4 Ways to Manage and Treat Scalp Psoriasis
If you have psoriasis, you may experience itchy, dry, flaky skin anywhere on your body—including your scalp. In fact, according to the National Psoriasis Foundation (NPF), scalp psoriasis affects up to 56% of people living with the skin condition.
Along with being uncomfortable, scalp psoriasis “can be embarrassing and often can extend past the hairline, becoming noticeable with red inflamed skin or flakes in the hair,” says Stefani Kappel, M.D., a board-certified dermatologist who practices in Newport Beach, California.
The good news? Many remedies and treatments are available to help ease scalp discomfort and reduce visible symptoms. These are some common strategies.
1. Gentle At-Home Remedies
Within your pantry and medicine cabinet, you might find some everyday products that can help alleviate symptoms by relieving itch and moisturizing and protecting skin.
Note: It’s always a good idea to discuss any new scalp psoriasis treatments you want to try with your dermatologist to make sure they think they’re a good option for your skin. They can also verify that they’re compatible with your other treatments.
Ease Itch with Baking Soda
Baking soda may help reduce skin itchiness and irritation in people with psoriasis, according to one small study published in the Journal of Dermatological Treatment.
For scalp psoriasis, mix a tablespoon of baking soda into a glass of water and apply it to your scalp—this concoction can ease the itch, Kappel recommends. You can pour the mixture over your head or dip a washcloth into the water to apply it on your scalp in a more targeted way.
Moisturize with Coconut or Avocado Oil
Applying coconut or avocado oil to your scalp adds some much-needed moisture to the affected area and may help reduce inflammation.
“Put on a shower cap and massage a few drops of each kind of oil, chilled or mildly heated, into your scalp,” recommends Anna Chacon, M.D., a board-certified dermatologist based in Miami. Wait 20 minutes before removing the hat and washing your hair as usual. Following this process may reduce or eliminate scaling, Chacon says.
Soothe with Aloe Vera
“Aloe vera is a plant that is well known for its skin-healing abilities,” Chacon says. “Creams containing 0.5% aloe can help relieve scalp irritation, inflammation, peeling, and redness,” she says.
Cream is preferred over gel, since gel is alcohol-based and may sting and burn when applying. You can apply a cream aloe vera directly to the affected areas on your scalp two to three times a day.
2. Shampoo with Active Ingredients
The right shampoo may help alleviate scalp psoriasis symptoms. Kappel recommends looking for one that contains salicylic acid, which softens dry, scaly skin on your scalp, helping it become loose enough to wash away.
Another helpful shampoo ingredient is coal tar, which is both safe and effective for long-term use to treat scalp psoriasis. Coal tar helps reduce itch, inflammation, and scaling due to psoriasis, according to the National Psoriasis Foundation.
You can find shampoos that contain salicylic acid or coal tar at most drugstores. Look for products that have the NPF Seal of Recognition, which means the organization deems the product safe for people with psoriasis.
When you suds up in the shower, be gentle. “Washing the hair too aggressively, using nails instead of fingertips, can scratch the scalp leading to a phenomenon called Koebnerization [or the Koebner phenomenon], which can exacerbate psoriasis in the area of trauma,” Kappel says.
Use the pads of your fingers to distribute shampoo. You can keep your nails trimmed so that scratching is less likely. Be gentle when brushing and combing your hair, as well, and avoid scratching as much as possible throughout the day, since that can also worsen psoriasis.
3. Prescription Treatments
Although DIY and over-the-counter tactics can often be quite helpful, they may not always cut it. A doctor-prescribed scalp psoriasis treatment may be necessary to help you find relief. That includes options such as prescription-strength topical medication, phototherapy, or biologics.
Topical corticosteroids are one of the most prescribed treatments for scalp psoriasis, according to a 2016 perspective on managing the condition. “A topical steroid in a liquid or gel form is often preferred by dermatologists because ointments and creams are hard to apply to the skin in hair-bearing areas,” Kappel notes. Plus, ointments and creams can make the hair oily, a side effect many people want to avoid.
Prescription shampoos, when used with over-the-counter shampoos, can be helpful, too. Commonly prescribed options include ketoconazole shampoo or ciclopirox shampoo. These are meant for the treatment of seborrheic dermatitis, but often people with psoriasis have yeast buildup on the scalp, which the shampoo helps reduce. An anti-inflammatory shampoo containing clobetasol can help reduce itch, inflammation, and flaking.
During phototherapy, you’re exposed to ultraviolet B (UVB) light, which can reduce inflammation and itching and tamp down an overly active immune system. This treatment can help with all forms of psoriasis and can be targeted to the area on the scalp where you’re experiencing symptoms. Smaller phototherapy devices designed for use on the scalp are sometimes covered by health insurance.
Biologics are a type of systemic treatment given by either injection or infusion. Unlike oral systemics, biologics target specific immune pathways to reduce the inflammation that’s causing symptoms.
Biologics are often prescribed to treat scalp psoriasis after other treatments aren’t sufficient. However, if you have moderate to severe psoriasis that affects the scalp as well as other areas, a biologic may be prescribed as a first-line therapy, according to a June 2021 review of tactics to manage scalp psoriasis published in the journal Dermatology and Therapy.
4. Healthy Lifestyle Choices
How you feel and what you eat, drink, and do can sometimes trigger psoriasis flare-ups—and may worsen them, too. That makes practicing healthy lifestyle habits extra important to managing your condition. Here’s what you can do in addition to treatment.
Manage Your Stress Levels
Stress is a common trigger for psoriasis, Chacon says. Stress can lead to higher levels of cortisol (often known as the stress hormone), which in turn contributes to flare-ups, Kappel explains.
Not sure where to start when it comes to reducing your stress levels? Try incorporating relaxation techniques into your routine, such as yoga, meditation, mindfulness, or spending time in nature. And don’t forget about the importance of your shut-eye—getting enough sleep helps you handle stress better, Chacon says.
Make Healthy Food Choices
An anti-inflammatory diet is often recommended to help people with psoriasis avoid or reduce flare-ups. This is an eating plan rich in leafy greens, olive oil, and fatty fish, such as salmon and mackerel.
Some people find that certain foods or beverages can bring on a flare. Common psoriasis trigger foods include alcohol, refined carbohydrates, and red meat. Keeping a food diary noting what you eat and how you feel after can help you pinpoint your specific triggers and know what foods to avoid.
Research suggests that smoking increases one’s risk for psoriasis, can make psoriasis more severe, and can interfere with treatment. If you need help quitting smoking, talk to your doctor about your options.
Alcohol may increase the inflammation that causes psoriatic symptoms. Limiting or avoiding it may help calm your psoriasis.
Keep Trying to Get Your Best Results
Often, finding the best methods for treatment of scalp psoriasis takes some trial and error.
It may work best to use a combination of approaches, Kappel says. For instance, you may use a salicylic acid shampoo followed by a topical steroid, or you may use moisturizing ingredients and an anti-inflammatory diet in addition to a biologic.
If you notice any side effects from a treatment or remedy, talk to your doctor. The great news is there are many ways to treat scalp psoriasis, so you can try something else with the doctor’s guidance.
There’s no reason to let symptoms go or allow them to worsen. “Prevention and control is much better than neglecting the problem and trying to reverse it later,” Kappel says.
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