From the Guidelines
For an 11-year-old with scalp psoriasis, the most effective treatment option is to start with gentle medicated shampoos containing salicylic acid, coal tar, or ketoconazole used 2-3 times weekly, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1. The treatment of scalp psoriasis in pediatric patients involves a multi-step approach, considering the severity of the disease, the patient's age, and potential side effects of treatments.
- Gentle medicated shampoos are the first line of treatment, with options including salicylic acid, coal tar, or ketoconazole, which help reduce inflammation and remove scale buildup.
- Topical steroids, such as fluocinolone 0.01% solution or clobetasol 0.05% solution, can be applied directly to affected areas once daily for 2-4 weeks, then tapered to prevent side effects, as they can cause skin thinning or irritation, especially in children 1.
- For moderate cases, calcipotriene (a vitamin D analog) may be prescribed, often combined with a steroid, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1.
- Ensuring the child uses lukewarm water for washing and applying moisturizing oils like coconut oil to soften scales before shampooing can also help alleviate symptoms.
- Gentle combing can help remove loose scales, and these treatments work by reducing inflammation, slowing skin cell growth, and removing scale buildup. If these options don't provide relief within 4-6 weeks, consulting a dermatologist is necessary, as prescription-strength treatments or systemic medications might be necessary, and always monitoring for skin thinning or irritation with steroid use, especially in children, is crucial 1.
From the FDA Drug Label
Directions ⬥ for best results use at least twice a week or as directed by a doctor ⬥ wet hair thoroughly ⬥ massage shampoo into the scalp ⬥ lather. Leave on hair and scalp for several minutes ⬥ rinse and repeat Warnings For external use only Ask a doctor before use if condition covers a large part of the body. The treatment options for scalp psoriasis in an 11-year-old pediatric patient include coal tar (TOP) shampoo, which should be used at least twice a week or as directed by a doctor. However, caution is advised, and it is recommended to ask a doctor before use if the condition covers a large part of the body. Methotrexate (PO) is not recommended for pediatric patients with scalp psoriasis due to potential serious adverse reactions. It is essential to consult a doctor for proper diagnosis and treatment. 2 2
From the Research
Treatment Options for Scalp Psoriasis in an 11-year-old Pediatric Patient
- Topical treatments are the mainstay of treatment for scalp psoriasis, with options including shampoos, lotions, gels, foams, creams, and ointments 3
- Active ingredients for topical treatments include keratolytics, coal tar, dithranol, corticosteroids, and vitamin D3 analogues 3
- Topical corticosteroids, such as betamethasone valerate, are effective for scalp psoriasis and can be used once or twice daily 4
- Vitamin D3 analogues are a patient-friendly and effective alternative to corticosteroids, although effects may take longer to appear 3
- Newer formulations, such as calcipotriene/betamethasone scalp solution and clobetasol propionate shampoo, have shown efficacy and safety in treating scalp psoriasis 5
- For pediatric patients, newer topical non-steroidal agents, such as roflumilast and tapinarof, are being developed and may provide promising options for managing scalp psoriasis 6
- A new foam formulation of halobetasol propionate has been approved for pediatric psoriasis, providing an additional treatment option 6
Considerations for Treatment
- Treatment should be individualized, taking into account the patient's specific needs and clinical picture 3
- Patient support and motivation are important for long-term treatment of scalp psoriasis, a chronic disease 3
- Topical treatments should be chosen based on the patient's preferences and the severity of their symptoms 7
- Systemic therapies may be necessary for recalcitrant or moderate-to-severe disease 7