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Scalp psoriasis is a chronic inflammatory skin condition that leads to the development of plaque-like lesions on the scalp. These lesions are characterized by redness, mild itching, and flaking that bears a resemblance to dandruff. The disorder is of a chronic-relapsing nature, meaning it fluctuates between periods of remission and reappearance or worsening of symptoms.
Scalp psoriasis develops due to a malfunction in the immune system, which triggers an accelerated proliferation of the epidermis cells. This rapid turnover happens in 3-7 days, instead of the usual 28-day cycle. Many people report a worsening of the disorder during stressful events, trauma, or infections, which can lower the immune defenses.
The exact causes of scalp psoriasis are still not fully understood. However, it is believed that an environmental trigger factor can elicit an inflammatory response on an autoimmune basis, leading to an accelerated cellular turnover at the epidermis level. These excess-produced cells accumulate on the scalp's surface, leading to the formation of psoriatic plaques.
Scalp psoriasis can affect individuals of any gender and age. It often appears following the intervention of triggering agents, such as trauma, infections, sunburns, hormonal changes, alcohol and smoking abuse, psycho-physical stress, poor eating habits, and certain drugs.
Scalp psoriasis manifests in various forms, with individual patches ranging in size, location, evolution, and color shade. The lesions may be asymptomatic or cause mild itching. Common symptoms include flaking similar to dandruff, the appearance of erythematous (reddish) and flaking plaque lesions on the scalp, scalp dryness, a burning or painful sensation, and increased hair loss.
In some cases, psoriasis can extend to the entire scalp, also involving the ears, the area above and behind the ears, the lobes, the nape of the neck, the forehead, and the hairline. Even if the symptoms associated with the disease are minimal, the aesthetic implications can be significant due to the location of the lesions.
While both conditions affect the scalp and share similar symptoms, such as itching, redness, and flaking, there are distinct differences. In psoriasis, the scales lift spontaneously, revealing a bright red scalp due to inflammation. The material produced by desquamation is silvery-white in color, as well as being more numerous and larger in size.
In contrast, dandruff flakes tend to be small and fine, yellowish or whitish in color. If you suspect you may have scalp psoriasis, it is advisable to consult a healthcare provider to correctly diagnose and appropriately treat the underlying condition.
The severity of scalp psoriasis varies from person to person. In some cases, the disease only causes slight discomfort; other times, rashes appear that cover large areas and are difficult to treat. Persistent lesions can lead to thinning hair or even hair loss. Regardless of the severity, scalp psoriasis can affect the quality of life of those affected, especially in visually evident cases, and can lead to negative psychological reactions.
The diagnosis of psoriasis is generally made by examining the patient's scalp and the distribution of the lesions. The dermatoscopy shows typical vascular alterations, which allow psoriasis to be differentiated from seborrheic dermatitis. Occasionally, a biopsy may be necessary to rule out other conditions.
Treatment options for scalp psoriasis are numerous and aim to keep the disease under control. Depending on the severity of the psoriasis, it is possible to resort to topical treatments, phototherapy, and/or systemic drugs.
Topical treatments for scalp psoriasis may involve both over-the-counter products and prescription products. Phototherapy is particularly effective for chronic plaque psoriasis, but it is difficult to apply to the scalp.
Systemic medications may be indicated for some patients with severe scalp psoriasis that is refractory to topical treatments. Active ingredients used include methotrexate, retinoids, cyclosporine, or biologics.
Proper hair care is crucial for those with scalp psoriasis. During hair cleansing, actions must be very gentle to avoid scratching the plaques. It's recommended to use a shampoo formulated with antipsoriatic active ingredients and selected ingredients to avoid irritation and dryness.
For most patients with scalp psoriasis, medicated coal tar-based products that can be purchased from pharmacies are suitable. If a hairdryer is used, it should be kept at least 30 cm away from the head, using the jet of fresh air or a low temperature. When brushing or combing the scalp, a brush with soft, natural bristles should be used.