7 Topical Treatment Options for Scalp Psoriasis

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.

Topical steroids aren’t usually applied long term since they can irritate the skin and cause it to become thinner and dryer over time. You may use a steroid daily for a few weeks to help get your psoriasis symptoms under control. After that, you may only need to apply it a couple of times a week to help keep your symptoms at bay. Or you may need to stop applying it altogether. Your prescriber will give you instructions based on your symptoms and response to treatment.

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. Some common examples include:

• Clobetasol

• Halobetasol (Ultravate)

• Diflorasone (Apexicon E)

• Betamethasone (Diprolene)

• Fluocinonide (Vanos)

Topical steroid dosage forms 

Topical steroids also come in several different dosage forms, including:

• Solutions (liquids)

• Sprays

• Creams

• Foams

• Gels

• Shampoos

Each dosage form has pros and cons to consider. Liquid formulations spread easily but may be messy to apply. Creams are less messy, but they can leave a residue behind in your hair. Foams provide the best of both a liquid and cream formula, but they tend to be more expensive than other dosage forms. Gels are usually clear and dry quickly, but are more likely to cause stinging and burning than other forms. Shampoos are another option, but you need to let them sit for several minutes before rinsing, which may not be as convenient as other options. 

Regardless of which form you’re using, you should wash your hands immediately after applying a topical steroid. And be aware that some products can stain clothing.

It may take some trial and error to find the best topical steroid for your needs. Don’t hesitate to reach out to your prescriber 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 production that leads to plaques.

The main vitamin D analogue used for scalp psoriasis is calcipotriene (Dovonex, Sorilux). It comes as a topical liquid, cream, and foam. 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.

Tazarotene can be used on its own, 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. 

Be sure to wear a hat or apply sunscreen to your scalp if you’re using tazarotene. It can make your skin more sensitive to the sun.

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.

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 also 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.

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. 

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. They’re not a substitute for prescription medications, but can be used alongside them in most cases. 

It’s best to talk to your prescriber before trying a coal tar product. They’ll make sure it’s safe to combine with your other treatments and let you know how often to use it.

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, such as 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.

In some cases, you may use a keratolytic treatment along with a prescription medication. You may also use it on its own 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

• Topical foam, cream, or gel, such as Keralyt or Salvax

Topical salicylic acid treatments may be applied 1 to 4 times a day, while shampoos are typically only used twice a week. Talk with your prescriber to figure out if it’s a good option for you and the best way to incorporate salicylic acid into your treatment plan.

What can make scalp psoriasis worse?

Scalp psoriasis may flare or worsen with certain triggers or behaviors. Here are some tips to avoid worsening your symptoms:

• Manage your stress levels. Try daily meditation or journaling to help keep stress levels low.

• Limit alcohol. Ask your prescriber about how much alcohol — if any — is OK to drink. They can tell you if a certain amount is more likely to exacerbate your symptoms.

• 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 to your healthcare team. They can help you determine the cause and suggest ways to manage flares in the future. 

Are there other options if topical treatments don’t work?

Yes. There are other scalp psoriasis treatment options available if topical medications don’t work for you. These include:

• Ultraviolet light therapy

• Oral medications, such as methotrexate

• Injectable biologic medications, such as etanercept (Enbrel)

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.

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Written by:

Jill Barat, PharmD

Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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