar is an effective medication, it can stain bedding and gray or white hair, and has a strong odor.
There are two kinds of tars: coal tar and wood tar. Coal tar is the most common form for treating psoriasis, but some wood tar products, especially soaps (such as Grandpa's Pine Tar soap), can treat scalp psoriasis. Soaps are less expensive and typically last longer than shampoos.
Coal tar is available in OTC products in concentrations from 1% to 5%, although higher concentrations are sometimes prescribed. Refined coal tars, such as liquor carbonis detergens, commonly referred to as LCD, have less of an odor and may cause less staining. Unfortunately, refined tars are not as strong, and may be harder to find.
How do you use tar on the scalp?
Massage tar shampoo into the scalp and leave it on for about five minutes before rinsing it off to allow for maximum absorption of the tar. Shampoo or conditioner can reduce the smell of the tar shampoo and make the hair more manageable.
Tar gels, creams, solutions and lotions can be massaged into the scalp and left on overnight. These tar products are used for psoriasis on other parts of the body as well.
Effectiveness will vary for each person. Tests have shown tar shampoos to be superior to shampoos without tar in treating scaling.
Topical steroids
Topical corticosteroid medications (steroids) can be effective against scalp psoriasis. These prescription medications come in solutions, gels, creams, lotions, sprays, ointments and foam.
Topical steroids range from very mild to very strong (potent). Normally, strong steroids can be used safely for scalp psoriasis, but they should not be used continuously for long periods of time. A two-week cycle of treatment is commonly recommended for strong steroids. In addition, they should not be used under a dressing or covering (occlusion). Follow your doctor's instructions carefully.
Abruptly stopping steroid treatments can cause a rebound (worsening, if stopped too quickly) flare of psoriasis. Slowly reducing the use of steroids can help avoid a rebound flare. Do not use steroid preparations on your face and other sensitive skin areas, such as under the breasts and genitals, unless directed by your doctor. Avoid getting steroids in your eyes.
Several topical steroid prescription medications are designed specifically for treating scalp psoriasis. These formulas are water- and alcohol-based, which makes it easier to wash them out after treatment.
Cormax Scalp Application, Clobex Shampoo, Temovate Scalp Application and Olux are four scalp products that contain clobetasol propionate, one of the strongest topical steroids. Clobetasol propionate can be very effective in clearing psoriasis.
Olux and Luxiq are foam-based prescription scalp medications that contain steroids. Foam-based applicators resemble styling mousse cans. The foam turns into liquid when applied to the skin and is absorbed quickly, leaving little residue.
Some scalp psoriasis cases become resistant to topical steroids. If this happens, you can switch to other scalp treatments, such as anthralin, Dovonex, Tazorac or tar. It can take several months before topical steroid medications will work again for skin that has become resistant.
Intralesional steroid scalp injections
Sometimes doctors inject scalp lesions with steroid medications. This is done only when the scalp psoriasis is mild and involves a few areas. It would not be appropriate to inject many plaques. Steroid injections are given sparingly because the medication can be absorbed into the system.
Anthralin
Anthralin is an older, prescription medication that may work for some people with scalp psoriasis. The typical use of anthralin for scalp treatment is 30 minutes with either 0.25% or 0.5% anthralin. Anthralin can be left on the scalp for as little as 10 minutes and then washed off. Higher concentrations are applied for shorter periods of time. This is called Short Contact Anthralin Therapy, or SCAT.
Anthralin can stain the skin and can cause irritation in some people. Remove anthralin from the scalp by rubbing the shampoo toward the back of the head to avoid getting anthralin on your forehead or in your eyes.
Psoriatec is the brand name of a 1% anthralin cream that may limit staining because the medication is released from tiny capsules only at skin temperature. Rinse Psoriatec from the scalp, clothing, towels or bathroom fixtures with cool or lukewarm water to prevent these capsules from breaking down; this may prevent the staining and irritation usually associated with anthralin.
CuraStain (available through a pharmacist as triethanolamine) is a product that may help control the staining associated with anthralin.
Dovonex
Dovonex (also known by its generic name calcipotriene) is a prescription topical vitamin D3 derivative that comes in a water- and oil-based scalp solution. After applying Dovonex at night, cover the scalp with a shower cap or plastic bag before going to bed. Confine Dovonex to the scalp because it irritates unaffected skin, particularly the face. You may wish to test a small area before applying it to the entire scalp. Avoid contact with your eyes.
Tazorac
Tazorac (also known by its generic name tazarotene) is a topical vitamin A derivative that comes in a cream or gel form for the treatment of psoriasis. The gel absorbs more rapidly than the cream, while the cream may be less irritating for people with dry or sensitive skin.
Apply Tazorac in a thin film to lesions on the scalp or hairline. The medication may dry out the skin; to reduce irritation, apply moisturizers 30 minutes before Tazorac is used. However, the skin should be dry when treated. Tazorac is safe to use on your face, but it should not be applied around the eyes. Do not cover treated skin.
Overnight application of Tazorac is recommended. Let the medication air dry on the scalp before going to bed, so you don't spread it on your pillow and face as you sleep.
Antimicrobial therapy
Scalp psoriasis can get worse if the scalp becomes infected with bacteria or yeast. If crusting of the scalp along with scaling occurs and/or the lymph nodes in your neck are enlarged, your doctor may prescribe antimicrobial treatment. Mild scalp psoriasis also may respond to treatment with antifungal shampoos such as Nizoral, a prescription shampoo that helps reduce yeast organisms. It may require the use of an antifungal shampoo once or twice a week to maintain results.
Ultraviolet light
Hair blocks UV light treatments from reaching the scalp. However, better results can be achieved with conventional UV units if you part your hair in many rows, if you have very thin hair or if you shave your head. Hand-held devices called UV combs are available to deliver a higher intensity of UV light. Natural sunlight may also help if the hair is very thin or the head is shaved.
See phototherapy and sun and water therapy for more information.
Medicated shampoos
Many coal tar and non-coal tar medicated shampoos for treating scalp lesions are on the market (click here for listing). Leave shampoos on the scalp as directed and rinse them out thoroughly.
Remember, medicated shampoos are designed for the scalp, not the hair. You may want to use a regular cosmetic shampoo or conditioner after your scalp treatment to reduce the smell of the medicated shampoo and make your hair more manageable.
Systemic treatments for psoriasis
If moderate to severe psoriasis is present on other skin sites in addition to the scalp, your doctor may prescribe systemic psoriasis medications (medications that are taken by mouth or injection). The most common include methotrexate, oral retinoids, cyclosporine and biologic medications. They may help clear scalp psoriasis, and are only appropriate for very severe cases.
Systemic psoriasis medications have side effects that must be weighed in relationship to their benefits. Hair loss can be a side effect of certain systemic psoriasis treatments. Ordinarily, the hair will grow back when the medication is stopped.
Updated October 2005
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