What lotion is recommended for treating scalp psoriasis?

Recommended Lotions for Scalp Psoriasis

For scalp psoriasis, calcipotriene foam or calcipotriene plus betamethasone dipropionate gel are the most effective topical treatments, with the combination therapy showing superior efficacy compared to either agent alone. 1

First-Line Treatment Options

Corticosteroid-Based Options

• Medium to high-potency topical corticosteroids:
  • Remain the mainstay of treatment for scalp psoriasis
  • Provide rapid relief (within 2-3 weeks)
  • Available in scalp-friendly formulations (solutions, foams, gels) 2
  • Example: Mometasone furoate lotion 0.1% (medium-potency) 2
  • Clobetasol propionate 0.05% for cases with significant inflammation 2

Vitamin D Analogues

• Calcipotriene foam:
  • Shown to be effective in an 8-week RCT (40.9% success rate vs 24.2% for vehicle) 1
  • Note: Efficacy becomes apparent at 8 weeks, not at 4 weeks 1

Combination Therapy

• Calcipotriene plus betamethasone dipropionate gel:
  • More effective than either agent alone 1
  • Safe and effective for 4-12 weeks of treatment 1
  • Provides benefits of both anti-inflammatory (steroid) and antiproliferative (vitamin D) actions

Treatment Algorithm Based on Symptom Presentation

1. For predominant inflammation and itching:

   • Start with clobetasol propionate 0.05% or calcipotriene/betamethasone combination 2

2. For predominant scaling:

   • Begin with salicylic acid to remove scales (keratolytic effect)
   • Follow with calcipotriene or combination product 2
   • Salicylic acid 5-10% has pronounced keratolytic effects 3

3. For maintenance therapy:

   • Reduce frequency to 2-3 times weekly
   • Consider weekend use of corticosteroids and weekday use of vitamin D analogues 2

Important Clinical Considerations

Formulation Selection

• Preferred formulations for scalp: Solutions, foams, gels, and lotions are more appropriate than creams and ointments 2
• Shampoo options: Coal tar shampoos (2-10%) can be effective 3

Treatment Duration and Safety

• Limit corticosteroid shampoos to 3-4 weeks to prevent side effects 2
• Vitamin D analogues are safe for longer-term use compared to corticosteroids 1

Combination Considerations

• Avoid combining salicylic acid with calcipotriene in the same application, as acidic pH inactivates calcipotriene 2
• Alternating therapy with corticosteroids and vitamin D analogues is recommended for long-term management 2, 4

Common Pitfalls to Avoid

1. Inadequate treatment duration: Vitamin D analogues require 8 weeks for optimal effect, while corticosteroids work within 2-3 weeks 1
2. Overuse of corticosteroids: No safety data supports use beyond 4 weeks; consider alternating with other treatments 4
3. Inappropriate vehicle selection: Using creams/ointments on scalp instead of solutions/foams/gels can reduce compliance and efficacy 2
4. Failure to address scaling first: In cases with significant scaling, keratolytics should be used before other treatments 2

For patients with severe or recalcitrant scalp psoriasis that doesn't respond to topical therapy, consider systemic treatments such as apremilast, adalimumab, or etanercept 5.