Beauty

Scalp psoriasis. Treatments and tips for scalp psoriasis

Psoriasis is a chronic inflammatory skin condition, characterized by the appearance of skin lesions with a clinical appearance that is easily differentiated from other skin conditions. Several types of psoriasis can be distinguished, the most common form being psoriasis vulgaris, which affects around 80-90% of people with psoriasis. In turn, psoriasis vulgaris can be differentiated into several subtypes. One of these subtypes is scalp psoriasis, which, as the name suggests, predominantly affects the scalp. In some cases, scalp psoriasis can occur either in isolation, or when it affects only the scalp, but it can also occur in association with other forms of psoriasis.

Scalp psoriasis – causes and risk factors

The causes that lead to psoriasis of the scalp are the same that lead, in general, to psoriasis vulgaris. In essence, it is an autoimmune condition mediated by T lymphocytes, which leads to the alteration of several physiological mechanisms, such as the proliferation of keratinocytes. In the case of scalp psoriasis, the keratinocytes multiply excessively, requiring approximately 3-4 days to complete a complete renewal cycle of the superficial layer of the skin. In healthy people, such a cycle lasts approximately 30 days. This is the reason why skin plates appear with a specific appearance, covered with scales (dead cells) white-silver, which have various sizes.

Although the causes that lead to scalp psoriasis are not fully known, it is considered to be the synergy between several triggering factors, such as:

  • Stress;
  • Infections (especially streptococcal ones, such asStreptococcus pyogenesinfection );
  • Skin trauma: psoriatic lesions can appear in the place where the trauma occurred, which is also valid in scalp psoriasis (scalp scratching, burns produced by used cosmetic products, irritations). The appearance of psoriatic lesions after skin trauma defines the so-called Köbner phenomenon;
  • Hormonal changes (especially those within hormonal treatments);
  • HIV infection;
  • Obesity;
  • Smoking and alcohol consumption;
  • Certain drug treatments (antimalarials, beta-blockers, lithium salts, along with different types of antibiotics and non-steroidal anti-inflammatory drugs);
  • Ultraviolet radiation;
  • Chronic stress.

Psoriasis presents itself with chronic inflammation, which is why people with this condition are prone to various complications. For example, psoriatic arthritis is one of the most common associated complications. Chronic inflammation also increases the risk of cardiovascular diseases, but also metabolic diseases.

Scalp psoriasis – symptoms and manifestations

Scalp psoriasis presents itself mainly with erythematous, red, thickened plaques and plaques with pearly scales. They are well-defined and can vary in size from a few millimeters to a few centimeters (even ten). Symptoms of scalp psoriasis are:

  • Erythematous plaques appear on the scalp, with uneven distribution, often covered with thick, silver scales. They are clearly delimited from the rest of the healthy skin. The scales can be removed with difficulty and when they are detached, they leave behind an erosive area that can bleed. Scales can accumulate, taking on the appearance of asbestosis pityriasis;
  • Itching is a common symptom in scalp psoriasis, although it occurs less often in other forms of psoriasis. The itching and discomfort are intense, which causes the person with scalp psoriasis to scratch excessively, aggravating the inflammation. Sometimes, people also feel the sensation of burning on the scalp;
  • Hair loss is common. It is not scalp psoriasis itself that causes cicatricial alopecia, but aggressive scratching, excessive application of topical treatments, or severe inflammation. However, the hair loss is temporary, and the hair grows again after the disappearance of the psoriatic lesions and the effective control of the inflammation;
  • In more severe cases, scalp psoriasis can go beyond the hairline, in which case it also affects the forehead, neck or the area behind the ears. This extension can have major implications from a psychological point of view, as the appearance given to the skin is often repulsive. In such cases, the person with scalp psoriasis becomes depressed and anxious, facing social stigmatization.

Scalp psoriasis and seborrheic dermatitis are often confused. Psoriatic lesions have a different appearance and also much thicker scales. Seborrheic dermatitis can resemble psoriasis, but the scales formed on the surface of the lesions are smaller.

Scalp psoriasis treatment

Treatment of scalp psoriasis is generally the same as for other forms of psoriasis. It should be mentioned that scalp psoriasis is a recurrent-remitting condition, with episodes of exacerbation and attack, followed by improvement of symptoms and so on. Current treatment strategies include:

Topical treatment

Topical treatment for scalp psoriasis is considered first-line. Several types of scalp psoriasis ointments, shampoos and foams have been formulated, which contain:

  • Topical corticosteroids that reduce inflammation and itching. However, long-term use has the potential to lead to skin atrophy and other adverse effects, which is why they are often used in short-term treatment cycles for scalp psoriasis;
  • Creams containing vitamin D analogues, which inhibit the hyperproliferation of keratinocytes;
  • Shampoos and ointments with coal tar, to reduce scaling and itching. Although its effectiveness is lower than that of other modern therapies, it is usually used in combination with other treatments for scalp psoriasis.

Phototherapy

Narrow-band UVB phototherapy is an effective treatment option for scalp psoriasis. Phototherapy reduces skin inflammation and inhibits the excessive proliferation of keratinocytes. However, scalp phototherapy can be difficult due to the presence of hair, which will play the role of a mechanical barrier to ultraviolet radiation. Special devices, such as UV combs, could deliver ultraviolet radiation directly to the scalp.

Systemic treatment

It involves the oral administration of certain drugs such as methotrexate, ciclosporin or acicretin. Biological therapy involves the administration of TNF-α inhibitors (adalimumab or etanercept), IL-17 inhibitors (secukinumab, ixekizumab) and IL-23 inhibitors (tildrakizumab or guselkumab). Of all the treatments for scalp psoriasis, the biological ones are among the most modern and have particularly good results. However, their accessibility is relatively limited and, therefore, they are not as easily available as the classic treatment alternatives.

How to manage scalp psoriasis

Effective management of scalp psoriasis requires a multilateral approach, which includes both medical treatments and lifestyle changes. Thus, specialists recommend:

  • Maintaining scalp hygiene, according to the doctor’s recommendations, using special lotions, creams and shampoos, such as those with coal tar, ketoconazole;
  • Hair should be washed with warm water, not hot;
  • Avoiding excessive scratching, the use of combs or hard, aggressive brushes, which could further damage the scalp;
  • It is recommended to avoid the use of aggressive cosmetic products (hairspray, hair dye), because they can cause additional irritation and exacerbate symptoms;
  • Adopting effective methods to manage daily stress;
  • Adopting a balanced diet, rich in omega-3 fatty acids, natural antioxidants, but also vitamin D could have a beneficial effect on psoriasis;
  • Avoiding factors that are known to exacerbate the symptoms of the condition (alcohol consumption, smoking, certain foods, stress or excessive exposure to the sun);
  • Periodic consultation with the dermatologist to monitor the evolution of the disease and the response to the previously indicated treatment.

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