The Basics: My Scalp Saviours

Recently diagnosed with psoriasis?

I’m going right back to basics with this series of blog posts that’s all about getting to grips with the fundamentals of managing a disease like psoriasis. This next post is about all things scalp-related – we’re facing hair loss, awkward treatment application, loose flakes and THAT itch, head on. 

As always, speak to your GP or healthcare provider before trying any new medications, treatments or products to ensure they are correct for your skin. I am not a doctor (just someone with psoriasis!) see disclaimer


My scalp psoriasis is definitely hardy. It stands strong in the face of things that are supposed to reduce it: steroids, shampoos, moisturisers. It doesn’t seem to be phased by things that we’re told to avoid (for me this is hair dye, I can’t resist). It’s blocked by hair that stops treatments like UVB getting to it. Can scalp psoriasis ever be conquered?

Praise the psoriasis saviours that have helped manage my scalp! My scalp was one of the areas I was the most self-conscious about, especially being dark-haired which makes loose flakes so obvious. These loose plaques are often dandruff-like and fall onto clothing as well as getting stuck in hair and although leaving your scalp alone is recommended, it really is impossible to avoid itching it. It is without a doubt, one of the most uncomfortable, stubborn and frustrating areas to try and treat. I’ve had scalp psoriasis for over 2 years and I still can’t shift it but I have picked up some tips on keeping it as under control as possible.

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What is scalp psoriasis? Isn’t that just dandruff?

Unfortunately, Head and Shoulders probably isn’t going to cut it for severe scalp psoriasis (although some have had success with antidandruff shampoos!). Dandruff is basically a condition that causes flakes of dry skin to fall from the scalp; it’s exceptionally common and in most cases, fairly easy to treat. The main cause of dandruff is dry skin but it can be down to seborrheic dermatitis or eczema.

Scalp psoriasis can cause similar-looking flakes but is also characterised by red or dark patches of skin covered with a silver, white or yellow scales. Scalp psoriasis can be noticeable around the hairline, forehead, behind the ears and on the neck. Like other forms of psoriasis, it feels itchy, dry, sore and can crack and bleed. Occasionally, scalp psoriasis can cause hair loss but this is usually temporary (don’t panic!). Although similar to other skin conditions, scalp psoriasis (like all psoriasis) is down to am immune response.

Are people grossed out by my flaky scalp?

This sort of question plagued my mind when I first got psoriasis.

Let’s be real – no one really wants a flaky scalp, regardless of its causes. It’s uncomfortable, annoying and dusting flakes out of hair and off your clothing is embarrassing. It’s important to remember that it’s just loose skin. If people are grossed out by your scalp psoriasis, that’s their problem, not yours. We’ve got enough problems with managing our psoriasis to need to start apologising for being flaky on top of that!

You’re not gross. You’re human.

But if you are really self-conscious of flakes, wearing patterned or light-coloured clothing can make these less noticeable.

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How do you treat scalp psoriasis?

Similar to psoriasis on other parts of the body, different people will have different experiences with what works best for their scalp. Finding a successful treatment plan is a journey involving a lot of trial-and-error but if you put the work in to try the suggested medication from your GP and OTC (over-the-counter) options, chances are that you’ll find a routine that can keep scalp psoriasis under control.

There are two key ingredients to keep an eye out for: coal tar and salicylic acid.

Products involving coal tar are often prescribed for scalp psoriasis, as well as other parts of the body. Coal tar has anti-inflammatory and anti-scaling properties and helps slow down the production of skin cells. The smell of tar is pretty overwhelming, especially the higher the concentration of tar in the product but I’ve found reasonable success with a variety of coal tar applications and shampoos. Be aware that tar can stain and it also makes skin more sensitive to sunlight.

Salicylic acid is a keratolytic which means that it works as a peeling agent, loosening skin and allowing it to shed. This means that it can soften and remove psoriasis scales. Salicylic acid may make hair more likely to break leading to hair loss (again, this is only temporary!).

My treatment plan that I have used involves a mixture of products involving these ingredients:

  • Wash hair around 4 times a week with either:

    Psoriderm Scalp Lotion (coal tar 2.5%, lecithin 0.3%).
    Capasal Shampoo (coal tar 1%, coconut oil 1%, salicylic acid 0.5%).

    As I don’t use conditioner on my roots, I opt for a sensitive conditioner and apply only to the ends of my hair, avoiding the scalp. The strong coal smell can usually be neutralised slightly by the smell of the conditioner.I wash my hair every day as I find this helps remove any loose flakes. For some, this much washing would irritate the scalp so find what works for you (I find colder showers are best for sore skin).

     

  • 1-3 times a week, I use Sebco Scalp Ointment (coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4%, in a coconut oil emollient basis).This is a very strong-smelling, thick ointment that you put onto your scalp for an hour. I then brush my scalp with a fine-toothed comb to loosen any skin and then wash off. This is a similar idea to a hair mask but make sure you get the product on your scalp.
  • Up to once a day I use Diprosalic solution (betamethasone 0.05%, salicylic acid 2%). This is a non-greasy, clear, almost water-like solution that smells strongly of alcohol on application but sinks into scalp quickly and is not noticeable.

There are a huge variety of natural products to try as well as prescribed and OTC options. Coconut oil can help loosen scales, allowing for the application of steroid treatments. Try gently melting the coconut oil and applying to the scalp, leaving on for as long as possible before brushing through and washing out. Others also suggest olive and almond oil as well as apple cider vinegar but I’ve not yet tested these out.

There are other treatments down the line for more serious cases of psoriasis but these are the medications you’ll be encouraged to try first of all. (Note: these treatments have all been discussed with a doctor – consult with yours first before making any changes to your treatment).

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What are your top tips for scalp psoriasis?

Psoriasis is clever. Over time it can become used to products and treatments that you use regularly, reducing their efficiency. It can be distressing and stressful to realise your ride-or-die, favourite scalp saviour isn’t working anymore.

To keep steroids and treatments as effective as possible, rotate your products. Try to not become too attached to a one product and be adaptable to trying new things if your psoriasis becomes accustomed to a certain treatment. Make sure for scalp psoriasis you part your hair so the treatments actually reach the scalp.

Another important thing to remember is that when drying hair, try to avoid directly aiming the hairdryer at the scalp and use a low heat setting. Drying and brushing your hair will allow for loose flakes to fall – putting a towel underneath and drying hair upside down can contain the flakes.

It’s important to also take care of the skin behind your ears and along your hairline. MooGoo Scalp Cream is a nice one for soothing dry skin and works best when applied to damp skin after the shower.

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Can I dye my hair?

Generally, it is recommended that you avoid dying your hair. However, when a disease affects your appearance, I totally understand why psoriasis-sufferers are tempted to dye their hair and claim a bit of personality and confidence back.

I admit that because my psoriasis is so hardy, I have just bitten the bullet and dyed my hair anyway. I try to go for semi-permanent dyes as you don’t leave these in for as long and I don’t find them so harsh on my scalp. Beware that if you have open wounds on your scalp, this is going to hurt and you need to wait until your scalp is healed completely before putting more chemicals on it.

One option is to get a hairdresser to do it rather than going for a box dye. Although more expensive, a hairdresser will be able to minimise the amount of dye that comes into contact with your scalp and be able to advise if your scalp looks too sore to risk it.

I’ve also had success with henna dye that I purchased from Lush. This was incredibly messy and if possible, rope a friend in to helping you out as by the time I was done, my entire kitchen was covered in henna! One positive was that I found the henna worked wonders on my scalp and left it beautifully clear for a while.


Scalp psoriasis basics: 

  • Medicated shampoos
  • Peeling agents (keratolytics)
  • Steroids
  • Fine-toothed comb
  • Try out natural alternatives to optimise medicated products’ efficiency and give skin a break
  • Rotate treatments
  • Moisturise the scalp and around the hairline and ears
  • Be careful with hair dyes and look into natural alternatives like henna
  • Always consult with your doctor about new treatments

Scalp psoriasis is hardy but with some dedication you can equip yourself to regain control of your scalp! What are your scalp psoriasis top tips or favourite products to use? 

References

Psoriasis Association – Scalp Psoriasis Information Sheet
Psoriasis Association – Coal Tar Sheet
National Psoriasis Foundation – OTC Topicals

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