This article was medically reviewed by Caroline Chang, MD, a board-certified dermatologist and member of the Prevention Medical Review Board, on August 17, 2019.
For most people struggling with an itchy scalp or dandruff, switching shampoos is enough to find relief. But for those with scalp psoriasis—a type of psoriasis that forms on the top of the head and can also spread to the top of the forehead, the back of the neck, and behind the ears—it’s not always so simple.
Scalp psoriasis typically appears as pink and/or red patches and silvery scales that may be accompanied by itching, soreness, or a burning sensation. The more severe it is, the more likely you’ll feel the crusty plaques on your head—and maybe even see them fall off if you scratch them. Scratching can also make the scalp bleed and cause temporary hair loss. As you can imagine, the condition can be incredibly difficult to live with, and can make some people feel embarrassed and ashamed of their symptoms.
Most patients with scalp psoriasis also have psoriasis on other areas of their body, and symptoms can flare up and recede over time. For instance, they’re often worse in the winter months or whenever you’re feeling stressed.
Just like with other types of psoriasis, it’s not clear what the cause of scalp psoriasis is and, unfortunately, there is no cure. But here’s the good news: There are plenty of safe and effective treatments that can help you find significant relief, according to board-certified dermatologists.
The best scalp psoriasis treatments
Shampoos and solutions
Dandruff shampoos like Selsun Blue or Head & Shoulders might help a very mild case of scalp psoriasis. “Anything beyond mild scaling will likely require a prescriptive agent for consistent control,” says Bobby Buka, MD, CEO and dermatologist at The Dermatology Specialists in New York City.
Head & Shoulders Anti-Dandruff Shampoo (Pack of 2)
Head & Shoulders Anti-Dandruff Shampoo (Pack of 2)
There are several types of prescription-strength shampoos that your doctor might suggest. In the past, tar-based shampoos were often used, but they smell lousy and can stain things, so many dermatologists are moving away from those now. Rhonda Q. Klein, MD, MPH, a board-certified dermatologist at Modern Dermatology of Connecticut will typically prescribe a zinc or selenium sulfide shampoo and have the patient rotate that with a steroid shampoo, or sometimes she’ll recommend an antifungal.
How often do you need to use a prescription shampoo? “There are patients that start off using one every day and after several weeks to months, they may only need it once every two weeks or once a month,” says Dr. Buka.
But there are some caveats. “It’s really important to take a thorough history of people’s hair-washing behaviors to figure out what the best topical treatment will be,” says Dr. Klein. For instance, some women don’t wash their hair every day, so for them, putting a solution in their hair at night two or three times a week, sleeping in it, and then washing their hair the next morning may be a better option.
Oral medications
If topical treatments aren’t providing enough relief, a dermatologist may move on to a systemic treatment. There are pills that you can take—anywhere from once weekly to twice daily, depending on the medication—to treat scalp psoriasis. One that is commonly prescribed is called apremilast.
Another option for some patients is acitretin, a vitamin-A derivative, but it can’t be used in women with childbearing potential because you can’t get pregnant within three years of taking it.
Other drugs like methotrexate and cyclosporine may also be considered, though they can have serious side effects. “With methotrexate, you can have liver issues and cyclosporine can affect the kidneys and blood pressure,” says Dr. Klein.
Light or laser therapy
You can go to a dermatologist’s office two or three times a week to receive what’s called narrow-band UVB phototherapy. (Most dermatologists no longer use full-spectrum light that contains UVA rays because that would increase your risk for skin cancer.)
It feels a lot like going to a tanning salon—you step into a vertical box that’s filled with lights. “You don’t really see maximum benefit until 10 to 12 weeks and many patients continue to do it for six months,” says Dr. Klein. “There are also home light box units that we try to get insurance to cover.” Light therapy is generally a good choice if you have scalp psoriasis, as well as psoriasis on other areas of your body.
Another variation: “You can get a comb with a light in it, so you can essentially brush with this light turned on that emits UVB rays,” says Dr. Buka. “That’s one way to suppress inflammation on the scalp without using a steroid.”
There’s also an excimer laser, which is a form of ultraviolet laser and can be used in a doctor’s office two to three times a week. “This works great for the scalp because it’s more of a targeted therapy and we actually put the laser where we see the plaques,” says Dr. Klein.
Biologics
“Biologic therapy is the hottest thing to hit dermatology and psoriasis in the last 10 years,” says Dr. Buka. It’s a shot or infusion that a patient can conveniently receive in a more spread-out fashion—sometimes every other week, sometimes every six weeks, or sometimes every three months.
Biologic therapy is typically used only if the psoriasis is covering a large percentage of the body or if the patient also has psoriatic arthritis. “Biologics are very safe and the success rate is in the 80 to 90 percent range,” says Dr. Buka. The downside is that they can be super expensive, so it’s a good idea to check with your insurance provider ahead of time to see what your out-of-pocket cost would be.
Home remedies
If you’re interested in trying home remedies, always talk to your dermatologist first to make sure they’re safe. As for their effectiveness, some home remedies might help a little, especially if you have a mild case of scalp psoriasis. But you will likely need something stronger and clinically proven to find major relief.
“There’s definitely great anecdotal evidence for acupuncture use. There’s wonderful, small-group evidence surrounding Chinese herbal medicine. Do I believe that non-traditional therapies can clear a heavily crusted scalp? No. Do I believe holistic medicine can result in significant improvement on a scalp? Definitely,” says Dr. Buka. “Patients who are dedicated to meditation, massage, stress reduction, and acupuncture can achieve marked improvements on their psoriasis.”
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Jane Bianchi is a writer and editor with more 13 years of experience specializing in health; she formerly worked as a health editor at Family Circle, and her work has appeared in Men’s Health, Women’s Health, Esquire, and more.
