Psoriasis on the scalp: symptoms and treatment

Psoriasis on the scalp is a chronic and recurrent inflammatory dermatosis. It is characterized by the presence of delimited erythematous plaques and white flaking. The plaques are usually located in the flexor areas of the limbs and on the scalp.

Causes of psoriasis on the scalp

It is considered a disease of great clinical variability and for that reason, it depends on the combination of different factors.

Genetic and immune factors

There are studies that show prevalence of psoriasis in relatives of those affected. However, the development of cellular immunology indicates the involvement of leukocytes in the pathogenesis of the disease.

Environmental factors

There are several factors that are related to the onset or outbreak, in particular in genetically predisposed people. These factors include:

Likewise, Any irritation of the skin can cause the appearance of psoriatic lesions. Stimulation such as scraping or pressing clothes can cause or aggravate existing injuries.


As for the drugs that can trigger or aggravate psoriasis There are lithium salts, beta-blockers, antimalarials and the sudden suspension of corticosteroid treatments.

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Obesity and smoking

Another important factor to consider is obesity. The relationship between psoriasis and obesity is bidirectional. Obesity predisposes to psoriasis and psoriasis favors obesity. With regard to tobacco use, chronic smoke inhalation alters many inflammatory processes, including the immune response.

Infectious factors

There is a relationship between infection by group A beta hemolytic streptococci and people who have a first outbreak of psoriasis. Especially when the outbreak appears in the oropharynx.

What are the symptoms of psoriasis on the scalp?

Psoriasis on the scalp presents a wide range of symptoms. There is great variability among the people who suffer from it, even in the same person.

The appearance may vary from papules to large scaly plaques. They usually do not generate alopecia. The area where the plaques appear most frequently, is the occipital region and can reach the forehead.

Itching is not a characteristic symptom. But nevertheless, scratching the scales can lead to bleeding. The diagnosis of scalp psoriasis is based on the presence of erythematous plaques with scales.

To evaluate the severity of psoriasis, morphological criteria are used. One of them is the psoriasis area and severity index. This index allows measuring the extent of the lesions, the degree of erythema and scales.

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However, since it is a chronic pathology, The objective is the control of psoriasis of the scalp. The affectation of this area is frequent and difficult to treat.

Topical treatment

The basic pillar of the treatment is topical treatment. Classic treatments include:

  • Emollients: they are used in combination with pharmacological treatment. They help maintain hydration and good condition of the stratum corneo of the skin. In this group are 20% urea, Vaseline and glycerin.
  • Keratolytics: they are used to eliminate rough plates. In addition, they favor the absorption of other topical products. Salicylic acid is usually used in shampoos and hair oils. Other keratolytics used are 10-30% urea, rectified acid, sulfur and keluamide.
  • Coal area: coal pitch reduces the thickness of the epidermis. It is indicated in children and when there are stable plates. Although it does not present systemic toxicity, it can be irritating.
  • Topical corticosteroids: it is the treatment of first choice in mild cases. They have anti-inflammatory and immunosuppressive action.

Systemic treatment of psoriasis on the scalp

It is used in cases where topical treatment does not respond in a satisfying way. The drugs include:

  • Methotrexate: This drug is indicated in the moderate and severe forms of psoriasis.
  • Ciclosporin: it is an immunosuppressant that inhibits the production of T-dependent antibodies.
  • Acitretin: It is a derivative of vitamin A. It has an inhibitory effect on psoriasis, including keratolytic disorders.