Practical treatment tips for the scalp
The forehead, neck and ears
Scalp psoriasis may creep down onto the forehead and the neck and around the ears. These areas can be treated with the same products used for the scalp. However, there are some specific considerations. For example, anthralin can stain facial skin. Strong steroid medications should never be used on the face because they can irritate and thin facial skin. Dovonex is not recommended for the face, although some people use it there successfully. Tazorac is considered safe for facial use, although it can irritate the skin.
The face, neck and ears require special care. For more information about psoriasis on the face and ears, click here.
Scale softening and removal
The first step in treating scalp psoriasis is to remove (lift) any scale on psoriasis plaques. Scale lifting is necessary to make it easier for topical medications to penetrate the plaques and clear them.
Keratolytics contain active ingredients such as salicylic acid, urea, lactic acid or phenol. A keratolytic is usually applied to the scalp, left on for a prescribed length of time (sometimes overnight) and shampooed off. The loosened psoriasis scales are washed away. You may avoid some of the messiness by applying them at night and covering your head with a shower cap.
Salicylic acid is the most common keratolytic, and can be used in combination with tar or selenium sulfide. Its popular nickname is "sal acid," and you will find it both in OTC and prescription products, mostly shampoos and soaps.
Treatments with high concentrations of salicylic acid can cause irritation. The body may absorb salicylic acid if used over large areas of the skin. Salicylic acid may also weaken hair shafts and make them more likely to break, causing temporary hair loss. This is not permanent; hair should return to normal after stopping treatment.
Soaking the scalp in warm (not hot) water can help loosen scales. Soaking with water "plumps up" scales and makes them easier to remove.
Another way to soften and loosen scales is to apply oils, lotions, creams or ointments to a damp scalp. Some people report that lubricants work better with a hot towel wrapped around the head. You can also apply heated olive oil to the scalp and wrap your head in a towel for several hours, or apply olive oil and sit under a hair dryer.
Once the psoriasis scale has been softened, it needs to be removed. People generally use round or fine-tooth combs, or brushes. One of the best methods is to comb the scalp gently with a light circular motion, holding the comb almost flat against the scalp. Once the scale is loosened, you may shampoo to flush the scale from the scalp and out of the hair. Some people use a hair dryer to blow additional scale from the scalp and hair.
Removing scales too vigorously can break the skin and lead to an infection. It can also break hair off at the scalp, causing temporary hair loss. The Koebner [keb-ner] response, a tendency for psoriasis to appear on damaged skin, can occur at the site of rough scratching or scraping. If treatments worsen your psoriasis or irritate your scalp, use plain oils and water until the irritations subsides. Great care should be taken when removing scales and applying topical medications to avoid triggering this response.
Occlusion and stain protection
Shower caps, towels, plastic wrap and plastic produce bags are good examples of the types of head covers used to occlude (cover) the scalp while also protecting pillows, clothes and furniture from medications and oils. Plastic produce bags are inexpensive, if not free, and do not make the annoying "crinkle" sound of a regular shower cap.
To protect your bedding from stains you can make a "treatment" pillowcase by sewing two towels together on three sides. Some people wear wigs during the day to hide psoriasis medications or to hide hair that is compromised by psoriasis treatments.
Never use a shower cap or other covering with prescription scalp medications, unless specifically directed by your doctor.
Scalp itch
Itching is often a problem for those with scalp psoriasis. OTC tar shampoos can help reduce itching. Topical steroids are often effective, and oral antihistamines are occasionally prescribed. Sometimes doctors add menthol to scalp medications; many over-the-counter medicated shampoos contain menthol.
Combining medications
A doctor can prescribe special combinations of medications, a process known as compounding. Specialized preparations prescribed by a doctor can be mixed by a pharmacist for individual cases. Be aware that some medications may inactivate others, so it is best to consult your doctor before combining medications on your own.
Effective application of medications
- Part your hair and hold it in place while you drip or pat oils or lotions directly on your scalp. Make a new part about a half-inch away and repeat. If you use a cream or ointment, rub it right into the psoriasis. Preparations should be used sparingly. Getting the medication on the hair is wasteful.
- Treat all of the affected areas, including those around the ears and hairline. Products such as anthralin and Tazorac may irritate the folds behind the ears. Protect those areas by covering them with a thin layer of petroleum jelly before applying medications. Avoid getting any medication in the eyes.
- Pre-treat the scalp lesions with keratolytic agents or oils to soften and remove the heavy scales and make scalp medications more effective. Shampoo before applying a scalp medication.
- Apply petroleum jelly to cotton balls and insert them gently into the ears before applying the medications or shampoos to keep shampoos and medications out of ears.
Updated October 2005
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