Dermatology (Skin conditions)

Psoriasis Scalp Treatment

Psoriasis of the scalp is very common. Areas may be red, dry or scaly, itch and shed skin. The hair is not affected, but the psoriasis may be difficult to hide. This information will explain the treatment of scalp psoriasis.

Before Treatment
If there is thick dryness known as scale on the scalp we start by using Salicylic Acid. The Royal Victoria Infirmary formulation is a thick, white ointment. It should be applied to psoriasis on the scalp and left on overnight and then washed off the following morning. The hair should be gently combed to remove the loose scale while the hair is still wet. This is not a treatment for psoriasis but rather a way to remove the thick scale so the psoriasis beneath can be treated. Other treatments would stay on top of the scale and not penetrate and therefore would not work. Salicylic acid should be used for a few days until the scale is removed. It is important in children not to use it over a long period as it contains aspirin which might be absorbed if used in large quantities.

What are the Treatments?
Tar Pomade and Cocois - these scalp treatments contain tar, which slows the production of new skin cells as well as reducing redness. Both products contain small amounts of Salicylic Acid to stop scale building up again. Ideally either product should be applied to the psoriasis on the scalp and left overnight and washed out the next day, scale can be gently combed out of wet hair.

Tar products occasionally cause irritation to the scalp and some people find them smelly and messy. They may stain clothing and bedding. However they are safe, easy to use and effective.

Dithranol Pomade - this product is made by the pharmacy and contains Dithranol, which helps to slow down skin cell turnover. It must be carefully applied only to the areas of psoriasis on the scalp. It may be left overnight and washed out the next day.

Dithranol Pomade comes in three strengths - 0.2%, 0.4% and 0.6%. It is important to start with the lowest strength and only increase to the next strength if it is tolerated by the scalp.

What are the side effects?
Dithranol Pomade is staining and therefore it should not be used on fair hair (tar pomade should be used instead). Use old clothes and bedding as it will stain. Dithranol can also irritate and burn the scalp. If any discomfort is felt the dithranol should be washed out immediately. If your scalp continues to feel sore contact the dermatology department. 

Do not let dithranol get into the eyes! If it does wash the eyes thoroughly with water for ten minutes and seek medical attention immediately.

Some people prefer to wear a glove to apply the treatment (these are not provided).

Like all medications it should be kept out of the reach of children.

Topical steroid preparations - such as Betnovate scalp application. These should be used to calm redness, itch or soreness in the scalp. They should only be used for a short time before resuming other treatments due to their side effects which include absorption of the steroid through the skin and exacerbation of the psoriasis when stopped. These products may sting if they are in an alcohol base.

Tips:

  • Shampoo frequently with a tar or mild shampoo but avoid perfumed shampoos.
  • Find a hairdresser who understands about psoriasis.
  • To treat your scalp thoroughly - start on one side of the head and make a parting, apply the treatment onto the scalp seen through the parting, then move down a few centimetres and part the hair again and continue this until every bit of scalp with psoriasis has been treated.

More information

For more details, please contact:

  • Dermatology
  • tel: 0191 282 4485

For further support contact:

The Psoriasis Association, 
Milton House, 
7 Milton Street, 
Northampton, 
NN2 7JG 
Telephone: 01604 711 129, 
Fax: 01604 792 894 
Website: www.psoriasis-association.org.uk


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