Current Treatment for Scalp Psoriasis
For scalp psoriasis, use calcipotriene 0.005% plus betamethasone dipropionate 0.064% gel or suspension applied once daily for 4-8 weeks as first-line therapy. 1, 2
Primary Treatment Regimen
Combination therapy with calcipotriene plus betamethasone dipropionate is superior to either agent alone, achieving clear or almost clear status in 69-74% of patients compared to 27% with vehicle control in 52-week studies. 1, 2
Dosing Specifications
- Apply calcipotriene 0.005% plus betamethasone dipropionate 0.064% gel or suspension once daily for initial treatment duration of 4-8 weeks 1, 2
- Do not exceed 100g per week in adults to prevent hypercalcemia 2, 3
- For adolescents ≥12 years, limit to 80g per week of the combination scalp formulation 2
- Treatment can be extended up to 52 weeks without serious adverse events including striae or HPA axis suppression 1
Alternative High-Potency Corticosteroid Monotherapy
If combination therapy is unavailable, use clobetasol propionate 0.05% solution or shampoo applied twice daily (morning and night) as an alternative. 4, 5, 6
Clobetasol Dosing Parameters
- Apply twice daily to affected scalp areas 4, 7
- Limit treatment to 2 consecutive weeks maximum 4
- Do not exceed 50 mL per week 4
- Clobetasol shampoo formulation allows short-contact therapy with excellent efficacy and tolerability 5, 6
Maintenance Therapy Options
After achieving initial control, consider these evidence-based maintenance regimens:
- Vitamin D analogues twice daily on weekdays plus high-potency corticosteroids twice daily on weekends (Strength of Recommendation B) 1
- Morning high-potency corticosteroid plus evening vitamin D analogue (Strength of Recommendation B) 1
- Calcipotriene foam monotherapy achieves 40.9% clear or almost clear status at 8 weeks 8
Critical Safety Warnings
Never combine salicylic acid with calcipotriene simultaneously - the acidic pH completely inactivates calcipotriene and eliminates its effectiveness. 1, 2, 3
Additional Safety Considerations
- Apply vitamin D analogues after phototherapy, not before - UVA radiation decreases calcipotriene concentration on skin 1, 8, 3
- Monitor for HPA axis suppression with prolonged high-potency corticosteroid use 2, 8, 3
- Monitor vitamin D metabolites in patients with calcium metabolism disorders or renal disease 2
Pediatric Dosing (≥12 Years)
- Use calcipotriene 0.005% plus betamethasone dipropionate 0.064% gel or suspension once daily for up to 8 weeks (Strength of Recommendation B) 2
- 58% of pediatric patients achieved disease clearance based on Patient's Global Assessment 2
- Pruritus decreased from 65% at initiation to 10% at trial end 2
Vehicle Formulation Considerations
Use scalp-specific vehicles (solutions, foams, shampoos) rather than creams or ointments to improve adherence and efficacy. 8 These formulations are less messy and more acceptable to patients, addressing the common problem of poor adherence due to inconvenience and frustration with greasy preparations. 8