Where is psoriasis typically located on the scalp?

Typical Locations of Psoriasis on the Scalp

Psoriasis on the scalp typically presents on the occipital region, behind the ears, along the hairline (particularly the forehead), and can extend beyond the hairline to involve the forehead, neck, and facial skin. 1, 2

Scalp Psoriasis Characteristics

Scalp psoriasis affects approximately 50% of patients with psoriasis and has distinctive features:

• Well-demarcated, red plaques with silvery scale 1
• Often thick gray or white scale that can shed 2
• Patients frequently complain of pruritus (itching) 2
• Lesions may extend beyond the hairline to involve the forehead and neck 3
• Can cause disproportionate psychosocial distress relative to the affected area 2

Clinical Significance

Despite the scalp representing only 10% of the body's surface area, scalp psoriasis has significant impact:

• Can be seriously debilitating 2
• Causes social and emotional distress due to visibility 2, 4
• Often requires separate treatment approaches from other body areas due to:
  • Presence of hair making application difficult
  • Thinner skin in certain areas
  • High visibility affecting quality of life 4

Management Challenges

Scalp psoriasis presents unique treatment challenges:

• Difficulty in applying topical agents due to hair interference 5
• Often more refractory to treatment than other body areas 5
• May require combination therapy approaches 5
• Treatment efficacy is often limited by poor compliance due to application difficulties 2

Treatment Considerations

The American Academy of Dermatology and National Psoriasis Foundation guidelines recognize that:

• Even when affecting less than 5% of body surface area, psoriasis in special locations like the scalp can be considered severe 1
• Treatment should account for the psychological impact of visible scalp lesions 1
• Care must be taken with topical steroid use due to the risk of skin atrophy, especially when treating areas that extend to the face 1, 3

Understanding the typical distribution of scalp psoriasis is essential for proper assessment and targeted treatment of this common and distressing manifestation of psoriasis.