From the Guidelines
Scalp psoriasis can be effectively managed with a combination of medicated shampoos and topical treatments, prioritizing coal tar or salicylic acid shampoos and prescription-strength topical corticosteroids for severe cases, as recommended by recent guidelines 1. The treatment approach should focus on reducing inflammation, slowing skin cell turnover, and removing scale buildup.
- Start with coal tar or salicylic acid shampoos like Neutrogena T/Gel or T/Sal, using them 2-3 times weekly, and leave the shampoo on the scalp for 5-10 minutes before rinsing.
- For more severe cases, prescription-strength topical corticosteroids such as clobetasol propionate 0.05% solution or foam can be applied directly to affected areas once or twice daily for up to two weeks.
- Vitamin D analogs like calcipotriene (Dovonex) can also be effective, applied once daily.
- To improve treatment penetration, consider using a descaling agent containing salicylic acid before applying medications.
- For thick plaques, applying treatments under a shower cap overnight can enhance effectiveness. If these approaches don't provide relief after 4-6 weeks, consult a dermatologist as systemic treatments or light therapy might be necessary, especially for widespread or resistant scalp psoriasis, as suggested by guidelines for the management of psoriasis with biologics 1. The choice of vehicle can significantly alter the use and penetration of the medication, and different vehicles are indicated for different body sites, including hair-bearing areas like the scalp, which can be treated with solutions, foams, shampoos, sprays, oils, gels, or other vehicles 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
The treatment for psoriasis of the scalp is clobetasol propionate topical solution.
- It is a topical corticosteroid that can be used to treat corticosteroid-responsive dermatoses, including scalp psoriasis.
- The treatment should be used with caution, as it may cause systemic absorption and reversible HPA axis suppression in some patients 2.
- Local adverse reactions may also occur, including burning, itching, and irritation 2.
From the Research
Treatment Options for Psoriasis of the Scalp
- Topical therapies, such as calcipotriene/betamethasone scalp solution, have been shown to be effective in treating scalp psoriasis, with a rapid onset of action and improved compliance 3.
- Clobetasol propitate shampoo 0.05% has been found to be safe and efficacious in the long-term management of scalp psoriasis, with a significant reduction in relapse rates compared to vehicle 4, 5.
- A new foam formulation of coal tar has been shown to be cosmetically acceptable and easier to apply, providing an alternative treatment option for scalp psoriasis 3.
- Short-term treatment with clobetasol lotion has also been found to be effective in reducing symptoms of scalp psoriasis, with a significant decrease in median PSI score, TEWL, and skin erythema 6.
- Medicated shampoos, including those containing fluocinolone acetonide and clobetasol propionate, provide a convenient alternative for patients who require topical administration of corticosteroids for scalp conditions 7.
Efficacy and Safety of Treatment Options
- Clobetasol propitate shampoo 0.05% has been found to be safe and efficacious in the treatment of moderate to severe scalp psoriasis, with no greater incidence of skin atrophy, telangiectasia, or hypothalamic-pituitary-adrenal (HPA) axis suppression compared to vehicle 4, 5.
- The use of clobetasol lotion has been found to be convenient and effective, with 83% of patients satisfied with the treatment result and feeling comfortable with applying the lotion 6.
- Tar shampoos have long been used to treat psoriasis and are effective for the long-term maintenance of remission in patients who respond to therapy 7.