Plaque psoriasis—which creates thick, scaly plaques on the skin—is the most common type of psoriasis: It accounts for over 80 percent of psoriasis cases, according to the National Psoriasis Foundation. One subtype of plaque psoriasis is scalp psoriasis, which is when plaques form predominantly on the scalp and neck.
Scalp psoriasis can be mild, causing fine scales with a silvery sheen, or it can be more severe, covering much of the scalp with thick plaques. The best treatment for scalp psoriasis depends on how severe your psoriasis is, how much surface area your scalp psoriasis is covering, and even your tolerance of certain side effects.
Topical Treatments for Scalp Psoriasis
“Probably the first and most common treatment [for scalp psoriasis] is to use a topical steroid,” says Michelle Henry, MD, dermatologist in New York City and clinical instructor at Weill Cornell Medical College. “Those topical steroids help to reduce that inflammation that causes the psoriasis.”
Steroid treatments can be very effective against symptoms of inflammation by reducing the immune response. Psoriasis is an autoimmune disease, which means it occurs when the immune system attacks the body’s skin, mistaking it as a foreign threat. These constant attacks lead to chronic inflammation, which manifests as red, itchy plaques on the skin. Topical steroids help reduce the inflammation and the appearance of plaques.
Other topical treatments for scalp psoriasis include:
Vitamin D analogs: Not to be confused with vitamin D supplements, these analogs help slow down the skin cell turnover that leads to psoriasis plaques.
Salicylic acid: This ingredient can be added to prescription medications or over-the-counter (OTC) products to break up and soften difficult-to-penetrate plaques.
Coal tar: This is another ingredient used in prescription and OTC products for psoriasis. “Coal tar has been used for centuries. It's probably one of the first documented treatments of psoriasis,” says Dr. Henry. “We still don't understand a lot about how it works, but we know that it's a quite effective anti-inflammatory agent.”
And medicated shampoos: These special shampoos often contain ingredients like coal tar or salicylic acid, among other ingredients known to help with psoriasis symptoms.
Of course, the thought of topical treatments to your scalp and hairline may lead to some valid questions: How do you apply thick creams to the scalp when your hair is in the way? Does it make the hair greasy? Does it weigh down the hair?
“Some of the treatments can stain the hair, and it can be a little bit cumbersome,” says Dr. Henry. “Some patients complain [that] maybe the treatments aren't as elegant as they'd like, that it doesn't allow them as much flexibility as they would like in styling.”
Non-Topical Treatments for Scalp Psoriasis
“If the topical treatments aren't working, we'll use oral medications if we need to, and we’ll use biologic medications if we need to,” says Dr. Henry.
Oral and biologic medications for psoriasis are systemic treatments, meaning they help clear plaques and psoriasis symptoms throughout the entire body. These are commonly used when someone has plaques covering an extensive area of the body, but they may also be used for severe scalp psoriasis if someone is not responding to topical treatments.
“We live in a really great time where we can find a treatment that works for you, most of the time,” says Dr. Henry. “Rare is the case when we can't improve, if not control quite well, so the outlook is quite good.”