Scalp Psoriasis

Understanding Psoriasis of the Scalp

Psoriasis is a chronic inflammatory skin condition that can affect many areas of the body, including the scalp.

Scalp psoriasis can range from small areas of relatively fine scaling to thick, well-defined plaques affecting large areas of the scalp.

It may also extend beyond the hairline onto the forehead, behind the ears or towards the back of the neck.

While psoriasis does not usually permanently destroy the hair follicles, severe inflammation, scratching and removal of thick scale can sometimes contribute to temporary hair loss.

What Does Scalp Psoriasis Look Like?

Scalp psoriasis varies considerably in severity.

Possible features include:

• Clearly defined areas of scaling
• Thick or layered scale
• Red, inflamed or discoloured skin
• Persistent flaking
• Itching
• Tightness or discomfort
• Soreness
• Crusting in more severe cases

Depending on skin tone, inflammation may not always appear bright red and can instead look darker, purple, grey or altered in colour compared with the surrounding skin.

Some patients have psoriasis confined mainly to the scalp, while others also have plaques elsewhere on the body or changes affecting their nails.

What Causes Psoriasis?

Psoriasis is an immune-mediated inflammatory condition.

It causes skin cells to be produced and replaced much faster than usual, leading to the characteristic build-up of scale and plaques.

Genetic susceptibility is important, and psoriasis can run in families.

Individual flare-ups may also be influenced by a range of factors, which can differ considerably between patients.

Psoriasis is not contagious and cannot be passed from one person to another.

Scalp Psoriasis and Hair Loss

Hair loss associated with scalp psoriasis is usually temporary rather than scarring.

Shedding or breakage may occur as a result of significant inflammation, repeated scratching or vigorous attempts to remove adherent scale.

Once the scalp inflammation has settled, the affected hair will generally have the opportunity to recover.

However, noticeable hair loss should not automatically be assumed to result from psoriasis.

If thinning is persistent, follows an unusual pattern or continues despite improvement in the scalp condition, another type of hair loss may also be present and should be assessed separately.

Psoriasis or Seborrhoeic Dermatitis?

Scalp psoriasis and seborrhoeic dermatitis can sometimes look similar.

Both can cause:

• Flaking
• Scale
• Redness or inflammation
• Itching
• Scalp discomfort

Psoriasis often produces more clearly defined and thicker plaques, whereas seborrhoeic dermatitis commonly produces finer or greasier scaling in sebaceous areas.

Some people can show features of both conditions.

Where the diagnosis is uncertain, appropriate medical or dermatological assessment may be recommended rather than attempting to identify the condition from symptoms alone.

Assessment at YT Medical

Where scalp psoriasis is present alongside concerns about hair loss, our focus is on understanding both elements of the presentation.

Assessment may consider:

• The location and extent of the scalp changes
• The character of the scale
• Inflammation and scalp condition
• Itching, soreness or tenderness
• Hair shedding and breakage
• Changes in hair density
• Previous diagnoses and treatments
• Psoriasis elsewhere on the body
• Relevant medical history

Digital trichoscopy can allow closer examination of the scalp and follicles where appropriate.

If psoriasis is extensive, difficult to control or requires medical management beyond the scope of the clinic, appropriate GP or dermatological care may be recommended.

Managing Scalp Psoriasis

Treatment depends on the severity and extent of the psoriasis.

Medical management may involve treatments designed to soften and remove scale, control inflammation and reduce excessive skin-cell turnover.

Different topical preparations, medicated shampoos and prescription treatments may be used according to the individual presentation.

More extensive or treatment-resistant psoriasis can require specialist dermatological management.

It is important to follow the instructions provided with prescribed treatments, particularly because products designed for the scalp may not be suitable for surrounding facial skin.

Removing Scale Safely

Thick scalp scale can be frustrating, particularly when it becomes caught within the hair.

However, aggressively picking, scratching or forcibly removing plaques can damage the scalp and contribute to temporary hair loss.

Where scale needs to be loosened, this should be done gently and in accordance with appropriate treatment advice.

The aim is to manage the underlying inflammation rather than repeatedly removing visible scale without addressing its cause.

Psoriasis and Wider Health

Psoriasis is more than a cosmetic scalp concern.

Some people with psoriasis can also develop inflammation affecting the joints, known as psoriatic arthritis.

Patients experiencing persistent joint pain, swelling or stiffness alongside psoriasis should therefore discuss this with an appropriate medical professional.

More widespread or severe psoriasis may also require care beyond treatment of the scalp itself.

Hair Restoration and an Inflamed Scalp

Where somebody is considering hair-restoration treatment, the health of the scalp matters.

Active or poorly controlled psoriasis may influence the timing or suitability of certain elective scalp treatments.

Our priority is therefore to understand and appropriately manage significant inflammation before progressing with procedures that could further irritate the affected skin.

Where separate pattern hair loss or another form of alopecia is also present, this can then be considered as part of the wider treatment plan.