Scalp Psoriasis

Medically Reviewed by Zilpah Sheikh, MD on December 17, 2024
Written by Rick Ansorge, Frances Gatta
11 min read

Scalp psoriasis is a common skin disorder. It may look different on different skin tones. If you're light- to medium-skinned, it often shows up as raised, reddish, or salmon-colored patches with white scales. On darker skin, the patches may be purple and the scales gray. It can be a single patch or several and can even affect your entire scalp. It can also spread to your forehead, the back of your neck, and behind and inside your ears.

You can't catch scalp psoriasis from another person. As with other types of psoriasis, we don't know what causes it. Doctors believe it comes from something wrong with your immune system that causes skin cells to grow too quickly and build up into patches. You may be more likely to get scalp psoriasis if it runs in your family.

About half of the estimated 7.5 million Americans with psoriasis — which can affect any skin surface — have it on their scalp. Sometimes, the scalp is the only place they have it, but that's uncommon.

Scalp psoriasis can be mild and almost unnoticeable. But it can also be severe, last a long time, and cause thick, crusted sores. Intense itching can affect your sleep and everyday life, and scratching a lot can lead to skin infections and hair loss.

 

 

Scalp psoriasis happens when your immune system mistakenly attacks your skin cells. This attack causes your body to produce new skin cells more quickly than normal, as often as ten times faster. Now, instead of taking weeks to form, new skin cells appear in days. The body doesn’t get rid of the extra skin cells, too, which build up on your scalp. These piled-up skin cells cause the patches and flaking you see in psoriasis.

Psoriasis runs in families, so you might be more prone to having it if your parent has it. But you might not have it even if you have genes linked to an increased risk of psoriasis. You may also have psoriasis when you don’t have these genes.

Psoriasis can be triggered by or get worse with

  • Infection
  • Stress
  • Alcohol
  • Tobacco
  • A cut, sunburn, or other skin injury
  • Cold, dry weather
  • Medicines like prednisone and hydroxychloroquine

Symptoms of mild scalp psoriasis may include only slight, fine scaling. Symptoms of moderate to severe scalp psoriasis include:

  • Red or purple bumpy patches
  • Silvery-white or gray scales
  • Dandruff-like flaking
  • Dry scalp
  • Itching
  • Burning
  • Soreness
  • Hair loss

If you have any of these symptoms, see your doctor or dermatologist. They may simply take a look or do a skin biopsy to rule out similar conditions like seborrheic dermatitis.

Scalp psoriasis hair loss

Scalp psoriasis itself doesn’t cause hair loss. But scratching a lot or picking at the scaly spots, harsh treatments, and the stress that goes along with the condition can lead to temporary hair loss. Fortunately, your hair usually grows back after your skin clears.

Inflammation from scalp psoriasis can also weaken hair roots and make them fragile. Hair can fall out with even a little stress, disturbance, or damage.

Plaque psoriasis is the most common type of psoriasis and the one that often appears on the scalp. It causes raised red patches and silvery white scales on the skin. Besides the scalp, you might also find it on your elbows and knees.

Other types of psoriasis include 

  • Guttate psoriasis, which often affects your torso or trunk and arms and legs.
  • Pustular psoriasis, commonly found on your hands and feet. 
  • Inverse psoriasis, typically seen in folds of skin under the breast, armpit, or groin. 
  • Erythrodermic psoriasis is a rare but serious type of psoriasis that affects almost every body part.

Your doctor can diagnose scalp psoriasis by looking at your scalp. They’ll look at the size, shape, and how much is on your scalp. They may also ask questions about

  • Your symptoms
  • Medical history
  • Family history of psoriasis.  
  • When you first noticed your symptoms
  • How itchy or painful it is
  • How often it appears, and whether it goes away
  • Any previous psoriasis diagnosis and the kind of treatment you got 
  • Other conditions you have
  • Medicines you might be taking

They may also take out a small skin sample to examine under a microscope. This test is called a biopsy, and they’ll use it to confirm that it is scalp psoriasis and not some other skin disorder like eczema.

Scalp psoriasis vs. dandruff

Dandruff is a common condition that also affects the scalp. When you have it, you’ll have tiny bits of dry skin flakes on your scalp. Your scalp may also itch.

Dandruff may happen when you have oily, irritated, or dry skin. It may also occur when you use hair care products that your scalp is sensitive to. Other health conditions, including psoriasis and eczema, may also cause it. 

Psoriasis also causes flaking and itching that comes with dandruff, but you’ll also have other symptoms like red or purple bumpy patches, soreness, and burning. Psoriasis only happens when your immune system attacks your skin cells. Unlike dandruff, it doesn’t have an obvious trigger.

Scalp psoriasis vs. seborrheic dermatitis

Like scalp psoriasis, seborrheic dermatitis is another common skin condition involving the scalp. It also causes scaly, crusty patches, flakes, and itching on your scalp. However, unlike scalp psoriasis, you won’t see symptoms outside your hairline. It's also easier to treat. 

On the other hand, psoriasis tends to cause thicker and drier patches on the skin. You might notice these patches not only on your scalp but also on areas like your elbows, knees, or lower back.

No one knows what causes seborrheic dermatitis, but dermatologists think it’s linked to a type of yeast that lives on the skin and the oil your skin makes. Psoriasis is related to the immune system working unusually.

Your doctor can tell if you have scalp psoriasis or seborrheic dermatitis by looking at your scalp.

The first line of defense is treatment you use directly on your skin (topical treatments). These include medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. You can get some of these products over the counter (OTC), but stronger ones require a prescription.

Prescription products for scalp psoriasis may have higher concentrations of FDA-approved medications, such as:

  • Anthralin, an older prescription medication
  • Antimicrobials, which treat bacterial or yeast infections that can come with scalp psoriasis
  • Calcipotriene and betamethasone dipropionate (a vitamin D derivative combined with a strong steroid)
  • Calcipotriene, a strong derivative (different form) of vitamin D
  • Other topical steroids
  • Roflumilast (Zoryve)
  • Tapinarof (Vtama)
  • Tazarotene, a derivative of vitamin A

If you have mild scalp psoriasis in a few areas, your doctor or dermatologist may consider intralesional steroid injections. They'll use a small needle to inject medication into scalp plaques to reduce inflammation. You can have this procedure at the doctor's office.

If your symptoms don't respond to topical treatments, phototherapy with a laser or non-laser light source may help. For example, an excimer laser focuses high-intensity light on affected areas and avoids the surrounding healthy skin.

Ultraviolet (UV) light — sometimes delivered with a handheld device called a UV comb — can be used to treat the entire scalp. Hair can block the light from reaching your scalp, so if you have thick hair, it may help to part it in rows. If you have very thin hair or a shaved head, your doctor may recommend that you go out in natural sunlight for brief periods.

If you have moderate to severe scalp psoriasis, your doctor may prescribe a drug you take by mouth or one that's injected or pumped through a needle into a vein. Oral medications include:

Because these medications can cause serious side effects, including liver damage, they require a doctor's close watch. It's also important to know that oral vitamin derivatives are different from — and more powerful than — vitamin supplements you can buy OTC. Ordinary vitamin A and D supplements do not help.

The latest class of FDA-approved medications is called biologics. These drugs, which you get by injection or IV, may keep your skin from making too many cells. According to the American Academy of Dermatology, these biologics may work:

Tumor necrosis factor blockers

TYK2 inhibitor

Interleukin (IL)-23 inhibitors

IL-17 inhibitors

IL-12 and IL-23 inhibitor

The first line of defense is treatments you use directly on your skin (topical treatments). These include medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. You can get some of these products over the counter, but stronger ones require a prescription.

Over-the-counter products often contain one of two medications approved by the FDA for psoriasis:

Salicylic acid is a peeling agent available in over-the-counter (OTC) and prescription shampoos and soaps. It can soften scales, making them easier to remove.

Coal tar products are available OTC as shampoos, creams, gels, ointments, foams, and soaps. They can help slow skin growth and reduce inflammation, itching, and scaling. To apply a coal tar shampoo, massage it into the scalp and leave on 5 to 10 minutes before rinsing out. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can help against the odor of tar shampoo.

To work, these treatments must be put on your scalp, not just your hair. Follow the directions exactly until your skin heals, which can take 8 weeks or more. Once your psoriasis has cleared, you can help keep it from coming back by shampooing regularly or twice weekly with a product that has coal tar or other medications.

To ease itchiness:

  • Use a conditioner after shampooing.
  • Limit hot tools for hair styling.
  • Use wet towels, cold packs, or cold water on itchy spots.

Scalp psoriasis shampoo

A medicated shampoo containing active ingredients like salicylic acid, corticosteroids, coal tar, menthol, or phenol creams can help relieve psoriasis symptoms. You can use these daily for scalp plaques but follow the directions.

If your scalp psoriasis doesn’t go away with other treatments, your dermatologist may recommend using a shampoo with an active ingredient called clobetasol propionate. Clobetasol propionate works well for scalp psoriasis when used in a shampoo. You can use it once or twice daily for four weeks to start, then continue it once or twice weekly. But follow your dermatologist’s instructions on how to use it.

If your scalp psoriasis becomes infected, you may have crusting, discoloration, warmth, tenderness, and sometimes swelling of your lymph nodes. Your doctor may prescribe an antibiotic to treat the infection.

There is no cure, but many treatments can help cut down on the number of flares you have and ease symptoms when they do happen. People who follow their treatment plan rarely have to endure severe scalp psoriasis for long.

Psoriasis support groups can also offer valuable tips to help medical treatments work better and ease the stress and sadness that this common condition can cause.

Having scalp psoriasis can feel like a heavy burden on you, especially when you always have to treat it with OTC or prescription medications. If your symptoms are visible to others, it can feel embarrassing and affect how you see yourself and your confidence and self-esteem.

However, you can learn to manage your symptoms better and feel more confident in your everyday life. Here are some helpful tips.

  • Educate yourself about your scalp psoriasis case. You can ask your doctor how serious your symptoms are, whether they are mild, moderate, or severe. Also, ask them about all available treatment options, the best treatment plan for your case, and how to prevent flare-ups. You can also do your own research by reading up on the conditions on websites like the National Psoriasis Foundation and American Academy of Dermatology Association
  • Engage in activities that help you relax and reduce your stress levels, like journaling, meditation, and walking. Stress can trigger flare-ups and worsen symptoms. 
  • Try to eat a healthy, well-balanced diet, stay physically active, and prioritize your sleep health.
  • Join support groups to meet other people with your condition who you could learn from and talk to. You can find support groups on the National Psoriasis Foundation and Psoriasis Association.   
  • You can also cover your hair with clothing items like a hat or scarf if that makes you feel more confident or comfortable.
  • Follow your doctor’s recommendations for managing your symptoms as strictly as possible.
  • Reduce sun exposure and wear sun-protective clothing and sunscreen during the day.
  • Moisturize your scalp often and avoid using harsh hair care products on it.

Scalp psoriasis is a common skin disorder that can cause annoying symptoms like itching and soreness. It can also change how your hair and scalp look. A doctor can usually diagnose it by looking at your scalp and asking about your personal and family health history. Your doctor will likely first recommend OTC treatment options that you use on your skin. But if your symptoms stay the same or worsen, they may move you to prescription options that you also use on your skin or take by mouth. There’s no way to prevent the condition, but seeing a doctor as soon as you notice your symptoms might help keep it in check quickly.

Do I have dandruff or psoriasis?

If it only causes itching and flakes on your scalp without other symptoms, it could be dandruff. If you notice other symptoms like bumpy patches, dry scalp, burning, soreness, and hair loss, it might be psoriasis. See a doctor, who may tell you for sure which you have.

What deficiency causes scalp psoriasis?

Vitamin D deficiency is tied to scalp psoriasis, as people with psoriasis often have this deficiency.

What triggers psoriasis on the scalp?

Psoriasis on the scalp and other body parts may be triggered by infection, stress, taking too much alcohol, scalp injury, and sunburn.

What is the root cause of scalp psoriasis?

The root cause of scalp psoriasis is linked to the immune system attacking your skin cells. 

How do I make my scalp psoriasis go away?

There is no way to cure scalp psoriasis permanently, but you can manage it with over-the-counter and prescription treatments.

How often should you wash your hair with scalp psoriasis?

You can gently wash your hair daily. But you can talk to your doctor about how often to wash your hair in your case.

Can you reverse scalp psoriasis hair loss?

Yes, you can reverse scalp psoriasis hair loss by treating your psoriasis symptoms and avoiding products that dry up or irritate your scalp, like hair color and sprays. 

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