Overview

Treating scalp psoriasis

Psoriasis is a skin condition that can affect any part of the skin surface. It commonly appears on the elbows, knees, and scalp. It usually appears as red, raised, scaly patches of skin, known as plaques.

This information is about how to treat psoriasis on your scalp. The scalp is the top of your head where hair grows.

Psoriasis is pronounced ‘suh-ry-uh-sis’.

How scalp psoriasis affects you

Scalp psoriasis can affect your hairline, forehead, behind your ears, and the back of your neck. It can range from mild and fine scaling, to very severe thick scaling. It can cover your entire scalp too.

It can sometimes cause hair loss, but your hair will normally grow back when the inflammation and scaling clears.

Psoriasis can be itchy, and can make your scalp feel tight and uncomfortable. Some people feel embarrassed by their psoriasis, especially if the scaling is easy to see. It’s normal to feel this way.

Difficulty treating scalp psoriasis

Scalp psoriasis can be more difficult to treat than psoriasis on other parts of the body. This is because your hair can get in the way of the area that needs treatment and can trap the scale so it’s less likely to rub off. 

The scale can build up more quickly, causing a thicker plaque. It can be difficult to see psoriasis on the scalp, so it is harder to apply the treatment.

Treatments for scalp psoriasis

Psoriasis treatment is different for each person. Your doctor will consider your hair type, hair styling practices, lifestyle, routines, and any physical limitations.

There is no cure for psoriasis, but the symptoms can usually be well controlled with a good treatment plan. In more severe cases, you might need to speak to a doctor about alternative treatment options.

There are different types of treatment, in forms such as a:

  • gel
  • mousse
  • shampoo
  • lotion
  • ointment

This means you can apply them to your scalp more easily.

Treatments containing liquid paraffin are a fire hazard and materials that may have become soaked in the treatment should be kept away from naked flames.

Important

Some treatments should not be used during pregnancy or breastfeeding, so before you use them, always check with your doctor or pharmacist.

Potent topical steroids

Potent topical steroids are commonly prescribed to treat scalp psoriasis. Examples include Locoid® scalp lotion and Diprosone® lotion.

You will use this treatment for only a few weeks at a time to control your psoriasis. You can then gradually stop using it. After this, you can change to using a coal tar shampoo or emollient.

Sometimes steroids become less effective after repeated use. You might need to try a different treatment if this happens.

Do not use potent topical steroids on your face and ears.

Vitamin D treatments

Vitamin D treatments can be prescribed as ointments, gels, or lotions. Examples include Curatoderm® lotion and Dovobet® gel.

You will apply these 1 or 2 times a day, and they do not need to be washed out. They do not smell or stain clothes, and are easy to use. They can be used to control your psoriasis.

Vitamin D treatments are generally safe on other areas of skin, like your forehead. They might cause irritation, so try testing a small patch of skin before applying to your entire scalp. Do not get this in your eyes.

Do not use Dovobet gel or Enstilar® lotion on your face or behind your ears. This is because they contain steroids.

Coal tar products

Coal tar products are available without a prescription. They are commonly used to treat scalp psoriasis, and can be used on your hairline, forehead and around your ears. Examples of coal tar products include Exorex® lotion, Psoriderm™ scalp lotion, and Sebco™ ointment.

You can use coal tar products at the same time as other medicines, like salicylic acid or coconut oil, to help remove scale. Tar is effective at treating scalp psoriasis, but it can stain clothes and jewellery. It also has a strong smell.

Coal tar products are usually massaged into the scalp and then left for 1 to 2 hours, then washed off. The instructions for use will depend on the product, so ask your nurse, doctor, or pharmacist how to use them safely and effectively.

You can wear a shower cap while the product is in your scalp, to stop clothes and bedding from staining.

Coal tar and medicated shampoos

Coal tar and medicated shampoos are used for treating scalp psoriasis. It might be your only treatment for scalp psoriasis if you only have mild flaking. You might want to use your normal shampoo after tar shampoo to reduce the smell of tar.

There are several coal tar and medicated shampoos available to buy without a prescription from your pharmacy. Speak to a pharmacist for advice on which one to buy.

If you use a coal tar shampoo, you will need to massage it into your scalp and leave it for 5 to 10 minutes before rinsing out.

If you have severe scalp psoriasis, you’ll usually be prescribed other treatments alongside coal tar or medicated shampoos.

Applying scalp psoriasis treatment

It might be useful to ask someone to help you apply the treatment. If you do it yourself, try to feel where the psoriasis is on your head. You might feel a rough patch, tightness, or crusting if the plaques are raised.

Try to make sure the treatment does not get onto your face or behind your ears, as the skin is thinner and might damage easily.

It’s important to wash your hands after using these treatments so that you do not spread the treatment to other places by mistake.

Treatment length

It can take at least 8 weeks to control your psoriasis well. This is for any treatment you use. If your scalp is not showing any improvement after 4 weeks of treatment, you should speak to your GP or nurse.

Remember to try and treat your psoriasis every day when it’s active.

When your scalp is clear, it’s important to maintain this by using tar shampoo or moisturising your scalp regularly with an oil or emollient. This will help if your scalp is becoming dry or mildly scaly.

If you cannot control your scalp psoriasis, you might need nurse-assisted scalp treatment. This takes place in a specialist treatment centre. In rare cases, you might need to take tablets.

Other ways to remove thick scale  

Emollient ointments or oils can be used to soften thick scale. They can be used before using prescribed treatments.

Your prescribed treatments will work better if the scale is removed first, because it’s easier for them to get into the area to be treated.

You can use oils such as peanut oil, olive oil, or coconut oil. You can also use an emulsifying ointment which are available to buy from pharmacies.

Instructions for removing thick scale

  1. Massage the oil or ointment into your scalp, section by section, avoiding too much going into your hair.
  2. Wrap your scalp in a towel, shower cap, or cling film. Leave for 1 hour, or overnight if you want to.
  3. After this, you can wash your hair with normal or tar shampoo.
  4. If you have long hair, comb it through. While your scalp is still damp, gently remove scale where it’s softened and loose. You might find it easier if someone helps you with this.
  5. Continue to remove scale using a plastic, fine-tooth comb. Use this flat against your scalp, while gently rotating it in a circular motion. Do not remove scales too aggressively, as this can damage the skin and cause hair loss.
  6. Shampoo and wash away any scaling from the scalp, and remove any oil or ointment from your hair. You might need to wash your hair again.
  7. Use a hairdryer to dry your hair on a cool or low heat setting.

Useful sources of information

The Psoriasis and Psoriatic Arthritis Alliance have information about all aspects of psoriatic conditions.

Resource number: 4397/V3
Date published: January 2025
Review date: January 2028
 

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