From the Guidelines
Scalp psoriasis can be effectively managed with a combination of treatments, starting with topical corticosteroids and vitamin D analogs, such as calcipotriene foam, which has been shown to be more effective than vehicle in achieving an Investigator’s Static Global Assessment score of 0 or 1 after 8 weeks of treatment 1.
Treatment Options
- For mild cases, start with medicated shampoos containing coal tar or salicylic acid, used 2-3 times weekly, and leave them on the scalp for 5-10 minutes before rinsing.
- Topical corticosteroids, such as fluocinonide 0.05% solution or clobetasol 0.05% solution, can be applied to affected areas twice daily for 2-4 weeks, and then reduced to once daily or a few times weekly for maintenance.
- Vitamin D analogs like calcipotriene solution can be used alone or alternated with steroids to reduce steroid side effects.
Systemic Treatments
- For severe or resistant cases, consider systemic treatments such as methotrexate, biologics, or phototherapy under medical supervision.
- Biologics, such as ustekinumab, can be used as monotherapy or in combination with topicals to augment efficacy for the treatment of moderate-to-severe plaque psoriasis 1.
Additional Tips
- Gentle removal of scales before applying medications improves effectiveness - try applying mineral oil to the scalp for an hour before shampooing.
- Regular use of prescribed treatments is essential for managing symptoms effectively.
- Scalp psoriasis occurs because skin cells multiply too quickly, creating thick, scaly patches, and treatments work by reducing inflammation, slowing cell growth, or both, allowing the skin to heal.
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
- Clobetasol propionate topical solution can be used to treat scalp psoriasis.
- The treatment may have systemic effects, including potential depression of plasma cortisol levels in some patients.
- However, HPA axis effects are transient and reversible upon completion of a 2-week course of treatment 2.
From the Research
Psoriasis of the Scalp
- Psoriasis is a chronic, debilitating disease that commonly involves the scalp, and despite various therapy options, scalp psoriasis remains difficult to treat 3.
- Topical therapies for scalp psoriasis can be difficult or unpleasant to apply, resulting in decreased adherence and efficacy 3.
Treatment Options
- A new formulation of calcipotriene/betamethasone scalp solution has a rapid onset of action with once daily dosing that improves compliance 3.
- Clobetasol propionate 0.05% shampoo is safe and efficacious in the long-term management of scalp psoriasis 3, 4.
- A new foam formulation of coal tar is shown to be cosmetically acceptable and easier to apply 3.
- Ultrapotent topical corticosteroids, such as clobetasol propionate, are the mainstay of psoriasis treatment, and newer formulations like sprays, foams, lotions, and shampoos may provide improved convenience and acceptance 5.
Efficacy and Safety
- The efficacy rates for newer formulations of clobetasol propionate are high, with most patients achieving success after 2-4 weeks of treatment in well-controlled clinical trials 5.
- Treatment adherence is likely to be a more important determinant of success than small differences in drug delivery 5.
- Short-contact treatment with clobetasol-17 propionate 0.05% shampoo has high user convenience and patient satisfaction rates, and is well-tolerated and efficacious from patients' perspective 4.
- Very potent or potent steroid treatments should be preferred to vitamin D3 analogue for chronic plaque psoriasis of the scalp, with approximately an average 10% additional improvement on a six-point scale 6.