What shampoo is recommended for scalp psoriasis?

From the Guidelines

For scalp psoriasis, I recommend using medicated shampoos containing coal tar, as it has been shown to be effective in reducing symptoms and improving quality of life 1. The use of coal tar shampoo is supported by a study published in the Journal of the American Academy of Dermatology in 2020, which found that coal tar can be used as a monotherapy or in combination with phototherapy to treat psoriasis 1. Some key points to consider when using coal tar shampoo include:

• Apply the shampoo to wet hair and massage it into the scalp
• Leave the shampoo on for 5-10 minutes before rinsing thoroughly
• Use the medicated shampoo 2-3 times weekly initially, reducing to once weekly for maintenance once symptoms improve
• On other days, use a gentle, fragrance-free shampoo
• Combine shampoo treatment with proper scalp moisturizing and avoid scratching the affected areas, as this can worsen symptoms and lead to infection Other options, such as salicylic acid and ketoconazole, may also be effective, but the most recent and highest quality study supports the use of coal tar shampoo 1. It's also worth noting that vitamin D analogues, such as calcipotriene, have been shown to be effective in treating mild to moderate scalp psoriasis, but the evidence for this is not as strong as it is for coal tar shampoo 1. Overall, the goal of treatment should be to reduce symptoms, improve quality of life, and minimize the risk of adverse effects, and coal tar shampoo appears to be a good option for achieving these goals 1.

From the FDA Drug Label

For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including ... psoriasis (including body, scalp, palms and soles).

• Salicylic acid can be used as a shampoo for scalp psoriasis.
• It is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders, including psoriasis on the scalp 2.

From the Research

Topical Therapies for Scalp Psoriasis

• Topical therapies for scalp psoriasis include topical corticosteroids (TCS), Vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos 3.
• TCS, vitamin D analogs, and tazarotene can be used in the treatment of nail psoriasis, and are also effective for scalp psoriasis 3.
• For scalp psoriasis, combined treatment with vitamin D and corticosteroid performed significantly better than vitamin D alone or corticosteroid alone 4.
• Vitamin D was significantly less effective than both potent corticosteroids and very potent corticosteroids when applied to psoriasis of the scalp 4.

Effectiveness of Topical Treatments

• Most vitamin D analogues were significantly more effective than placebo when used on the body, with the standardised mean difference (SMD) ranging from -0.67 to -1.66 4.
• Potent corticosteroids performed better than placebo, with an SMD of -0.89, while very potent corticosteroids had an SMD of -1.56 4.
• Dithranol, combined treatment with vitamin D/corticosteroid, and tazarotene all performed significantly better than placebo 4.

Safety and Tolerability

• Potent corticosteroids were less likely than vitamin D to cause local adverse events, such as burning or irritation 4.
• Combined treatment with vitamin D/corticosteroid on either the body or the scalp was tolerated as well as potent corticosteroids, and significantly better than vitamin D alone 4.
• There remains a lack of evidence about the risk of skin dermal atrophy with long-term treatment with corticosteroids 4.