From the Guidelines
Treatment options for scalp psoriasis include both topical and systemic approaches, with first-line treatments being corticosteroid solutions or foams, such as clobetasol propionate 0.05%, fluocinonide 0.05%, or betamethasone valerate 0.1%, applied directly to affected areas once or twice daily for 2-4 weeks, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines 1. For mild to moderate cases, these treatments reduce inflammation and slow skin cell growth.
- Vitamin D analogues like calcipotriene (Dovonex) can be used alone or combined with steroids as in Taclonex (betamethasone/calcipotriene) for better efficacy, with studies showing that calcipotriene foam and calcipotriene plus betamethasone dipropionate gel are safe and effective for the treatment of mild to moderate scalp psoriasis 1.
- Coal tar shampoos (1-2%) used 2-3 times weekly can help reduce scaling and itching.
- For more resistant cases, salicylic acid preparations (6%) help remove scales before applying other medications, but should be avoided when using calcipotriene due to reduced effectiveness 1. When topical treatments fail, systemic options include oral medications like methotrexate (7.5-25mg weekly), acitretin (10-25mg daily), or biologics such as adalimumab, etanercept, or secukinumab for severe cases, as outlined in the joint American Academy of Dermatology-National Psoriasis Foundation guidelines for the management of psoriasis with systemic nonbiologic therapies 1. Phototherapy with UVB light can also be effective. Regardless of treatment, gentle hair washing with medicated shampoos and avoiding scratching are important to prevent worsening and infection. Treatment typically requires maintenance therapy as psoriasis is chronic, with periods of remission and flare-ups. The choice of vehicle can significantly alter the use and penetration of the medication, and therefore alter the efficacy, with different vehicles being indicated for different body sites, such as solutions, foams, shampoos, sprays, oils, gels, or other vehicles for hair-bearing areas including the scalp 1.
From the FDA Drug Label
To treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).
The treatment option for scalp psoriasis is adalimumab (SQ), which is used to treat moderate to severe chronic plaque psoriasis in adults.
- Key points:
- Adalimumab is a tumor necrosis factor (TNF) blocker.
- It can be used alone or with other medicines.
- It is given by an injection under the skin.
- The dosage and frequency of injections are determined by a healthcare provider based on the condition being treated 2.
From the Research
Treatment Options for Scalp Psoriasis
The treatment of scalp psoriasis involves a variety of options, including topical therapies, systemic therapies, and phototherapy. The choice of treatment depends on the severity of the disease, the patient's preferences, and the presence of any comorbidities.
- Topical therapies are the mainstay of treatment for mild to moderate scalp psoriasis, with options including:
- Corticosteroids, which are fast-acting and effective, but may have limited safety data for long-term use 3, 4
- Vitamin D3 analogues, such as calcipotriol, which are effective and well-tolerated, but may take longer to achieve maximal efficacy 3, 5
- Coal tar shampoos, which are effective, but may have a strong odor and staining properties 4
- Salicylic acid, which has a keratolytic effect and can be used in combination with other treatments 4
- Systemic therapies, such as methotrexate, cyclosporine, and acitretin, are reserved for patients with recalcitrant or moderate to severe disease 4, 6
- Phototherapy, including localized phototherapy, can be effective for scalp psoriasis, but may be limited by the presence of hair-bearing areas 6
- Biologics and new small-molecule agents have shown excellent effects on scalp psoriasis, but may be limited by their high cost and are typically reserved for extensive scalp psoriasis 6
Combination Therapies
Combination therapies, such as the use of calcipotriol solution with other treatments, can increase treatment response and improve outcomes 5. The use of topical corticosteroids in combination with vitamin D3 analogues, such as calcipotriol-betamethasone dipropionate, has been shown to be effective and well-tolerated 6.
Patient Preferences and Adherence
Patient preferences and adherence to treatment are important factors in the management of scalp psoriasis. Newer vehicle options, such as shampoos and lotions, can provide more attractive and pleasing products for patients, improving adherence to treatment 7. The cosmetic acceptance of treatments, such as calcipotriol solution, can also improve patient satisfaction and adherence to treatment 5.