Key takeaways:
Topical treatments are typically the first step for treating scalp psoriasis symptoms.
Topical corticosteroids (“steroids”) are the most common option, as they’re effective and come in a variety of forms to choose from.
Other prescription topical treatments for scalp psoriasis include vitamin D analogues, retinoids, and tapinarof (Vtama).
Over-the-counter treatments for scalp psoriasis include coal tar, salicylic acid, and urea.
You can combine different topical treatments for an added benefit.
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Scalp psoriasis can be an itchy and irritating skin problem. The good news is that there are several different treatment options to help manage your symptoms.
In most cases, your scalp psoriasis treatment will start with one or more topical medications. But what types of topical treatments are available, and what’s the difference between them?
1. Topical corticosteroids
Topical corticosteroids (“steroids”) are a common first-choice scalp psoriasis treatment. They work to calm your immune system to help combat inflammation, itchiness, and flaky patches.
How to use
Topical steroids can irritate and thin out the skin, so it’s better not to use them long term. You may start by using a steroid once or twice a day for a few weeks to get symptoms under control. After that, you may only need to apply it a couple of times a week or you may stop it altogether. A healthcare professional will give you instructions based on your symptoms and response to treatment.
Types of topical steroids
There are a variety of topical steroids available for scalp psoriasis. They range from low to high potency (strength) products. In many cases, you’ll need a high-potency steroid to manage scalp psoriasis symptoms. Here are some common examples from strongest to weakest:
Halobetasol (Ultravate)
Fluocinonide (Vanos)
Diflorasone (Apexicon E)
Betamethasone (Diprolene)
Topical steroid formulations
Topical steroids also come in several different formulations, and each has pros and cons to consider:
Solutions (liquids) spread easily but can be messy.
Sprays are easy to apply but can drip and be messy.
Creams are easy to spread but can leave a residue behind in your hair.
Foams combine the best of a liquid and cream but tend to be more expensive.
Gels are usually clear and dry quickly, but they’re more likely to burn and sting.
Shampoos need to sit on your scalp for a few minutes, which can be inconvenient.
It may take some trial and error to find the best topical steroid for your needs. Don’t hesitate to reach out to your healthcare team if the one you’re using isn’t working for you or you’d like to try a different option.
2. Calcipotriene (Dovonex)
Topical vitamin D analogues are lab-made versions of vitamin D. It’s not entirely clear how these medications work, but they seem to reduce inflammation and help slow down the excess skin growth that leads to plaques.The main vitamin D analogue used for scalp psoriasis is calcipotriene (Dovonex, Sorilux).
How to use
Calcipotriene comes as a topical liquid, cream, and foam, and it’s usually applied once or twice a day. It’s also available in combination with the topical steroid betamethasone as a liquid, cream, and foam. This combination works better than either medication alone, and it also seems to be safe and effective for long-term use.
3. Tazarotene (Tazorac)
Tazarotene (Tazorac) is a topical prescription retinoid medication that comes in a cream or a gel. It helps control redness and swelling, and it can also reduce the formation of psoriasis plaques on your scalp.
How to use
Tazarotene can be used on its own once a day, but it’s often irritating to the skin. Combining tazarotene with a topical steroid can help lessen side effects and improve scalp psoriasis symptoms. A topical lotion that contains both tazarotene and the steroid halobetasol is available under the brand name Duobrii.
4. Tapinarof (Vtama)
Tapinarof (Vtama) is a newer plaque psoriasis treatment option. It activates the aryl hydrocarbon receptor (binding site) in the body, which helps regulate inflammation in your skin.
How to use
Vtama was officially approved for plaque psoriasis, but a recent clinical study showed that it’s very effective for plaque psoriasis symptoms on the scalp. And it doesn’t leave behind a greasy residue the way other creams can. Vtama is usually used once a day, and it seems to improve symptoms within 1 to 4 weeks. And the results often last for several months after treatment is stopped.
5. Anthralin (Zithranol)
Anthralin (Zithranol) is an older psoriasis medication. It helps reduce inflammation and slow the production of plaques, but it’s known for staining skin, clothing, and even ceramic bathtubs. So it’s not used as often now that other options are available.
How to use
Anthralin shampoo is usually left on the skin for a few minutes, and then washed off. Anthralin creams may be left on longer. All forms of anthralin can cause skin burning and irritation. Applying a topical steroid after using it can help lessen these side effects.
6. Coal tar
Coal tar is an older remedy for scalp psoriasis symptoms that may help reduce itchiness, inflammation, and plaque formation. It’s a common ingredient in over-the-counter (OTC) products for scalp issues, such as Neutrogena T/Gel or MG217.
How to use
How often and long you use coal tar depends on the type of product you’re using. A healthcare professional can tell you the best way to use it. Coal tar shampoos may have an unpleasant smell and can stain your clothes or light-colored hair. They can also make your scalp more sensitive to the sun. Coal tar is often combined with other products.
Good to know: Large amounts of coal tar were linked to an increased risk of cancer in some studies. But the amount of coal tar used for psoriasis is much lower and doesn’t seem to carry the same risk. Still, it’s best to limit how often you use coal tar products and only use them with a healthcare professional’s OK.
7. Keratolytics, like salicylic acid
Salicylic acid is a common ingredient in OTC skin care products. It belongs to a group of medications called keratolytics. It helps soften the thick, scaly patches of skin caused by scalp psoriasis. Other keratolytics include urea or alpha-hydroxy acids. Some products contain more than one keratolytic for a combined effect.
How to use
Topical salicylic acid treatments may be applied 1 to 4 times a day, while shampoos are typically only used twice a week. In some cases, you may use a keratolytic treatment along with a prescription medication or in between courses of topical steroids.
Salicylic acid treatments are available OTC, but stronger products are also available with a prescription. Examples include:
Shampoos, such as Neutrogena T/Sal or Nizoral Psoriasis
Can I cure my scalp psoriasis permanently?
No, there’s no permanent cure for scalp psoriasis (or psoriasis anywhere else). But, by sticking with a good treatment regimen, you can keep your skin clear and symptoms at bay.
What can make scalp psoriasis worse?
Scalp psoriasis may flare or worsen with certain triggers or behaviors. These are different for every person, but common ones include certain medications (like beta blockers), infections (like a strep throat), and stress.
Here are some tips to help keep your scalp psoriasis from getting worse:
Manage your stress levels. Try daily meditation or journaling to help keep stress levels low.
Limit alcohol. Try to limit — or even completely eliminate — your alcohol consumption.
Avoid foods that trigger your symptoms. Sugar, gluten, and dairy are common culprits.
Be gentle with your scalp. Avoid picking at your scalp and protect your head against sunburn. It may also be helpful to avoid dyeing your hair or using heated styling tools.
If you notice a change in your scalp psoriasis symptoms, talk with your healthcare team. They can help you determine the cause and suggest ways to manage flares in the future.
Are there other treatment options for scalp psoriasis?
Yes. There are other scalp psoriasis treatment options available if topical medications don’t work for you. These include:
Targeted ultraviolet light therapy (excimer laser)
Oral medications, like methotrexate and apremilast (Otezla)
Injectable biologic medications, like etanercept (Enbrel) and ustekinumab (Stelara)
Keep in mind that everyone responds to medications differently. It may take a few tries before you land on the best treatment regimen for your symptoms.
Frequently asked questions
Treating your scalp psoriasis overnight can help get rid of thick scales. This will help psoriasis creams be more effective. Follow these steps before going to bed:
Massage an oil (like mineral oil) into your scalp in between your hair.
Wrap your scalp in a towel or shower cap.
In the morning, wash your hair with regular shampoo or tar shampoo.
While your hair is damp and soapy, gently comb out the softened scale with a fine-tooth comb.
Wash away any remaining scale.
Dry your hair with a low-heat setting on your hair dryer.
Scalp psoriasis doesn’t spread in the same way an infection spreads. But, it’s possible to have psoriasis on different parts of the body at the same time. So, some people with scalp psoriasis may also develop psoriasis on their neck. But this doesn’t mean that the scalp psoriasis has spread. It just means that psoriasis also developed on the neck.
Psoriasis on the scalp (and anywhere else) can start at any age. But people are most likely to develop it during two times of their life — between the ages of 15 and 25, and 50 and 60.
Scalp psoriasis and dandruff can sometimes look similar, but they’re different conditions.
Psoriasis is a chronic skin condition that causes thick white or gray plaques on the skin. It’s caused by different factors, like an overactive immune system, your genetics, and certain environmental factors (like a strep throat infection). Seborrheic dermatitis (dandruff), on the other hand, is caused by an overreaction to a yeast that normally lives on your skin. It usually causes yellow or white greasy flakes.
Treating your scalp psoriasis overnight can help get rid of thick scales. This will help psoriasis creams be more effective. Follow these steps before going to bed:
Massage an oil (like mineral oil) into your scalp in between your hair.
Wrap your scalp in a towel or shower cap.
In the morning, wash your hair with regular shampoo or tar shampoo.
While your hair is damp and soapy, gently comb out the softened scale with a fine-tooth comb.
Wash away any remaining scale.
Dry your hair with a low-heat setting on your hair dryer.
Scalp psoriasis doesn’t spread in the same way an infection spreads. But, it’s possible to have psoriasis on different parts of the body at the same time. So, some people with scalp psoriasis may also develop psoriasis on their neck. But this doesn’t mean that the scalp psoriasis has spread. It just means that psoriasis also developed on the neck.
Psoriasis on the scalp (and anywhere else) can start at any age. But people are most likely to develop it during two times of their life — between the ages of 15 and 25, and 50 and 60.
Scalp psoriasis and dandruff can sometimes look similar, but they’re different conditions.
Psoriasis is a chronic skin condition that causes thick white or gray plaques on the skin. It’s caused by different factors, like an overactive immune system, your genetics, and certain environmental factors (like a strep throat infection). Seborrheic dermatitis (dandruff), on the other hand, is caused by an overreaction to a yeast that normally lives on your skin. It usually causes yellow or white greasy flakes.
The bottom line
Topical medications are usually the first step for scalp psoriasis. Steroid treatments are a good first choice. Other options like vitamin D analogues, retinoids, and tapinarof (Vtama) work, too. They can even be combined, for additional benefit. OTC ingredients like salicylic acid, urea, and coal tar can be added to boost results, but they aren’t as effective on their own. Many people need more than one topical medication. If symptoms persist, oral or injectable treatments may be the next step. Your healthcare team can help tailor an approach that works for you.
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References
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