Scalp Psoriasis

About half of the estimated 7.5 million Americans with psoriasis, which can affect any skin surface, have it on their scalp. Sometimes the scalp is the only place they have it, but that’s uncommon.

What are the different types of psoriasis?

Psoriasis is an inflammatory skin condition that can present in many ways. Different types of psoriasis can vary in severity, location, and form.

Psoriasis is an inflammatory skin condition that affects around 3.2% of the United States population.

There are a number of different types of psoriasis, which can vary in their severity, location on the body, and physical appearance. Fortunately, there are many treatments available that can help.

In this article, we take a look at different types of psoriasis and how they can affect people.

Psoriasis is a skin condition that causes skin cells to form too quickly. Because these grow faster than the body can shed existing skin cells, thick, scaly patches form.

Americans see their primary care doctors less often than they did a decade ago. Adults under 65 made nearly 25% fewer visits to primary care providers in 2016 than they did in 2018, according to National Public Radio. In the same time period, the number of adults who went at least a year without visiting a primary care provider increased from 38% to 46%.

On lighter skin tones, psoriasis usually appears as pink or red patches with silvery-white scales. On darker skin, psoriasis is more likely to appear as purple patches with gray scales or as a dark brown color.

There are several types of psoriasis. Most types of psoriasis tend to be mild to moderate. However, some types of psoriasis can be severe.

Types of the condition include:

• plaque psoriasis
• psoriasis of the scalp
• guttate psoriasis
• inverse psoriasis
• pustular psoriasis
• erythrodermic psoriasis

People with psoriasis may initially only develop one type of psoriasis, but can develop another type at a later point in time.

While a person’s symptoms will vary with the type of psoriasis they have, most people with psoriasis will experience some combination of:

• itchy skin
• burning, sore, or painful areas on the skin
• patches of thick skin with visible scales
• small scaly spots
• swollen or stiff joints

Psoriasis is often a lifelong condition, and symptoms tend to be cyclical . This means that they may increase in intensity at certain periods and lessen at others. People refer to these periods of heightened symptoms as flares.

Flares can vary in severity and duration.

Plaque psoriasis, also known as psoriasis vulgaris, causes areas of plaque buildup on the skin and is the most common form of psoriasis. Around 80-90% of people with psoriasis develop plaque psoriasis.

Plaque is a thickened area of skin. On lighter skin types, it often has a white or silvery, scaled appearance, and on darker skin types it may appear as purple patches with gray scales.

Plaque psoriasis tends to be mild to moderate but can be severe. Typically, mild plaque psoriasis covers less than 3% of the body, moderate plaque psoriasis 3-10%, and severe cases cover 10% or more.

Symptoms

Symptoms of plaque psoriasis vary from person to person. These symptoms can include:

• areas of dry skin lesions covered with silvery scales
• plaques that itch or burn
• problems that affect the nails

Areas of plaque may appear anywhere on the body but are most common on the knees and elbows.

Treatment

Treatment of mild or moderate plaque psoriasis will vary depending on a person’s individual symptoms. However, treatment will typically include the application of topical ointments to affected areas, and in some cases exposing the skin to ultraviolet light.

Scalp psoriasis typically occurs on a person’s scalp. However, it can also appear on the forehead, back of the head, down the neck, and behind the ears.

Scalp psoriasis is common among people with psoriasis. In the United States, approximately 45-56% of people living with psoriasis have scalp psoriasis.

A person with scalp psoriasis can have psoriasis on other parts of their body at the same time.

Symptoms

Scalp psoriasis shares many symptoms with plaque psoriasis, but may also result in:

• patches of thick skin on the scalp
• dandruff-like flakes on the scalp
• itching and bleeding scalp
• a dry scalp
• temporary hair loss during flares

Treatments

Treatment for scalp psoriasis often involves more than one method at a time. As with plaque psoriasis, a doctor will tailor a treatment program to a patients’ needs.

Treatment options for scalp psoriasis include:

• medicated shampoos and ointments
• UV light therapy
• injections
• scalp therapy

Guttate psoriasis is characterized by red, purple, or dark dots and spots spread throughout the skin. The dots and spots are not as thick as plaques in plaque psoriasis.

This type of psoriasis often starts in childhood or young adulthood and appears after an infection.

Symptoms

Guttate psoriasis typically causes spots to appear on the legs, arm, and torso. However, these may also appear on the face, scalp, and ears.

In severe cases of guttate psoriasis, there may be hundreds of these spots, and they may cover the majority of an affected area.

Treatments

Doctors will typically recommend topical creams and ointments as the first step for treating guttate psoriasis. These treatments may help reduce swelling and alleviate itching.

As the condition can appear following infections such as strep throat, a doctor may recommend antibiotics to treat the infection alongside addressing the psoriasis symptoms. In some cases, they may also suggest a patient undergo light therapy.

Inverse psoriasis appears as patches of discoloration that are most often found in the folds of the skin, such as in the armpits and groin. People with inverse psoriasis often have other forms of psoriasis elsewhere on their bodies.

Symptoms

On white skin, inverse psoriasis presents as bright red or pink marks. On black or brown skin it may appear as red, purple, or darker than the surrounding area.

Areas of the body that are most likely to be affected by inverse psoriasis include:

• armpits
• groin
• under the breasts
• behind the knee

Treatment

The areas of the body that are most often affected by inverse psoriasis tend to have thinner skin than other areas. This can make treating this type of psoriasis more difficult.

A doctor will typically recommend topical steroid ointments to reduce inflammation. As skin folds are common sites of yeast infection, they may also suggest a person take anti-yeast and anti-fungal treatments as well.

Pustular psoriasis is a severe, rare type of psoriasis. It causes widespread inflammation of the skin and white or yellow blisters that contain pus.

Symptoms

Pustular psoriasis blisters can be limited to one area of the body or appear more generally. Once the blisters have gone away, the skin may become scaly.

A person with pustular psoriasis may also experience:

• fever
• extreme tiredness
• muscle weakness
• other forms of inflammation throughout the body

A specific kind of pustular psoriasis called palmoplantar pustulosis causes blisters to form on the palms and soles of the feet. These blisters form in a studded pattern. Over time, the blisters turn brown and become crusty.

Treatment

Due to the rarity of the condition, there is a lack of evidence-based treatment guidelines . As a result, medical professionals may recommend a combination of topical ointments, oral medications, and therapies.

They may also cycle between medications and therapies to find the most effective option and reduce the risk of side effects.

A person with mild pustular psoriasis may be able to treat the condition with prescription topical ointments. However, those with more extensive symptoms may require hospital treatment.

While most forms of psoriasis tend to be mild or moderate, erythrodermic psoriasis is severe and can be a life-threatening medical emergency.

This type of inflammatory psoriasis covers 80-90% of the body. It causes an extremely painful, peeling rash that looks like a burn.

Erythrodermic psoriasis is a rare condition and affects 1-2.25% of people with psoriasis.

Symptoms

Unlike symptoms of the types of mild psoriasis, symptoms of erythrodermic psoriasis tend to be serious. They may include:

• widespread area of inflamed, discolored skin
• skin that peels off in sheets
• severe itching, pain, or burning
• faster heart rate
• fever or lower body temperature
• swelling in feet or ankles

People who have erythrodermic psoriasis are prone to infection. They may also experience other serious problems, including heart failure and pneumonia.

Treatments

People with erythrodermic psoriasis are often hospitalized and may require emergency treatment. This may include fluid replacement and systemic medications, which affect the whole body.

Depending on the severity of the condition, a medical professional may recommend oral retinoids, which are medicines derived from Vitamin A that can slow skin cell growth and reduce swelling, and immunosuppressive drugs, which reduce the body’s immune system response.

Biologic therapy is also a potential course of treatment. Biologics target cytokines, which are signaling molecules that assist in the movement of cells to sites of inflammation. By suppressing or inhibiting these signals, biologics can reduce the severity of inflammation from erythrodermic psoriasis.

In mild cases, focused treatment for the symptoms of erythrodermic psoriasis may include topical steroid creams and ointments, wet dressings, and oatmeal baths.

Most types of psoriasis tend to be of mild to moderate severity. This exception is erythrodermic psoriasis, which can be a life-threatening medical emergency.

Psoriasis varies in its appearance and symptoms, but most treatment approaches are similar. Typically people with mild psoriasis can manage their symptoms using topical treatments, according to treatment guidelines.

However, if a person has moderate to severe symptoms a doctor may prescribe new biologic therapies. These can help treat the underlying cause of skin changes and may reduce the number of flares and severity of symptoms.

People who suspect that they have psoriasis should consult their doctor before beginning treatment. People with symptoms of erythrodermic psoriasis should seek immediate medical attention.

Last medically reviewed on July 5, 2021

How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Scalp Psoriasis

Scalp psoriasis is a common skin disorder. It may look different on different skin tones. If you’re light- to medium-skinned, it often shows up as raised, reddish or salmon-colored patches with white scales. On darker skin, the patches may be purple and the scales gray. It can be a single patch or several, and can even affect your entire scalp. It can also spread to your forehead, the back of your neck, or behind and inside your ears.

You can’t catch scalp psoriasis from another person. As with other types, we don’t know what causes it. Doctors believe it comes from something wrong with your immune system that causes skin cells to grow too quickly and build up into patches. You may be more likely to get scalp psoriasis if it runs in your family.

About half of the estimated 7.5 million Americans with psoriasis, which can affect any skin surface, have it on their scalp. Sometimes the scalp is the only place they have it, but that’s uncommon.

Scalp psoriasis can be mild and almost unnoticeable. But it can also be severe, last a long time, and cause thick, crusted sores. Intense itching can affect your sleep and everyday life, and scratching a lot can lead to skin infections and hair loss.

Symptoms of Scalp Psoriasis

Symptoms of mild scalp psoriasis may include only slight, fine scaling. Symptoms of moderate to severe scalp psoriasis include:

• Scaly, red or purple bumpy patches
• Silvery-white or gray scales
• Dandruff-like flaking
• Dry scalp
• Itching
• Burning or soreness
• Hair loss

Scalp psoriasis itself doesn’t cause hair loss, but scratching a lot or very hard picking at the scaly spots, harsh treatments, and the stress that goes along with the condition can lead to temporary hair loss. Fortunately, your hair usually grows back after your skin clears.

If you have any of these symptoms, see your doctor or dermatologist. They may simply take a look or do a skin biopsy to rule out similar conditions like seborrheic dermatitis.

Treatments for Mild Scalp Psoriasis

The first line of defense is treatment you use directly on your skin (topical treatments).These include medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. You can get some of these products over the counter, but stronger ones require a prescription.

Over-the-counter products often contain one of two medications approved by the FDA for psoriasis:

Salicylic acidis a peeling agent available in over-the-counter (OTC) and prescription shampoos and soaps. It can soften scales, making them easier to remove.

Coal tar products are available OTC as shampoos, creams, gels, ointments, foams, and soaps. They can help slow skin growth and reduce inflammation, itching, and scaling. To apply a coal tar shampoo, massage it into the scalp and leave on 5 to 10 minutes before rinsing out. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can help against the odor of tar shampoo.

Medicated shampoos are available in coal tar and non-coal tar varieties. Some OTC shampoos have menthol or phenol creams as an active ingredient. You can use these daily for scalp plaques, but follow the directions.

You can also check with your doctor about taking OTC antihistamine pills.

Prescription products for scalp psoriasis may have higher concentrations of either or both of these, as well as other FDA-approved medications, such as:

• Anthralin, an older prescription medication
• Antimicrobials, which treat bacterial or yeast infections that can come with scalp psoriasis
• Calcipotriene, a strong derivative (different form) of vitamin D
• Calcipotriene and betamethasone dipropionate (a vitamin D derivative combined with a strong steroid)
• Other topical steroids
• Tazarotene, a derivative of vitamin A

To work, these treatments must be put on your scalp, not just your hair. Follow the directions exactly until your skin heals, which can take 8 weeks or more. Once your psoriasis has cleared, you can help keep it from coming back by shampooing regularly or twice weekly with a product that has coal tar or other medications.

To ease itchiness:

• Use a conditioner after shampooing.
• Limit hot tools for hair styling.
• Use wet towels, cold packs, or cold water on itchy spots.

Scalp Psoriasis Treatments at the Doctor’s Office

If you have mild scalp psoriasis in a few areas, your doctor or dermatologist may consider intralesional steroid injections. They’ll use a small needle to inject medication into scalp plaques to reduce inflammation. You can have this procedure at the doctor’s office.

If your symptoms don’t respond to topical treatments, phototherapy with a laser or non-laser light source may help. For example, the excimer laser focuses high-intensity light on affected areas and avoids the surrounding healthy skin.

Ultraviolet (UV) light — sometimes delivered with a handheld device called a UV comb — can be used to treat the entire scalp. Hair can block the light from reaching your scalp, so if you have thick hair, it may help to part it in rows. If you have very thin hair or a shaved head, your doctor may recommend that you go out in natural sunlight for brief periods.

Systemic and UV Treatments for Scalp Psoriasis

If you have moderate to severe scalp psoriasis, your doctor may prescribe a drug you take by mouth or one that’s injected or pumped through a needle into a vein. Oral medications include:

• Acitretin (Soriatane), a strong derivative of vitamin A
• Apremilast (Otezla), a small molecule inhibitor taken twice daily
• Corticosteroids
• Cyclosporine (Sandimmune) lowers immune system function, which helps to reduce the inflammation of psoriasis.
• Methotrexate (Rheumatrex) slows an enzyme involved in the rapid growth of skin cells.
• Tapinarof (Vtama) cream 1%
• Upacitinib (Rinvoq), a Janus kinase inhibitor taken once daily

Since these medications can cause serious side effects, including liver damage, they require a doctor’s close watch. It’s also important to know that oral vitamin derivatives are different from — and more powerful than — vitamin supplements bought over the counter. Ordinary vitamin A and D supplements do not help.

The latest class of FDA-approved medications is called biologics. These drugs, which you get by injection or IV, may keep your skin from making too many cells. According to the American Academy of Dermatology, 11 biologics may work:

• Adalimumab (Humira)
• Certolizumab peg (Cimzia)
• Etanercept (Enbrel)
• Infliximab (Remicade)

Interleukin inhibitors

• Brodalumab (Siliq)
• Guselkumab (Tremfya)
• Ixekizumab (Talz)
• Risankizumab-rzaa (Skyrizi)
• Secukinumab (Cosentyx)
• Tildrakizumab-asmn (Ilumya)
• Ustekinumab (Stelara)

Complications of Scalp Psoriasis

If your scalp psoriasis becomes infected, you may have crusting, discoloration, warmth, tenderness, and sometimes swelling of your lymph nodes. Your doctor may prescribe an antibiotic treatment for this problem.

Preventing Scalp Psoriasis Flares

There is no cure, but many treatments can help cut down on the number of flares you have and ease symptoms when they do happen. People who follow their treatment plan rarely have to endure severe scalp psoriasis for long.

Psoriasis support groups can also offer valuable tips to help medical treatments work better and ease the stress and sadness that this common condition can cause.

Show Sources

American Academy of Dermatology: “What Is Scalp Psoriasis?” “Understanding Scalp Psoriasis May Head Off Hair Loss,” “Can You Get Psoriasis if You Have Skin of Color?” “Psoriasis Treatment: Biologics.”

FDA: “FDA approves Amjevita, a biosimilar to Humira.”

Medscape: “FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis.”

National Psoriasis Foundation: “Scalp Psoriasis,” “Specific locations: scalp,” “Over-the-Counter (OTC) Topicals,” “Traditional systemic medications,” “Moderate to severe psoriasis: Biologic drugs.”

Handa, S. Indian Journal of Dermatology, Venereology and Leprology, 2010.

Skin Therapy Letter: “Treatments for Scalp Psoriasis with Emphasis on Calcipotriol Plus Betamethasone Dipropionate Gel (Xamiol).”

Stanford Medicine: “Psoriasis.”