From the Guidelines
Scalp psoriasis should be treated with calcipotriene foam or calcipotriene plus betamethasone dipropionate gel for 4 to 12 weeks, as it has been shown to be safe and effective for mild to moderate cases, according to the most recent guidelines 1.
Treatment Options
When considering treatment for scalp psoriasis, the following options are available:
- Medicated shampoos, such as coal tar or salicylic acid shampoos, used 2-3 times weekly
- Topical corticosteroids, such as fluocinonide 0.05% solution or clobetasol 0.05% solution, applied directly to affected areas once or twice daily for 2-4 weeks
- Vitamin D analogues, like calcipotriene, used alone or alternated with steroids to prevent thinning of the skin
- For thick, stubborn plaques, applying mineral oil or olive oil to the scalp before bedtime, covering with a shower cap, and washing out in the morning to help soften and remove scales
Systemic Treatments
If topical treatments fail, systemic medications like methotrexate, cyclosporine, or biologics may be necessary, as recommended by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics 1.
Key Considerations
- Maintaining consistent treatment and following up with a dermatologist is essential for managing this chronic condition effectively
- The treatment should aim to reduce inflammation, slow skin cell growth, and modulate the immune system, as psoriasis results from an overactive immune response causing rapid skin cell turnover
- The most recent and highest quality study should be prioritized when making treatment decisions, as it provides the best evidence for effective treatment, in this case, the 2021 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.
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
- Treatment of scalp psoriasis: Clobetasol propionate topical solution can be used for the treatment of scalp psoriasis.
- Key considerations: The treatment may cause systemic absorption, leading to reversible HPA axis suppression, and other adverse effects such as burning, itching, and folliculitis.
- Recommendation: Use clobetasol propionate topical solution with caution and under careful patient supervision, as it may exacerbate the disease or provoke the pustular form of psoriasis in rare instances 2.
From the Research
Treatment Options for Scalp Psoriasis
- Topical therapies, such as calcipotriene/betamethasone scalp solution, clobetasol propionate shampoo, and coal tar foam, have been shown to be effective in treating scalp psoriasis 3, 4
- Systemic agents, including methotrexate, cyclosporine, and oral retinoids, can also be used to treat scalp psoriasis, especially in cases where topical therapies are not effective 5, 6
- Biologic therapies have been found to offer greater efficacy in treating scalp psoriasis, with near complete or complete clearance of the scalp 6
- Phototherapy and complementary therapy may also be used to treat scalp psoriasis, although more research is needed to determine their effectiveness 7
Challenges in Treating Scalp Psoriasis
- Difficulty in applying topical agents to the scalp can lead to decreased adherence and efficacy 3, 5
- Scalp psoriasis can be refractory to treatment, making it challenging to manage 6
- Patient dissatisfaction with currently available treatments highlights the need for new, effective, and well-tolerated treatment options for scalp psoriasis 3
Effective Therapies for Scalp Psoriasis
- The combination treatment of topical betamethasone and calcipotriene has been found to be the most effective topical therapy for scalp psoriasis 6
- Clobetasol propionate shampoo has been shown to be safe and efficacious in the long-term management of scalp psoriasis 3
- Newer formulations of topical corticosteroids, such as sprays, foams, and lotions, may provide improved convenience and acceptance for patients with scalp psoriasis 4