From the Guidelines
Scalp psoriasis can be effectively treated with a combination of medicated shampoos, topical treatments, and lifestyle modifications, with the most recent guidelines recommending the use of vitamin D analogues and topical corticosteroids as first-line treatments 1. The treatment of scalp psoriasis should prioritize the reduction of inflammation, slowing of skin cell turnover, and addressing the autoimmune component of the disease.
- Medicated shampoos such as coal tar or salicylic acid shampoos like Neutrogena T/Gel or T/Sal can be used 2-3 times weekly, leaving on the scalp for 5-10 minutes before rinsing.
- For moderate to severe cases, prescription topical corticosteroids such as clobetasol propionate 0.05% solution or foam can be applied directly to affected areas once or twice daily for 2-4 weeks.
- Vitamin D analogues like calcipotriene (Dovonex) can be used alone or alternated with steroids to prevent thinning of the skin, with studies showing that calcipotriene foam is effective for the treatment of mild to moderate scalp psoriasis 1.
- Combination treatments with vitamin D analogues and potent topical corticosteroids can be used for up to 52 weeks and are recommended for the treatment of psoriasis 1.
- Systemic treatments including methotrexate, biologics, or oral retinoids may be necessary for severe cases that don't respond to topical therapy, with etanercept being a recommended treatment option for moderate-to-severe plaque psoriasis affecting the scalp 1.
- Lifestyle modifications such as managing stress, avoiding scalp injury, and using gentle hair care products can help prevent flare-ups and complement medical treatments.
- The application of vitamin D analogues twice daily on weekdays in conjunction with high-potency topical corticosteroids twice daily on weekends can be considered for maintenance treatment for psoriasis 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
- Scalp Psoriasis treatment: Clobetasol propionate topical solution can be used for the treatment of scalp psoriasis.
- Key points:
- The treatment can depress plasma cortisol levels in some patients.
- Hypothalamic-pituitary-adrenal (HPA) axis effects are transient and reversible upon completion of a 2-week course of treatment 2.
- Adverse reactions: Common adverse events include burning and/or stinging sensation, scalp pustules, and tingling and folliculitis 2.
From the Research
Treatment Options for Scalp Psoriasis
- Topical therapies are the mainstay of treatment for scalp psoriasis, with corticosteroids and vitamin D3 analogues being commonly used 3
- Topical treatments can be formulated as solutions, lotions, gels, foams, sprays, oils, or shampoos, making them suitable for the scalp 3
- Clobetasol propionate 0.05% shampoo has been shown to be efficacious and safe for long-term control of moderate scalp psoriasis 4, 5
- Maintenance therapy with twice weekly application of topical treatments may decrease the time to first relapse in frequent relapsers 3
Systemic Therapies for Scalp Psoriasis
- Systemic therapies such as apremilast, adalimumab, and etanercept may be considered for patients with moderate-to-severe psoriasis who have failed topical therapy 3
- These therapies have been shown to significantly improve scalp psoriasis in patients with moderate-to-severe disease 3
Practical Management of Scalp Psoriasis
- Effective therapeutic regimens for scalp psoriasis are essential to improving the quality of life of patients 6
- An algorithm for the practical management of scalp psoriasis can be used to guide treatment decisions 6
- Recent data on topical therapies, phototherapy, systemic agents, and complementary therapy have demonstrated that it is possible to achieve and maintain significant improvement in scalp psoriasis 6