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Scalp Psoriasis – Causes, Symptoms and Treatment

Scalp psoriasis is a chronic inflammatory skin condition causing scaling, redness, and itching on the scalp. It is not contagious and highly treatable.

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Things worth knowing about "Scalp Psoriasis"

Scalp psoriasis is a chronic inflammatory skin condition causing scaling, redness, and itching on the scalp. It is not contagious and highly treatable.

What is Scalp Psoriasis?

Scalp psoriasis (medically known as Psoriasis capitis) is a chronic inflammatory skin disease that affects the scalp, either exclusively or as part of a more widespread condition. It is one of the most common locations for psoriasis, affecting up to 80 percent of all people with the disease. Scalp psoriasis is not contagious and typically follows a relapsing-remitting course, meaning periods of flare-ups alternate with periods of remission.

Causes

The exact cause of psoriasis is not fully understood, but the following factors are known to play a significant role:

Genetic predisposition: Psoriasis tends to run in families. Having a first-degree relative with the condition increases the risk of developing it.
Immune system dysfunction: In psoriasis, the immune system is overactive. Inflammatory molecules such as TNF-alpha and interleukins drive an abnormally rapid turnover of skin cells (keratinocytes).
Trigger factors: Stress, infections (e.g., streptococcal throat infections), skin injuries, hormonal changes, certain medications (e.g., beta-blockers, lithium), and alcohol or tobacco use can trigger or worsen flare-ups.

Symptoms

The characteristic signs and symptoms of scalp psoriasis include:

Silvery-white or yellowish scales on the scalp, which may fall onto hair and clothing
Red, inflamed plaques on the scalp
Persistent itching (pruritus)
Burning sensation or tightness of the scalp
In severe cases: extension of plaques beyond the hairline onto the forehead, neck, and ears
Rarely: temporary hair loss in affected areas (hair typically regrows after treatment)

Diagnosis

Scalp psoriasis is usually diagnosed through a clinical examination by a dermatologist. The characteristic silvery scaling and well-defined red plaques are often sufficient for diagnosis. In uncertain cases, a skin biopsy (tissue sample) may be performed to rule out other conditions such as seborrhoeic dermatitis or tinea capitis (fungal infection of the scalp).

Treatment

Treatment of scalp psoriasis depends on the severity of the condition and is tailored to the individual patient.

Topical (External) Treatment

Keratolytics (e.g., salicylic acid): Help remove scales and improve the absorption of other active ingredients
Corticosteroids: Anti-inflammatory agents available as shampoos, solutions, or foams
Calcipotriol (a vitamin D analogue): Slows down the excessive division of skin cells
Coal tar preparations: Established anti-inflammatory agents, less commonly used today

Systemic Treatment

For moderate to severe scalp psoriasis, systemic medications that target the immune system may be prescribed:

Methotrexate, ciclosporin, or acitretin (conventional systemic therapies)
Biologics (e.g., anti-IL-17 or anti-IL-23 antibodies): Targeted therapies for severe or treatment-resistant cases

Additional Measures

Gentle hair care using mild, fragrance-free shampoos
Avoiding known trigger factors such as stress and alcohol
Regular follow-up appointments with a dermatologist

References

World Health Organization (WHO): Global report on psoriasis. Geneva: WHO Press, 2016.
Menter A. et al. - Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities. Journal of the American Academy of Dermatology, 2021.
Griffiths C.E.M., Barker J.N.W.N. - Pathogenesis and clinical features of psoriasis. The Lancet, 2007; 370(9583): 263-271.

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