From the Guidelines
The most effective treatment for scalp psoriasis is calcipotriene foam, which has been shown to be more effective than vehicle in achieving an Investigator’s Static Global Assessment score of 0 (clear) or 1 (almost clear) after 8 weeks of treatment 1.
Treatment Options
When considering treatment options for scalp psoriasis, it's essential to take into account the severity of the condition. For mild cases, topical corticosteroids like clobetasol propionate 0.05% solution or fluocinonide 0.05% solution can be effective as first-line treatments. These should be applied once or twice daily for 2-4 weeks, then tapered to maintenance use.
Combination Therapies
For moderate to severe cases, calcipotriene (a vitamin D analog) can be used alone or combined with steroids, such as in the product Taclonex (betamethasone/calcipotriene) 1. Coal tar shampoos like T/Gel or medicated shampoos containing salicylic acid can help remove scales before applying other treatments.
Systemic Treatments
For severe or resistant cases, systemic treatments like methotrexate, biologics, or oral retinoids might be necessary. However, the use of biologics such as etanercept is generally recommended for moderate-to-severe plaque psoriasis affecting the scalp, with a recommended starting dose of 50 mg taken as a self-administered subcutaneous injection twice weekly for 12 consecutive weeks 1.
Key Considerations
It's crucial to part the hair and apply solutions directly to the scalp, not just the hair, and to continue treatment even after symptoms improve to prevent quick recurrence. Additionally, combining separate vitamin D and corticosteroid preparations into specific easy-to-follow regimens can be used to reduce both the adverse effects of topical corticosteroids and the cost for some patients 1.
From the FDA Drug Label
Following repeated nonocclusive application in the treatment of scalp psoriasis, there is some evidence that clobetasol propionate topical solution has the potential to depress plasma cortisol levels in some patients
- Clobetasol propionate is a medication that can be used for the treatment of scalp psoriasis.
- The medication has anti-inflammatory and immunosuppressive effects, making it effective in treating corticosteroid-responsive dermatoses.
- However, it is essential to consider the potential systemic effects of clobetasol propionate, including the depression of plasma cortisol levels in some patients 2.
From the Research
Medication Options for Scalp Psoriasis
- Clobetasol propionate 0.05% shampoo is efficacious and safe for long-term control of moderate scalp psoriasis, with a median time to first relapse of 141 days 3.
- A new formulation of calcipotriene/betamethasone scalp solution has a rapid onset of action with once daily dosing, improving compliance 4.
- Clobetasol propionate 0.05% spray is effective and well tolerated for moderate-to-severe plaque psoriasis of the scalp, with 85% of patients achieving success after four weeks of treatment 5.
- Clobetasol propionate foam 0.05% is a novel topical formulation that has been shown to be effective in reducing disease severity in patients with plaque-type and scalp psoriasis 6.
Key Findings
- The CalePso study examines the safety profile of clobetasol propionate 0.05% shampoo and reports that it is safe and efficacious in the long-term management of scalp psoriasis 4.
- A literature review of effective therapies for scalp psoriasis highlights the importance of finding effective therapeutic regimens to improve the quality of life of patients 7.
- Topical therapies, phototherapy, systemic agents, and complementary therapy have been shown to be effective in achieving and maintaining significant improvement in scalp psoriasis 7.
Treatment Considerations
- The choice of medication for scalp psoriasis should be based on the severity of the disease, patient preferences, and potential side effects 3, 5.
- Clobetasol propionate 0.05% shampoo and spray have been shown to be safe and effective for long-term control of moderate scalp psoriasis 3, 5.
- New formulations, such as calcipotriene/betamethasone scalp solution and clobetasol propionate foam 0.05%, offer alternative treatment options for patients with scalp psoriasis 4, 6.