What shampoo is recommended for scalp psoriasis?

Recommended Shampoo for Scalp Psoriasis

For scalp psoriasis, use clobetasol propionate 0.05% shampoo as first-line therapy, applied once daily for up to 4 weeks as a short-contact treatment (left on for 15 minutes before rinsing), followed by twice-weekly maintenance dosing to prevent relapse. 1, 2

First-Line Treatment Algorithm

Initial Therapy (Weeks 1-4)

• Clobetasol propionate 0.05% shampoo is the preferred first-line agent for moderate to severe scalp psoriasis, demonstrating superior efficacy compared to calcipotriol solution 3
• Apply once daily, massage into scalp, leave on for 15 minutes, then rinse thoroughly 4, 5
• This short-contact formulation provides equivalent efficacy to leave-on gel formulations while minimizing systemic absorption and side effects 4
• Treatment duration should be up to 4 weeks initially 1, 5

Maintenance Therapy (After Initial Response)

• Transition to twice-weekly application of clobetasol propionate shampoo once symptoms improve (global severity score ≤2) 2
• This maintenance regimen keeps 31.1% of patients relapse-free at 6 months versus only 8.1% with vehicle 2
• If relapse occurs (severity score >2), resume once-daily treatment until controlled, then return to twice-weekly maintenance 2

Alternative First-Line Options

Combination Calcipotriene/Betamethasone Products

• Calcipotriene 0.005% plus betamethasone dipropionate 0.064% gel or foam represents an equally effective first-line option 1
• Achieves 69-74% clear or almost clear status over 52 weeks with once or twice daily application 1
• More effective than either agent alone (69-74% vs 27% with vehicle) 1
• No serious adverse events including striae or HPA axis suppression observed over 52 weeks 1

Calcipotriene Foam Monotherapy

• Calcipotriene foam achieves 40.9% clear or almost clear status after 8 weeks 1
• Note that vitamin D analogues show efficacy at 8 weeks but not at 4 weeks, so plan treatment duration accordingly 1

Adjunctive Coal Tar Shampoo

For long-term management and maintenance, coal tar shampoo (2.5% coal tar topical solution containing 0.5% coal tar) can be used at least twice weekly 6:

• Wet hair thoroughly, massage into scalp, lather and leave on for several minutes, then rinse and repeat 6
• Helps control symptoms of dandruff, psoriasis, and seborrheic dermatitis 6
• Can be combined with corticosteroids for long-term management 1

Safety Considerations

Clobetasol Propionate Shampoo Safety Profile

• The short-contact shampoo formulation does not cause HPA axis suppression or skin atrophy, unlike leave-on gel formulations 4
• No increased incidence of telangiectasia or skin atrophy compared to vehicle during long-term maintenance 2
• Better tolerated than calcipotriol solution, with significantly fewer burning sensations 3

Pregnancy Considerations

• Most topical psoriasis medications are pregnancy category C 1
• Tazarotene is category X and contraindicated 1

When to Escalate to Systemic Therapy

Consider systemic therapy if topical treatment fails, particularly when there is symptomatic disease or more than minimal impact on quality of life 1. The European League Against Rheumatism considers scalp psoriasis a "vulnerable area" warranting this approach 1.

Common Pitfalls to Avoid

• Poor adherence is common due to inconvenience and messy formulations—the shampoo vehicle specifically addresses this issue 1
• Do not apply calcipotriene before UVA phototherapy, as UVA radiation decreases its concentration; apply after phototherapy instead 1
• Avoid using creams or ointments on the scalp when vehicle formulations (solutions, foams, shampoos) are available, as they improve adherence and efficacy 1