Understanding scalp psoriasis
Check out this answer from Consensus:
Scalp psoriasis is a prevalent and challenging condition that requires a multifaceted treatment approach. While topical corticosteroids and vitamin D analogues remain the mainstay of treatment, emerging therapies offer new hope for patients with more severe or refractory disease. Ongoing research and clinical trials are essential to further improve the management and quality of life for individuals affected by scalp psoriasis1 2 3 4 5 6 9 10.
Scalp psoriasis is a common manifestation of psoriasis, a chronic autoimmune skin disease characterized by red, scaly patches. Affecting nearly 80% of individuals with psoriasis, scalp involvement can significantly impact a patient’s quality of life due to its visibility and associated symptoms such as itching and discomfort2 3.
Causes and Symptoms
Psoriasis is an inflammatory condition driven by an overactive immune system that accelerates the growth cycle of skin cells. This results in the buildup of cells on the skin’s surface, forming scales and red patches. Scalp psoriasis can range from mild, with fine scaling, to severe, with thick, crusted plaques covering the entire scalp2 7.
Diagnosis
Diagnosing scalp psoriasis can be challenging due to its similarity to other dermatological conditions such as seborrheic dermatitis, tinea capitis, and lichen planopilaris. Accurate diagnosis often requires a thorough clinical examination and may involve skin biopsies or cultures to rule out other conditions7.
Treatment Options
Topical Treatments
Topical treatments are the first line of defense against scalp psoriasis. These include:
- Corticosteroids: These are highly effective in reducing inflammation and are often recommended as the first-line treatment. They are available in various formulations such as shampoos, lotions, and foams1 2 10.
- Vitamin D Analogues: Calcipotriol and other vitamin D analogues are effective in slowing down the growth of skin cells. They are often used in combination with corticosteroids for enhanced efficacy1 2 10.
- Keratolytics: Agents like salicylic acid help in removing scales, making it easier for other medications to penetrate the skin2 10.
- Coal Tar and Anthralin: These have anti-inflammatory properties and can be effective, although they are less commonly used due to their messiness and potential for irritation2 10.
Systemic Treatments
For more severe cases, systemic treatments may be necessary:
- Methotrexate, Cyclosporine, and Acitretin: These conventional systemic agents are effective but come with potential side effects and require monitoring2 3.
- Biologics: Newer biologic agents such as etanercept and secukinumab have shown excellent efficacy in treating scalp psoriasis, often achieving near-complete clearance. However, their high cost can limit their use to more severe cases4 9.
Emerging Treatments
Recent studies have explored the efficacy of newer treatments:
- Apremilast: This oral phosphodiesterase 4 inhibitor has shown significant improvement in scalp psoriasis symptoms and quality of life measures5.
- Roflumilast Foam: A topical treatment that has demonstrated promising results in reducing scalp psoriasis severity with a favorable safety profile6.
Challenges in Management
Managing scalp psoriasis is particularly challenging due to the difficulty in applying topical treatments through hair and the sensitive nature of the adjacent facial skin. Long-term management often requires a combination of treatments and continuous patient support to ensure adherence and address psychosocial impacts1 2 10.