From the Guidelines
Scalp psoriasis can be effectively managed with topical treatments, particularly vitamin D analogs such as calcipotriene foam, which has been shown to be safe and effective for mild to moderate cases. According to the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1, calcipotriene foam and calcipotriene plus betamethasone dipropionate gel are effective treatment options for scalp psoriasis.
Treatment Options
- Topical corticosteroids, such as clobetasol propionate 0.05% solution or foam, can be used for moderate to severe cases, applied once or twice daily for 2-4 weeks to reduce inflammation and scaling.
- Vitamin D analogs like calcipotriene solution can be used alone or alternated with steroids to prevent thinning of the skin with long-term steroid use.
- Medicated shampoos, such as coal tar or salicylic acid shampoos, can be used 2-3 times weekly, leaving on the scalp for 5-10 minutes before rinsing.
- For thick, stubborn plaques, applying mineral oil or olive oil to the scalp before bedtime, covering with a shower cap, and shampooing in the morning can help soften and remove scales.
Lifestyle Modifications
- Avoid scratching, which can worsen inflammation and potentially lead to infection.
- Stress management techniques may help prevent flares, as psychological stress is a known trigger for psoriasis.
- If these treatments prove ineffective, consulting a dermatologist about systemic medications or light therapy may be necessary.
The choice of vehicle can significantly alter the use and penetration of the medication, and therefore alter the efficacy, as noted in the guidelines of care for the management of psoriasis and psoriatic arthritis 1. It is essential to match patient expectations with practical considerations and tailor treatment to meet individual patients' needs, taking into account body location, characteristics of the psoriasis, and patient preferences.
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 However, hypothalamic-pituitary-adrenal (HPA) axis effects produced by systemically absorbed clobetasol propionate have been shown to be transient and reversible upon completion of a 2-week course of treatment.
- Scalp psoriasis management with clobetasol propionate topical solution is effective, but it may cause systemic absorption and HPA axis suppression in some patients.
- The adverse effects of clobetasol propionate topical solution include local reactions such as burning, stinging, and folliculitis, as well as systemic effects like reversible HPA axis suppression and Cushing's syndrome 2.
- It is recommended to use clobetasol propionate topical solution for short treatment periods (up to 2 weeks) and to monitor patients carefully for any adverse effects 2.
From the Research
Treatment Options for Scalp Psoriasis
- Topical corticosteroids are the most frequently used treatments for psoriasis of the scalp, providing good effects and usually recommended as first-line treatment 3, 4, 5, 6
- Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components 5, 6
- Coal tar shampoos, containing 2 to 10% coal tar solution, are effective in scalp psoriasis, with crude coal tar being the most effective tar available for the treatment of psoriasis 3
- Salicylic acid 5 to 10% has a pronounced keratolytic effect and should be formulated in an ointment that can be washed off easily 3
- Imidazole antifungals have been used with success in scalp psoriasis, particularly in cases of resistance to other topical treatments 3
- Systemic treatments such as methotrexate, cyclosporine, and acitretin are indicated in patients with recalcitrant disease 3, 5, 6
- Biologics offer a greater efficacy, with near complete or complete clearance of the scalp 6
Management Strategies
- Management of scalp psoriasis requires long term strategies to reach an optimal improvement of the condition, while avoiding the adverse effects associated with the long term use of treatments 3
- Successful management of scalp psoriasis includes topical therapies that are acceptable to the patient for mild-to-moderate disease, and systemic therapies for recalcitrant or moderate-to-severe disease 4
- An algorithm for the practical management of scalp psoriasis is essential to improving the quality of life of patients 7