Scalp psoriasis is a chronic inflammatory disease that affects the scalp, forehead, back of the neck or back of the ears. Dandruff-like flakes and thick, whitish scales appear on these areas, causing itching, scaling and, in the most severe cases, scarring alopecia. There is a wide range of local, systemic and disease-modifying treatments available to manage flare-ups of the disease without eliminating it permanently.
What is the goal of a scalp psoriasis treatment?
The objective of a scalp psoriasis treatment is to:
- calm the itching, which can be very severe and difficult to live with on a daily basis
- control the multiplication of keratinocytes, the cells that make up 90% of the surface layer of the epidermis and which renew themselves very quickly in the case of psoriasis (4 to 5 days compared to the usual 28)
What medications are recommended for scalp psoriasis?
Research has progressed considerably in recent years and there are now many medications available to effectively treat scalp psoriasis flare-ups.
For localized psoriasis, the dermatologist will only prescribe local treatments, such as:
- Dermocorticoids: dermocorticoid-based lotions and shampoos will be used to fight the inflammation caused by the disease. Since there are some side effects and a risk of addiction, their use must be limited in time and restricted to daily application.
- Vitamin D3 analogues: this is often the first treatment suggested by the doctor, as they slow down the multiplication of keratinocytes. The ointment is applied to the lesions once or twice a day depending on the analogues. They are often combined with dermocorticoids.
- 10% salicylic acid: this is used to dissolve the superficial layer of the epidermis that has become too thick. It can be used in combination with petroleum jelly to remove the most scaly lesions and is often an important prerequisite for the application of any other local treatment.
- Tazarotene: this is a topical retinoid derived from vitamin A. It is used for very localized psoriasis, but is strictly forbidden for pregnant women.
Another way to fight psoriasis is phototherapy. There are two types of phototherapy, both of which are equally effective:
- Puvatherapy: the patient is exposed to UVA light in a cabin. Puvatherapy is used in combination with a psoralen which has a photo-sensitizing effect. The patient must attend three sessions per week for two months. Over time, the lesions caused by psoriasis will disappear.
- UVB phototherapy: the patient is exposed to ultraviolet rays (closer to the sun’s rays). No additional medication is required and the frequency of sessions is the same as for puvatherapy.
If the psoriasis is severe or irreversibly damages the hair follicles, the dermatologist may suggest a systemic treatment, for example:
- Retinoids: these chemical derivatives of vitamin A are administered orally once a day (young women that do not use contraception should not take it for up to two years after stopping the treatment)
- Methotrexate: this is an antiproliferative drug that prevents the multiplication of keratinocytes. It is taken once a week in the form of tablets or intramuscular or subcutaneous injections.
- Ciclosporin: this tablet is taken orally every day. The duration of the treatment cannot exceed one to two years because of increased renal risks.
In cases of moderate or severe psoriasis and if the patient has not responded well to two other treatments (such as phototherapy, ciclosporin, methotrexate), the doctor may prescribe biomedicines, such as:
- Anti-TNF drugs that block the effects of pro-inflammatory proteins
- Interleukin inhibitors (such as utekinumab) that inhibit the activity of interleukins IL 12 and IL 23
Biomedicines are new, expensive, but effective treatments. They can only be taken in a hospital.
How to prevent recurrences?
Here are a few good practices that are easy to implement and that can act on the factors that trigger psoriasis, thus helping to reduce the risk of recurrence:
- a varied and balanced diet
- avoid alcohol, refined sugar, coffee and spicy food
- reduce stress (relaxation, meditation, sophrology, yoga)
- avoid taking beta blockers or anti-malarial drugs as much as possible
- use a mild shampoo that is less irritating to the scalp
- let your hair dry in the open air
- avoid headbands, hats or caps, especially in hot weather
- brush your hair gently
- avoid tight hairstyles