Unravelling Scalp Psoriasis: Causes, Symptoms, Diagnosis and Treatment Options

Scalp psoriasis is a common but often misunderstood condition that can significantly impact the quality of life for affected individuals. Characterised by red, scaly patches that can be itchy and sometimes painful, scalp psoriasis is more than just a skin issue; it’s a chronic autoimmune disease that requires comprehensive understanding and management. In this article, we will delve into the intricacies of scalp psoriasis, exploring its causes, identifying its symptoms, outlining the diagnostic process, and discussing the various treatment options available. By unravelling the complexities of this condition, we aim to provide valuable insights and practical information to help those affected navigate their journey towards better scalp health.

What is Scalp Psoriasis?

Scalp psoriasis is a chronic autoimmune condition that causes raised, reddish, and often scaly patches to appear on the scalp. It occurs when the immune system mistakenly attacks healthy skin cells, causing them to grow and build up rapidly on the surface of the skin, resulting in thick, silvery scales and red patches that can be itchy, sore, and sometimes lead to temporary hair loss due to scratching or the severity of the condition. While scalp psoriasis can occur in isolation, it is often associated with psoriasis on other parts of the body, and can range from mild, with slight scaling, to severe, with thick crusted plaques covering large areas of the scalp. 

Who does Scalp Psoriasis Affect?

Scalp psoriasis can affect individuals of any age, gender, or ethnicity. It is most commonly diagnosed in adults, but it can also occur in children and adolescents. The condition tends to run in families, indicating a genetic predisposition. Individuals with a family history of psoriasis or other autoimmune diseases are at a higher risk of developing scalp psoriasis. Additionally, those who already have psoriasis on other parts of their body are more likely to experience it on their scalp as well.

How Common is Scalp Psoriasis?

Scalp psoriasis is a relatively common condition. Approximately 2-3% of the global population is affected by psoriasis, and among those with psoriasis, it is estimated that 50-80% will experience scalp involvement at some point during their illness. This makes scalp psoriasis one of the most prevalent manifestations of the disease. Despite its frequency, many individuals may not recognize the symptoms or may misattribute them to other scalp conditions, underscoring the importance of proper diagnosis and awareness.

What are the Causes of Scalp Psoriasis?

Scalp psoriasis, like other forms of psoriasis, is a complex condition with multiple contributing factors. Here are the primary causes:

Immune System Dysfunction

Psoriasis is an autoimmune disorder. The immune system mistakenly attacks healthy skin cells, leading to an overproduction of new skin cells. These cells build up rapidly on the surface of the skin, forming the characteristic scaly patches.

Environmental Triggers

Certain environmental factors can trigger or exacerbate scalp psoriasis. Common triggers include:

• Stress: Psychological stress can worsen psoriasis or trigger flare-ups.
• Infections: Infections, particularly streptococcal throat infections, can trigger psoriasis in some individuals.
• Weather: Cold and dry weather conditions can exacerbate the symptoms of psoriasis.
• Injury to the skin: Any injury to the scalp, such as cuts, scrapes, or severe sunburn, can trigger a psoriasis flare-up, a phenomenon known as the Koebner response.

Lifestyle Factors

Certain lifestyle choices can influence the onset and severity of scalp psoriasis:

• Smoking: Smoking has been linked to an increased risk of developing psoriasis and can exacerbate the condition.
• Alcohol Consumption: Excessive alcohol intake can worsen psoriasis symptoms.

Certain Medications

Some medications can trigger or worsen psoriasis, including:

• Beta-blockers: Used for high blood pressure and heart conditions.
• Lithium: Used for bipolar disorder and other mental health conditions.
• Antimalarials: Used to prevent or treat malaria.
• NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Used to reduce inflammation and pain.

Genetic Predisposition

Psoriasis often runs in families, suggesting a strong genetic component. Specific genes associated with the immune system are linked to an increased risk of developing psoriasis. If you have a family member with psoriasis, your chances of developing the condition are higher.

Hormonal Changes

Hormonal fluctuations, particularly during puberty, pregnancy, and menopause, can influence the severity of psoriasis. These changes can trigger or exacerbate flare-ups.

Understanding these causes and triggers is crucial for managing scalp psoriasis effectively. Identifying and avoiding specific triggers can help reduce the frequency and severity of flare-ups, improving overall quality of life for those affected.

What are the Signs and Symptoms of Scalp Psoriasis?

Scalp psoriasis manifests through various signs and symptoms that can range from mild to severe. Here are the key indicators of this condition:

• Red or purple bumpy patches: These raised patches are often the first visible sign of scalp psoriasis. They can vary in colour depending on your skin tone; red on lighter skin and purple on darker skin.
• Silvery-white or grey scales: The patches are typically covered with thick, silvery-white scales (on lighter skin) or grey scales (on darker skin). These scales are a result of the rapid buildup of skin cells.
• Dandruff-like flaking: Scalp psoriasis can cause excessive flaking that resembles dandruff. The flakes are often more prominent and extensive than typical dandruff.
• Dry scalp: The affected areas can become very dry, leading to further discomfort and potential cracking of the skin.
• Itching: One of the most common symptoms is intense itching, which can be severe and persistent, often leading to scratching that can worsen the condition.
• Burning sensation: Some individuals experience a burning or stinging sensation on the scalp, adding to the discomfort.
• Soreness: The affected areas can become sore and tender, particularly if the scalp is scratched or if scales are forcibly removed.
• Hair loss: While scalp psoriasis itself does not directly cause hair loss, excessive scratching, inflammation, and damage to the hair follicles can lead to temporary hair loss. Once the scalp heals and the condition is managed, hair typically regrows.

Recognizing these signs and symptoms is crucial for timely diagnosis and treatment. If you experience any of these symptoms, it is advisable to seek medical advice to confirm the diagnosis and begin appropriate treatment to manage the condition effectively.

What Triggers Scalp Psoriasis Flare-ups?

Scalp psoriasis flare-ups can be triggered by various factors, often making the condition worse or causing new symptoms to appear. Understanding these triggers can help in managing and reducing the frequency of flare-ups. Here are some common triggers:

• Stress: Psychological stress is a significant trigger for scalp psoriasis. Stress can cause the immune system to overreact, leading to increased inflammation and psoriasis flare-ups.
• Infections: Infections, particularly streptococcal throat infections, can trigger or worsen psoriasis. The body’s immune response to these infections can also attack healthy skin cells, causing a flare-up.
• Weather conditions: Cold, dry weather can exacerbate scalp psoriasis symptoms by drying out the skin and causing it to crack and become more inflamed. Conversely, some people may find that hot and humid weather worsens their condition.
• Skin injuries: Any trauma to the scalp, such as cuts, scrapes, or severe sunburn, can trigger a psoriasis flare-up. This phenomenon, known as the Koebner response, can also occur with tattoos or surgical wounds.
• Certain medications: Some medications can trigger or worsen psoriasis. These include beta-blockers (used for high blood pressure), lithium (used for mental health conditions), antimalarials, and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Alcohol consumption: Excessive alcohol intake can trigger or exacerbate psoriasis flare-ups. Alcohol can disrupt the immune system and increase inflammation, leading to worsening symptoms.
• Smoking: Smoking is a known trigger for psoriasis. The toxins in cigarette smoke can affect the immune system and skin health, leading to more frequent and severe flare-ups.
• Hormonal changes: Hormonal fluctuations, such as those occurring during puberty, pregnancy, or menopause, can influence the severity of psoriasis. These changes can trigger or worsen flare-ups.
• Diet: While diet does not directly cause psoriasis, certain foods can trigger inflammation and worsen symptoms. Some individuals may find that spicy foods, red meat, or dairy products can exacerbate their condition.
• Allergens: Exposure to allergens, such as certain hair care products or environmental allergens, can trigger scalp psoriasis flare-ups. Identifying and avoiding these allergens can help manage symptoms.

By identifying and avoiding specific triggers, individuals with scalp psoriasis can better manage their condition and reduce the frequency and severity of flare-ups.

How is Scalp Psoriasis Diagnosed?

Diagnosing scalp psoriasis involves a combination of medical history, physical examination, and sometimes additional tests to rule out other conditions. Here are the primary methods used to diagnose scalp psoriasis:

• Medical history and physical examination: The diagnosis often starts with a thorough medical history and a physical examination of the scalp and other potentially affected areas. The doctor will look for characteristic signs of psoriasis, such as red or purple bumpy patches covered with silvery-white or grey scales.
• Dermatoscopy: A dermatoscope is a handheld device that allows for a magnified view of the skin. Using a dermatoscope, a healthcare provider can closely examine the scales and skin lesions, which helps in distinguishing scalp psoriasis from other scalp conditions such as seborrheic dermatitis or fungal infections.
• Biopsy: In some cases, a biopsy may be performed to confirm the diagnosis. This involves taking a small sample of the affected skin and examining it under a microscope. A biopsy can help differentiate psoriasis from other skin conditions, such as seborrheic dermatitis or fungal infections.
• Allergy test: Although not typically used to diagnose psoriasis, an allergy test may be conducted to rule out allergic reactions that could be causing similar symptoms. This helps ensure that the correct diagnosis is made and appropriate treatment is provided.
• Blood tests: Blood tests are not typically required to diagnose scalp psoriasis; however, they may be done to rule out other conditions that can mimic psoriasis symptoms or to check for related health issues, such as psoriatic arthritis. Blood tests can also help identify any underlying inflammation or infection.

By combining these diagnostic methods, healthcare providers can accurately diagnose scalp psoriasis and distinguish it from other conditions with similar presentations. This ensures that patients receive the most appropriate and effective treatment for their specific condition.

How is Scalp Psoriasis Treated?

Treating scalp psoriasis involves a multifaceted approach tailored to the severity of the condition and the individual's response to various treatments. Here are the primary treatment options:

Topical Ointments

• Corticosteroids: These anti-inflammatory drugs are commonly prescribed to reduce inflammation and relieve itching. They come in various strengths and forms, such as lotions, creams, gels, and foams.
• Vitamin D analogues: Synthetic forms of vitamin D, such as calcipotriene and calcitriol, can slow down skin cell growth.
• Coal tar: Available in shampoos, creams, and ointments, coal tar can reduce scaling, itching, and inflammation.
• Salicylic acid: Often used in combination with other treatments, salicylic acid helps to soften and remove scales.
• Topical retinoids: These vitamin A derivatives can help reduce inflammation and regulate skin cell growth.

Prescription Treatments

• Calcineurin inhibitors: Medications like tacrolimus and pimecrolimus, usually used for eczema, can be effective for sensitive areas like the scalp. They help reduce inflammation and plaque buildup.
• Anthralin: This medication helps normalise DNA activity in skin cells and has anti-inflammatory properties. It is typically used for short durations due to its potential to stain skin and clothing.

Phototherapy

• UVB light therapy: Exposure to ultraviolet B (UVB) light can slow the growth of affected skin cells. This can be done in a healthcare provider’s office or with a home-use phototherapy unit.
• PUVA therapy: This involves taking a medication called psoralen that makes the skin more sensitive to light, followed by exposure to UVA light. This treatment is generally reserved for more severe cases.
• Excimer laser: This targeted form of phototherapy uses a high-intensity beam of UVB light to treat small, localised areas of psoriasis.

Systemic Therapies

• Oral medications: For moderate to severe scalp psoriasis, oral medications like methotrexate, cyclosporine, and acitretin can be prescribed to reduce immune system activity and slow skin cell turnover.
• Biologics: These are advanced medications that target specific parts of the immune system. Biologics, such as adalimumab, etanercept, and ustekinumab, are often used for moderate to severe psoriasis. They are administered via injection or infusion.
• Oral retinoids: These vitamin A derivatives, like acitretin, can reduce the rate of skin cell production. They are typically used for severe cases and under close medical supervision.

Combination Therapy

In some cases, a combination of treatments is used to achieve the best results. For example, a patient might use topical treatments alongside phototherapy or systemic medications. The goal is to reduce symptoms, control flare-ups, and improve the quality of life for those affected by scalp psoriasis.

What are the Complications of Scalp Psoriasis?

While scalp psoriasis primarily affects the skin, if left untreated, it can lead to several complications that impact overall health. These complications include:

• Psoriatic arthritis: Up to 30% of individuals with psoriasis may develop psoriatic arthritis, a condition that causes joint pain, stiffness, and swelling. Early diagnosis and treatment are crucial to prevent joint damage and maintain mobility.
• Crohn’s disease: There is a higher prevalence of inflammatory bowel diseases, such as Crohn’s disease, in individuals with psoriasis. This connection is thought to be due to the shared inflammatory pathways involved in both conditions.
• Uveitis: Uveitis, an inflammation of the middle layer of the eye, can occur in people with psoriasis. Symptoms include eye redness, pain, and blurred vision. Untreated uveitis can lead to complications such as glaucoma or vision loss.
• Depression: The chronic nature of psoriasis and its visible symptoms can lead to significant emotional distress. Many individuals with psoriasis experience depression and anxiety due to the impact on their quality of life and self-esteem.
• Heart disease: Psoriasis is associated with an increased risk of cardiovascular diseases. Chronic inflammation in psoriasis can contribute to the development of conditions such as hypertension, atherosclerosis, and ultimately, heart disease.
• Heart attack: Individuals with psoriasis, particularly severe cases, are at a higher risk of heart attacks. The persistent inflammation associated with psoriasis can accelerate the process of plaque buildup in arteries, leading to cardiovascular events.
• Metabolic syndrome: Metabolic syndrome encompasses a group of conditions, such as obesity, high blood pressure, and insulin resistance, and people with psoriasis are more likely to develop metabolic syndrome. 

Dietary recommendations for scalp psoriasis management

• Fish: Include fatty fish such as salmon, mackerel, sardines, and trout in your diet. These fish are rich in omega-3 fatty acids, which have anti-inflammatory properties that can help reduce psoriasis symptoms.
• Leafy vegetables: Consume a variety of leafy greens like spinach, kale, and Swiss chard. These vegetables are high in vitamins, minerals, and antioxidants, which support overall health and can help reduce inflammation.
• Olive oil: Use extra virgin olive oil as a primary cooking oil and for salad dressings. Olive oil contains healthy fats and antioxidants that have anti-inflammatory effects and can benefit skin health.
• Avoid alcohol: Limit or avoid alcohol consumption. Alcohol can trigger psoriasis flare-ups, interfere with certain medications, and increase inflammation.
• Limit dairy products: Consider reducing or eliminating dairy products if they seem to worsen your symptoms. Some individuals find that high-fat dairy products can trigger or exacerbate symptoms.
• Citrus fruits: Monitor your intake of citrus fruits like oranges, lemons, and grapefruits. Some people with psoriasis find that these fruits can trigger flare-ups.
• Avoid gluten: If you suspect gluten sensitivity or have celiac disease, consider a gluten-free diet. Some individuals report improvement in psoriasis symptoms after eliminating gluten.

Final Words

Understanding scalp psoriasis is crucial for effective management and improving the quality of life for those affected. By recognizing the causes, identifying the symptoms, and knowing the diagnostic and treatment options available, individuals can take proactive steps towards managing their condition. While home remedies and lifestyle adjustments can provide relief, professional medical advice is invaluable for comprehensive care. If you or someone you know is struggling with scalp psoriasis, consider consulting with a healthcare professional at Max Hospitals for expert guidance and personalised treatment plans. With the right support and treatment, managing scalp psoriasis becomes a more attainable goal, paving the way for healthier skin and a better quality of life.