What are the treatment options for scalp psoriasis?

From the Guidelines

Scalp psoriasis can be effectively managed with a combination of medicated shampoos, topical treatments, and systemic therapies for severe cases, with the most recent guidelines recommending the use of biologics such as etanercept for moderate-to-severe plaque psoriasis affecting the scalp 1. The treatment approach should prioritize reducing inflammation and slowing skin cell turnover, which addresses the underlying cause of psoriasis—an overactive immune system causing rapid skin cell production and buildup of scaly patches on the scalp. Some key considerations for treatment include:

• Starting with coal tar shampoos like Neutrogena T/Gel or salicylic acid shampoos such as Neutrogena T/Sal, using them 2-3 times weekly and leaving on the scalp for 5-10 minutes before rinsing.
• Using prescription topical corticosteroids like fluocinonide 0.05% solution or clobetasol 0.05% solution for moderate cases, applied directly to affected areas once or twice daily for 2-4 weeks.
• Utilizing vitamin D analogues such as calcipotriene (Dovonex) alongside steroids or as maintenance therapy.
• 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 for thick, stubborn plaques.
• Considering systemic treatments, including oral medications like methotrexate (starting at 7.5-15mg weekly) or biologics such as adalimumab or secukinumab, for severe or resistant cases. The choice of treatment should be tailored to the individual patient's needs, taking into account the severity of the disease, anatomic location, and age of the patient, as well as patient preferences and expectations 1. It is also important to note that the duration of therapy depends on factors such as the strength of topical corticosteroids and the severity of the disease, and that intralesional corticosteroids can be effective for localized nonresponding or very thick lesions on glabrous skin, scalp, nails, palms, and soles 1. Overall, the goal of treatment should be to reduce symptoms, improve quality of life, and minimize the risk of adverse effects, with the most recent guidelines providing evidence-based recommendations for the management of scalp 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 The treatment for scalp psoriasis is clobetasol propionate topical solution.

• Key points:
  • Clobetasol propionate is a corticosteroid with anti-inflammatory and immunosuppressive effects.
  • It can be absorbed through the skin and has the potential to depress plasma cortisol levels in some patients.
  • The treatment should be used with caution and under medical supervision 2

From the Research

Treatment Options for Scalp Psoriasis

• Topical therapies are useful in treating scalp psoriasis, including topical corticosteroids (TCS), vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos 3, 4.
• The combination treatment of topical betamethasone and calcipotriene is considered the most effective topical therapy for scalp psoriasis 5.
• New formulations of topical therapies, such as a new foam formulation of coal tar and a new formulation of calcipotriene/betamethasone scalp solution, have been shown to be effective and improve compliance 3.
• Systemic agents, including conventional agents such as methotrexate, cyclosporine, and oral retinoids, are also available for the treatment of scalp psoriasis 5.
• Biologics have been shown to offer greater efficacy in treating scalp psoriasis, with near complete or complete clearance of the scalp 5.

Efficacy and Safety of Treatment Options

• The efficacy and safety of new formulations and treatment options for scalp psoriasis have been reviewed, with a focus on improving compliance and treatment outcomes 3, 6.
• Clobetasol propionate 0.05% is available in various formulations, including spray, foam, lotion, and shampoo, which may provide improved convenience and acceptance for patients with psoriasis 7.
• The importance of treatment adherence in the management of psoriasis has been emphasized, with adherence likely to be a more important determinant of success than small differences in drug delivery 7.

Management of Scalp Psoriasis

• Effective therapeutic regimens for scalp psoriasis are essential to improving the quality of life of patients, and 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.
• An algorithm for the practical management of scalp psoriasis has been presented, taking into account the various treatment options available and their efficacy 6.