In many cases, a physical exam is all it takes.
If you think you may have scalp psoriasis—a subtype of plaque psoriasis—getting an official diagnosis is so important, even if your symptoms seem mild and “not a big deal.” Not only can psoriasis affect your quality of life, but it may also be affecting your body in ways you might not realize.
“Psoriasis is really a systemic condition,” says Michelle Henry, MD, dermatologist in New York City and clinical instructor at Weill Cornell Medical College. That means that even though scalp psoriasis manifests on the skin of the scalp and neck, it can cause inflammation throughout the rest of the body. Somewhere between 10 and 30 percent of people with psoriasis also end up developing psoriatic arthritis—when the immune system starts to affect the joints as well.
That’s why getting an accurate diagnosis is essential: to begin treatment, reduce inflammation throughout the body, and prevent the condition from worsening or causing complications of psoriasis.
Here’s what a doctor may do to diagnose scalp psoriasis:
Skin examination: Many times, scalp psoriasis and other types of psoriasis can be diagnosed purely from a physical examination. A primary care doctor or a dermatologist can do a full skin examination to look for evidence of inflammation, silvery scale, and plaques.
Skin biopsy: In some cases, a physician may use a biopsy to diagnose psoriasis and differentiate it from a fungal infection, for example.
Screening for psoriatic arthritis: When any type of psoriasis is expected, it’s encouraged for physicians to assess your joint health. Catching psoriatic arthritis early can help control the progression of the disease and may impact which treatment is best for you. This screening will likely include questions about joint pain, back pain, and morning stiffness.
If you are diagnosed with scalp psoriasis, other types of psoriasis, or psoriatic arthritis, you can begin treatment to get your symptoms under control. Learn more about treatment options for scalp psoriasis here.
“The outlook [for scalp psoriasis] is quite good if you’re with someone who understands psoriasis and is comfortable with walking up the therapeutic ladder,” says Dr. Henry. “We live in a really great time where we can find a treatment that works for you.”
Dr. Henry is a board-certified dermatologist and dermatologic surgeon in New York City, and a clinical instructor at Weill Cornell Medical College.
00:00:01.533 --> 00:00:02.466
00:00:02.467 --> 00:00:06.499
Psoriasis is a chronic, autoimmune, inflammatory condition
00:00:06.500 --> 00:00:08.932
that manifests with thick, scaly plaques.
00:00:08.933 --> 00:00:11.532
We often see psoriasis in families,
00:00:11.533 --> 00:00:16.099
but it can also be triggered by infections, certain medications,
00:00:16.100 --> 00:00:18.966
so it is a pretty complex condition.
00:00:18.967 --> 00:00:25.166
00:00:25.167 --> 00:00:28.499
The most common variant of psoriasis is plaque-type psoriasis.
00:00:28.500 --> 00:00:30.866
Those are big, thick plaques that cover
00:00:30.867 --> 00:00:35.766
oftentimes the elbows, the knees, the chest, really anywhere.
00:00:35.767 --> 00:00:38.966
If someone is noticing that they have thick, adherent scale
00:00:38.967 --> 00:00:42.966
to the scalp, especially if it has a quite inflamed base,
00:00:42.967 --> 00:00:44.366
you could have psoriasis.
00:00:44.367 --> 00:00:47.066
If your scale is worsening and not getting better
00:00:47.067 --> 00:00:51.099
with standard dandruff shampoos, you could potentially have psoriasis.
00:00:51.100 --> 00:00:54.299
Sometimes with psoriasis, you could have such robust inflammation
00:00:54.300 --> 00:00:57.232
and sometimes even itch, that that can lead to hair loss.
00:00:57.233 --> 00:01:01.266
Those are all reasons why you should seek out professional care.
00:01:01.267 --> 00:01:03.499
Psoriasis really affects one's quality of life.
00:01:03.500 --> 00:01:06.399
A lot of my patients complain that it's even hard to go to work
00:01:06.400 --> 00:01:09.166
because their scale is falling everywhere.
00:01:09.167 --> 00:01:12.499
We're kind of in the era of these kind of group-work environments,
00:01:12.500 --> 00:01:13.832
and when you're in that space,
00:01:13.833 --> 00:01:16.099
and you're littering your environment with scale,
00:01:16.100 --> 00:01:18.499
it can make it quite difficult to work,
00:01:18.500 --> 00:01:20.932
and it can be a little bit embarrassing to discuss.
00:01:20.933 --> 00:01:24.499
Psoriasis is really a systemic condition, so although it manifests
00:01:24.500 --> 00:01:27.599
on the scalp, you can also have psoriatic arthritis,
00:01:27.600 --> 00:01:30.332
and so really making sure you have the right diagnosis
00:01:30.333 --> 00:01:32.932
will help you pay attention to your body and pay attention
00:01:32.933 --> 00:01:35.932
to any other changes, so if you have early psoriatic arthritis,
00:01:35.933 --> 00:01:38.632
you can treat it early, before you sustain any damage.
00:01:38.633 --> 00:01:40.232
We live in a wonderful time.
00:01:40.233 --> 00:01:42.032
We have lots of treatments.
00:01:42.033 --> 00:01:47.366
Rare is the case that we can't improve, if not control quite well,
00:01:47.367 --> 00:01:48.932
so the outlook is quite good.
00:01:48.933 --> 00:01:53.232
We can find a treatment that works for you, most of the time.
00:01:53.233 --> 00:01:57.233
Psoriasis: epidemiology, clinical manifestations, and diagnosis. Waltham, MA: UpToDate, 2020. (Accessed on February 26, 2020 at https://www.uptodate.com/contents/psoriasis-epidemiology-clinical-manifestations-and-diagnosis.)
Statistics. Portland, OR: National Psoriasis Foundation. (Accessed on February 26, 2020 at https://www.psoriasis.org/content/statistics.)
Treatment of psoriasis in adults. Waltham, MA: UpToDate, 2020. (Accessed on February 26, 2020 at https://www.uptodate.com/contents/treatment-of-psoriasis-in-adults.)