Scalp Psoriasis – Diagnosis and Treatments
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Scalp Psoriasis – Diagnosis and Treatments

Psoriasis is an auto-immune disease which affects around 2% of people in the UK, with many of these particularly affected by scalp psoriasis. The condition occurs when skin cells grow too quickly in response to a faulty signal from the body’s immune system. The excess skin accumulates as red or purple patches, sometimes accompanied by silvery scales.

More than 50% of psoriasis sufferers get lesions on the scalp. The excess skin can flake off, causing dandruff and broken skin. There is currently no known cure, although treatments to reduce symptoms are available.

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Symptoms

Scalp psoriasis usually manifests in hard, flaky plaques across the scalp and hairline. They can be extremely itchy, or you may barely feel them.

You may have scalp psoriasis if you notice any of these symptoms:

  • Red or purple areas with white or silver scales — skin discoloration and hardening is the most common sign of scalp psoriasis
  • Dandruff — the dry skin or scales can flake off to cause dandruff, especially if your psoriasis is particularly itchy
  • Itchiness — itchy dry patches can lead to broken skin and bleeding if scratched too much
  • Pain — some people experience soreness and tightness with their scalp psoriasis

Causes of scalp psoriasis

Psoriasis is more common in people with a family history of the condition. So if a close relative has psoriasis, you may be more likely to experience it yourself.

Other people experience psoriasis as a result of a faulty immune response. T-cells, which the body’s immune system uses to protect you from infection, can sometimes attack healthy cells by mistake. This causes the body to rapidly produce more skin cells, which manifest as the common psoriasis patches.

Common triggers

Scalp psoriasis is a chronic condition. That means if you’re predisposed to scalp psoriasis, either due to your genetics or an autoimmune condition, you may experience flare ups for the rest of your life. Flare ups usually occur if you’re exposed to one of your psoriasis triggers.

Knowing what your psoriasis triggers are can help you manage the condition. Common triggers include:

  • Injury to the skin, such as a cut, scrape, insect bite or sunburn – known as the Koebner response
  • Drinking excessive amounts of alcohol
  • Smoking
  • Stress
  • Hormonal changes, particularly in women – for example, during puberty and the menopause
  • Certain medicines – such as lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, and ACE inhibitors (used to treat high blood pressure)
  • Throat infections – in some people (mostly children and young adults) a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection. However, most people who have streptococcal throat infections don’t develop psoriasis
  • Other immune disorders, such as HIV, which cause psoriasis to flare up or appear for the first time

Impact of scalp psoriasis

While scalp psoriasis can be irritating and sore, it is usually a benign condition. Most cases can be managed with medication, topical treatments, and lifestyle changes.

In severe cases, scalp psoriasis can lead to hair loss. If you’re worried this may be affecting you, speak to a dermatologist or trichologist to discuss potential treatment options.

Scalp psoriasis can also have a psychological effect on those affected by it. The visible signs of psoriasis (such as red patches and dandruff) can cause embarrassment and anxiety. In severe cases, this can lead to social isolation and depression. Mental health support is available to people with psoriasis.

How long does scalp psoriasis last?

With treatment, it can take more than 8 weeks for your skin to heal after a flare up of scalp psoriasis. Visit a dermatologist or trichologist to get the right treatment for your condition to improve the chances of fast healing and recovery.

Will scalp psoriasis go away on its own?

There’s currently no cure for psoriasis, but most people can manage the symptoms and triggers to minimise the impact on their life.

Your psoriasis may not disappear forever, but there are things you can do to reduce outbreaks and manage pain or itchiness.

Treatments

There are a number of treatment options to help you manage your scalp psoriasis. Consult with a dermatologist or trichologist to find out which is the best option for you.

Topical treatments

The first port of call for most people with scalp psoriasis is topical treatments. This includes creams, ointments and scale softeners that can reduce redness, flaking and itchiness.

Doctors usually prescribe one or more of the following:

  • Emollients — creams that create a protective barrier over the skin, helping retain moisture and reduce itchiness
  • Steroid creams — treatments that slow the development of new skin cells to reduce inflammation and itching
  • Calcineurin inhibitors — reduce immune activity to slow the development of new skin cells, usually if steroid creams are ineffective
  • Other medicated creams and ointments

Therapies

Phototherapy is another effective technique for treating psoriasis. This involves exposing the affected areas to artificial light to improve your symptoms. Sometimes this is prescribed in combination with topical or medical treatments.

Effective types of phototherapy include:

  • UVB phototherapy — invisible ultraviolet B light is directed at the scalp for a few minutes to reduce skin cell production
  • PUVA phototherapy — ultraviolet A light therapy is combined with a dose of psoralen, which helps make your skin more sensitive to light

It’s important to note that there are certain side effects associated with phototherapy. This includes nausea, headaches, and burning. Discuss any concerns you have with your doctor before you start the therapy.

Medication

Your doctor may recommend oral or injected medications your condition is severe, or hasn’t responded to other types of treatment. Oral treatments include immunosuppressants, retinoids and anti-inflammatories to reduce the symptoms of scalp psoriasis. Injections are usually drugs that target overactive immune system cells to prevent them from producing too many cells.

There are potentially serious side effects to many of these treatments, so make sure to discuss any risks with your doctor beforehand. This is especially important if you’re pregnant or planning to try for a baby soon.

Support for those suffering from scalp psoriasis

Scalp psoriasis can be very distressing, and can take a toll on your mental health. If you’re feeling low as a result of your condition, there is support available to you.

  • Support groups — the Psoriasis Association runs online support groups specifically for sufferers of psoriasis
  • Therapy — CBT or other talking therapies can help you manage anxiety or depression stemming from psoriasis
  • Trichologist consultation — a hair loss consultant can help you understand your triggers and help you find the right treatment path

Should you see a trichologist for scalp psoriasis?

Visiting a trichologist at an experienced hair loss clinic can help you manage your condition. A trichologist will understand the emotional impact of psoriasis, and can offer practical helpful advice as well as treatment.

If you’re worried about your scalp psoriasis and you want to speak to a hair and scalp specialist, book a consultation with a trichologist. They can fully diagnose your condition and discuss a plan to manage it with you.

Sources

  1. Psoriasis overview – NHS
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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