From the Guidelines
Scalp psoriasis can be effectively treated with a combination of medicated shampoos, topical treatments, and in severe cases, systemic medications, with calcipotriene foam being a highly effective option, achieving an Investigator’s Static Global Assessment score of 0 (clear) or 1 (almost clear) in 40.9% of patients after 8 weeks, as compared to 24.2% with vehicle (1). The treatment of scalp psoriasis should prioritize reducing inflammation, slowing skin cell turnover, and modulating the immune response that drives psoriasis.
- Medicated shampoos, such as coal tar or salicylic acid shampoos, can be used 2-3 times weekly, leaving on the scalp for 5-10 minutes before rinsing.
- For moderate cases, prescription topical corticosteroids, such as fluocinonide 0.05% solution or clobetasol 0.05% solution, can be applied directly to affected areas once or twice daily for 2-4 weeks.
- Vitamin D analogues, like calcipotriene (Dovonex), can be used alongside steroids or as maintenance therapy, with calcipotriene foam being a highly effective option (1).
- Combination treatments with vitamin D analogues and potent topical corticosteroids can be more effective than either agent alone for the treatment of psoriasis (1).
- For thick, scaly plaques, applying mineral oil or olive oil to the scalp before bedtime, covering with a shower cap, and washing out in the morning can help soften and remove scales.
- If these treatments fail, phototherapy or systemic medications like methotrexate, cyclosporine, or biologics may be necessary, with etanercept being a recommended monotherapy treatment option for adult patients with moderate-to-severe plaque psoriasis affecting the scalp (1). The use of calcipotriene or tacalcitol ointment combined with hydrocortisone is efficacious for the treatment of facial psoriasis, and the efficacy of vitamin D analogues can be noted at 8 weeks but not at 4 weeks, which can be considered and addressed with patients when planning appropriate topical treatment (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
- Treatment option: Clobetasol propionate topical solution is a treatment option for scalp psoriasis.
- Key consideration: The use of clobetasol propionate topical solution may have systemic effects, including the potential to depress plasma cortisol levels in some patients 2.
From the Research
Treatment Options for Scalp Psoriasis
- Topical treatments are the mainstay of treatment for scalp psoriasis, with various vehicles such as shampoos, lotions, gels, foams, creams, and ointments available 3
- Active ingredients for topical treatments include keratolytics, coal tar, dithranol, corticosteroids, and vitamin D3 analogues 3
- Topical corticosteroids are the most commonly used treatment for scalp psoriasis, with rapid effects and patient-friendly formulations, but their safety during prolonged use is not well established 3
- Vitamin D3 analogues are a effective alternative to corticosteroids, with optimal effects after 8 weeks, but may cause facial irritation in some patients 3
Specific Treatment Options
- Clobetasol propionate foam is an effective treatment for scalp psoriasis, with significant improvement in symptoms after 2 weeks of treatment 4, 5
- Medicated shampoos, such as those containing fluocinolone acetonide or clobetasol propionate, provide a convenient alternative for patients with scalp psoriasis 6
- Tar shampoos are effective for long-term maintenance of remission in patients with psoriasis 6
- Ultraviolet B phototherapy is an option for patients with >10% affected body surface area who have not responded to topical treatments, but its use on the scalp is not specifically mentioned 7
Treatment Approach
- Each patient should be examined individually to determine the best treatment approach 3
- Deteriorating factors should be excluded, and treatment should be chosen based on the clinical picture 3
- Intermittent use of topical corticosteroids alternating with vitamin D3 derivatives, either combined or not with liquor carbonis detergens containing shampoo, is a suitable treatment for most patients 3