Don’t fear your flakes

| Emily Delzell

When Caroline Sills was 7 years old, a dermatologist diagnosed her with scalp psoriasis. He told her her treatment — using a medicated shampoo — would be simple and painless.

He told her he used it himself and bent down to show her his flake-free hair. But with his clean hair came an odor. Smelling the coal tar, she said, “But your hair stinks,” then burst into tears.

Since that time, things have changed dramatically. Sills is now 48 and controls her scalp psoriasis with occasional topical steroid applications and frequent swims in the ocean where she lives in Virginia Beach, Virginia. For other patients, dermatologists have a raft of therapeutic options — most far less odorous than coal tar — and getting appropriate care for scalp psoriasis is the first step toward healthier, better-looking hair, said Dr. Kristina Callis Duffin, associate professor of dermatology at the University of Utah in Salt Lake City.

“We have many options, from medicated shampoos to foams, oils and ointments, to systemic medications to laser therapy,” she said.

In addition, handheld ultraviolet B (UVB) combs deliver narrowband light to the scalp. The devices, which are often covered by insurance and have an inset comb to part hair to better deliver light therapy, are generally not the best option when the entire scalp is affected, but they can be useful for some people, said Duffin.

Once you and your doctor have identified the right medical prescription for your needs, finding a hair care routine that works for you — and a knowledgeable stylist — can help you make (most) bad hair days a thing of the past.

Find a savvy stylist

The right stylist, said master hairdresser Fran Klapow, is sensitive to your scalp condition and savvy enough to create a cut that highlights your hair’s natural good looks, while at the same time camouflaging issues you don’t want to expose.

“If you can get a recommendation from a friend with psoriasis, start there,” said Klapow, who works in a salon on Long Island, New York, and has scalp psoriasis. “If you’re starting from scratch, call a salon you’re interested in and ask if they have someone who understands psoriasis and who can be sensitive to your needs. Keep looking until you find someone who’s comfortable and fun to work with.”

Finding the right person may take time, but it’s worth the search, as an experienced stylist likely has had many clients with scalp psoriasis and will know how to work with your needs, Klapow said.

Phyllis Detwiler, 58, of Newport, Rhode  Island, found such a stylist, someone who is not fazed by her scalp psoriasis.

“My stylist says she has seen everything, even though, at times, my scalp psoriasis has been shockingly bad — painful, itchy and falling like a snowstorm,” Detwiler said. “But she’s well versed in my issues and says she has a large percentage of clients with psoriasis.”

Karen Abell, 57, of Jacksonville, Florida, said it took her a year to feel comfortable in a salon, but she finally found a stylist she’s happy with. She has had scalp psoriasis for 40 years, at times so severe that a simple shampoo caused painful bleeding. In the past, a visit to the salon often resulted in whispered conversations among employees and embarrassment for Abell. Today, however, she said stylists seem to take her scalp condition in stride.

Detwiler and Abell both wear their hair fairly long to cover flares.

“My medications control my scalp psoriasis most of the time, and I can even wear my hair up,” said Detwiler. “But I always keep it long enough so I have the option of covering my ears and neck. When I’m flaring, I wear paler colors and, in the winter, light-colored, patterned scarves to hide flakes.”

Klapow said men with scalp psoriasis might consider a little more length as well.

“When you cut your hair close to the scalp, you can see everything — and if you’ve got the confidence to wear it, that’s great!” she said. “If not, slightly longer styles can cover problem areas.”

Use chemicals with caution

Any chemical process, whether it’s color, permanent curling or straightening services such as a Brazilian blowout, can cause irritation in people with scalp psoriasis. But it’s not only those with scalp psoriasis who can be sensitive to chemical treatment, said Duffin. “These chemicals can cause reactions even in people without psoriasis,” she said.

It’s hard to predict which products will cause a reaction in an individual because there are so many different products and they all have different formulations.

“If something burns during the process, or causes irritation later, ask your stylist to try a different product,” Duffin said. “Some organic hair dyes may be less irritating, although it’s important to remember that people can be sensitive to anything, whether it’s ‘natural’ or not.”

Duffin also cautions against anyone getting Brazilian blowouts, which use liquid keratin, a preservative solution, and a hair iron to straighten hair. The problem here isn’t psoriasis but the use of formaldehyde in some of these preparations. The additive can cause nausea, chest pain, vomiting and other problems.

Hair dye can also be an issue, as dyes can leave color on psoriatic scalp plaques, said Klapow. But she added that some people with scalp psoriasis may still be able to color their hair.

“To remove color [from lesions], apply oil to the affected area and massage, which will take off color and also help to gently remove scales,” she said.

Baby oil, coconut oil and prescription products in an oil base — as long as you aren’t allergic to them — all work for this treatment, Duffin said.

Hair care at home

Although the coal tar shampoos commonly used when 7-year-old Caroline Sills got her first whiff of them more than 40 years ago aren’t used as often today, medicated products for scalp psoriasis can still leave behind a subtle, unpleasant odor.

Medicated shampoos aren’t designed to clean hair but rather to treat the scalp, said Klapow, who found it especially difficult as a hairstylist to use products that left her long, thick hair dried out and dull.

To counter that, she developed a technique she now recommends to clients with scalp psoriasis. The method can remove most of the medicated odor and leave hair soft and shiny.

“After treating your scalp with your medicated product, apply your favorite shampoo to the ends of hair and work up a lather, moving it up your hair about an inch from the scalp,” she said. “Rinse. Repeat the process with a good conditioner.”

She said the process takes a little more time than simply shampooing, but “your hair will smell and look good. Even though you have psoriasis, you can treat your hair like hair — and yourself to nice products.”

Learn more about managing your scalp psoriasis

Watch our webinar, "Dare to wear black by managing your scalp psoriasis," to learn tips and tricks on handling your flakes. 

Discover the Seal of Recognition

The National Psoriasis Foundation’s Seal of Recognition product categories include personal care, household items, fabrics, mobility and supplements. The program highlights over-the-counter products that have been created or are intended to be non-irritating and safe for people with psoriais and PsA, as well as individuals living with severe sensitive skin or joint mobility limitations. Visit the full product directory.

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For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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