Is Your Dandruff Actually Scalp Psoriasis?

“I usually recommend treating scalp psoriasis from the outside first,” Dr. Bhutani says, explaining that she often prescribes topical corticosteroids first. Although topical treatments are very effective for short-term management of scalp psoriasis flare-ups, if the symptoms are severe or if the plaques spread to other areas of the body, additional treatment may be needed.

“If we’ve given it a good go with the topicals and we’re still not getting enough relief, I will talk to patients about systemic therapies, where we treat the psoriasis from the inside out,” Dr. Bhutani adds. “Because scalp psoriasis is so visible, I won’t wait too long to initiate systemic therapy if someone is really affected by their psoriasis.” (Dr. Bhutani notes this approach is of special consideration for some people of color, whose hair can be damaged from frequent hair washing required with using topical treatments.) Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.

Do scalp psoriasis home remedies work?

How you take care of your hair and scalp can have a big impact on your scalp psoriasis flare-ups. In addition to the treatment plan your doctor recommends, you may want to try some of the following tips at home12:

Skip styling tools when possible: Since heat can further dry out your scalp and exacerbate symptoms, it’s best to avoid blow-drying, curling, and straightening tools if you can. When brushing your hair, use gentle pressure to avoid further irritation. If you have natural hair and are used to consistent styling that requires heat, talk to your dermatologist or stylist to figure out a plan that reduces the risk of potential flare-ups while maintaining the health of your hair.

Avoid the tight up-do: If you have longer hair and have hair loss, you may also want to avoid pulling it back tightly in a ponytail, since that can pull on the already-fragile scalp and possibly lead to more hair loss. If you must pull your hair back, keep the hair low and loose to prevent excess tugging.

Choose hair products wisely: Using certain hair products, such as hair dyes, can also be irritating to your scalp. Ask your dermatologist for brand recommendations or if there are ways your stylist can dye your hair that might be more gentle on your scalp.

Adjust your shower routine: Try alternating between your medicated psoriasis shampoo with a gentler cleansing wash to avoid drying out your scalp. When shampooing, be careful not to scrub or rub your scalp too vigorously. Using a moisturizing conditioner can also help prevent your hair from breaking, possibly reducing excess hair loss.

Stop scratching: Understandably, this can be really hard when the itching becomes unbearable. Noticing all of the times you scratch is the first step, Dr. Bhutani says. Once you’re aware of how often you’re scratching, try distraction techniques. “Every time you feel an itch, you can use a fidget spinner, squeeze a stress ball, or chew gum,” she suggests.

And, of course, do your best to be mindful of your triggers to avoid scalp psoriasis flare-ups as much as possible. “I tell patients to think about what is triggering their skin—things like stress,” Dr. Bhutani says. That might be easier said than done, but keeping a journal of things like your meals, weather, work events, and other daily activities can help you identify the things that make your scalp psoriasis feel worse, or help you realize when flares might happen so you can be ready with the right treatment.

Sources

1. Centers for Disease Control and Prevention, What is Psoriasis?

2. Mayo Clinic, Psoriasis

3. American Academy of Dermatology Association, Scalp Psoriasis: Causes

4. Psoriasis: Targets and Therapy, Management of Scalp Psoriasis: Current Perspectives

5. University of California San Francisco, Tina Bhutani, M.D.

6. American Academy of Dermatology Association, Scalp Psoriasis: Symptoms

7. American Academy of Dermatology Association, Can You Get Psoriasis If You Have Skin of Color?

8. International Journal of Molecular Sciences, The Genetic Basis of Psoriasis

9. Cleveland Clinic, Psoriasis

10. Mayo Clinic, Dandruff

11. American Academy of Dermatology Association Scalp Psoriasis: Shampoos, Scale Softeners, and Other Treatments

12. American Academy of Dermatology Association: Hair Styling Tips That Can Reduce Flares of Scalp Psoriasis

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